Diabetic feet belong in professional hands
16.11.2021 11:23
Protecting and caring for the feet is a top priority for people with diabetic foot syndrome. Even the smallest injuries and pressure points can develop into chronic wounds that are difficult to treat. In the worst case, the toes, forefoot or even lower leg may have to be amputated. Protective shoes and individually made insoles are therefore important medical aids for those affected.
These must be professionally manufactured and individually adapted, as the German Diabetes Society (DDG) emphasizes. The contactless ordering of insoles on the Internet - as the BARMER health insurance company offered its patients until a few weeks ago and for which the TK has already initiated a tendering process - can in no way replace this procedure. In a statement, the specialist society warns of possible dangers for patients.
The diabetic foot is one of the most common complications of diabetes mellitus. “Up to a third of those affected develop diabetic foot syndrome (DFS) over the course of their lives,” says Dr. med. Michael Eckhard, chief physician at the GZW Diabetes Clinic Bad Nauheim and chairman of the DDG Diabetic Foot AG. Too often, chronic wounds resulting from DFS lead to amputations. “Two thirds of the amputations of the feet and legs carried out in Germany affect people with diabetes mellitus,” emphasizes the expert.
DFS is caused by inadequate blood sugar control, as a result of which nerves and blood vessels undergo pathological changes. While the so-called angiopathy leads to poorer wound healing, the sensitivity of the feet decreases due to neuropathy. “As a result, those affected lack important warning systems such as the sensation of pain, pressure or temperature, which draw attention to damaging influences in good time,” explains Eckhard. “Pressure points or small wounds are therefore often not noticed or only noticed late, and protective mechanisms are not activated. Those affected literally ran into their foot problems.” In English, this phenomenon is known as “loss of protective sensation” or “LOPS” for short, in German it means “loss of protective perception”.
This loss of sensitivity is also noticeable in the choice of footwear. “People with diabetic foot syndrome often buy shoes that are too small or too tight because they are the only ones that give them the feeling of sufficient support,” says Eckhard. For the same reasons, they cannot judge with sufficient reliability whether an insole fits properly and is suitable for their foot. The entire process of providing insoles must therefore be professionally accompanied, emphasizes DDG President Prof. Dr. med. Andreas Neu, Acting Medical Director of the Department of Neuropediatrics, Developmental Neurology and Social Pediatrics at the University Children's Hospital Tübingen. “It starts with the examination and indication by a specialized doctor, continues through the expert pressure removal, production and adjustment by orthopedic shoe technicians and only ends with the professional acceptance of the insole,” says Neu. This multi-stage process cannot be carried out online - not even in parts. Online orders that leave the creation of a 2D or 3D impression solely to the patient are therefore highly problematic. The removal of the finished insole must also take place in direct contact with the patient. The unit of insole and shoe must be viewed directly on the patient's foot and assessed both while standing and walking. “In view of the enormous potential danger posed by unsuitable insoles or shoes, advice only by telephone or video is by no means sufficient,” says Neu. Anyone who wants to save money here is endangering the success of the treatment and ultimately also the patients' feet and legs.
The DDG therefore calls for high-risk patients such as people with diabetes, diabetic or neuropathic foot syndrome of other causes to be explicitly excluded from the online insole or shoe supply offer. This is due to medical necessity and is independent of the outcome of possible legal examinations, which the BARMER health insurance company has announced in order to implement its planned project. For all other indications, it must at least be examined at the same time as to whether the medical results of online care are sufficient and appropriate compared to those of on-site care.
Link to the (DDG) statement on the agreement on the online supply of deposits: https://www.deutsche-diabetes-gesellschaft.de/politik/stellungnahmen/stellungnahme-der-deutschen-diabetes-gesellschaft-ddg-zur-vereinbarung-ueber-die-online-versorgung-von-einlagen-produktgruppe-08