Der diabetische Fuß

In the last 20 years the prevalence of diabetes in Germany has increased by approximately 50%. Associated with this is a distinct rise of diabetes-induced comorbidities and long-term consequences. One of the most frequent consequences is the diabetic foot or the diabetic foot syndrome. This is an ulceration of neuropathic and angiopathic origin, which often reaches a chronic stadium due to a poor healing tendency. Despite the disease management program for diabetes in Germany which mainly concentrates on the prophylaxis and multidisciplinary treatment of chronic diseases, there are approximately 250,000 patients with lesions of the foot caused by diabetes of which approximately 50% have to be amputated within 4 years. To achieve a reduction of the amputation rate identification of the main reasons is necessary. In addition a professional therapy of the vascular disorders and a stage-adjusted wound therapy have to take place in an interdisciplinary collaboration in a centre for wound care. Last but not least this aim can only be achieved by a preventive education of diabetics.     

Der diabetische Fuß – eine interdisziplinäre Aufgabe

Ohne Zusammenfassung     

Was kann eine Fußsprechstunde leisten?

Trauma und Berufskrankheit - Arbeitsunfälle betreffen nicht selten die Fußregion, an erster Stelle das Sprunggelenk. Aufgrund der positiven Resultate nach Einführung des...     

Der nicht verhornende Plattenepithelkrebs der äußeren Haut

Ohne Zusammenfassung     

Über eine symmetrische Synostose der Hand-und Fußwurzelknochen

Ohne Zusammenfassung     

Über eine Universaloperation zur Behandlung der Fußdeformitäten

Zusammenfassung Es wird über eine Universaloperation zur Behandlung der Fu?deformit?ten berichtet, die gegenüber bereits beschriebenen Verfahren den Vorteil weitgehendster Anwendbarkeit besitzt und ein, ausgezeichnetes funktionelles als auch statisches Ergebnis zeitigt. Neben der Wiedergabe der Technik ist das Dauerresultat dieser Operation an 266 nachuntersuchten F?llen erh?rtet worden. Mit 10 Textabbildungen (=19 Einzelbildern)     

Der Fixateur externe zur Rekonstruktion der Fußstatik bei neurogenen Osteoarthropathien

The localization of neurogenic osteopathy in the hindfoot often results in deformities which cannot be corrected by conservative methods. Indications for operation are recurring ulcers, deep infection, and reduced stability with progressive deformity. The aim of this study was to ascertain whether external fixation enables reestablishment of foot stability even when the osteoarthropathic processes have not entirely ceased. A bilaterally mounted Hoffman 2 fixator was used for open repositioning and restabilization on 14 patients with osteoarthropathy of the hindfoot: 12 had diabetes mellitus and 13 had florid processes. Revision with axial correction was necessary in 2 patients. One underwent amputation according to Syme and received a prosthesis. Thirteen were completely remobilized: ten were fitted with an orthosis and three with a rigid orthopedic shoe. Complicated deformities of the hindfoot from neurogenic arthropathy can be satisfactorily restabilized in the edematous and demineralizing stages by surgery and the application of external fixation.     

Fuß und Sprunggelenk

Die Unfallchirurgie -     

Diabetisches Fußsyndrom

For patients with a diabetic foot wound the risk for amputation is high. The three main reasons for developing foot ulcers in diabetes are biomechanical factors, neurologic and vascular alterations. According to this the ulcers can be categorized in neuropathic (50%), ischemic (15%) and neuroischemic (35%). Sensomotoric polyneuropathy leads to the loss of perception of pain in the feet and in combination with extrinsic and intrinsic biomechanical factors, chronic wounds evolve (malum perforans). The therapy should take place within an interdisciplinary network and based on guidelines. Besides pressure off-loading debridement of the wound is mandatory. The arterial occlusions in diabetes mainly affect the cruropedal vessels and when ischemia occurs a reconstruction must be attempted. The risk of recurrence is high so that regular follow-up examinations, screening to detect high risk patients and education are necessary.