Die Dos and Don’ts bei der Behandlung des diabetischen Fußsyndroms aus chirurgischer Sicht

Due to diabetic polyneuropathy (PNP) with its loss of protective sensation (LOPS), people with diabetes-related foot problems differ significantly from people without PNP in terms of the diagnostics, relief strategy, surgical treatment and aftercare concept.

The multifactorial clinical picture of PNP not only causes the sensory restriction in pain perception, feeling of pressure and temperature but also the motor restriction of the intrinsic muscles with resulting foot malpositioning and dysfunction of the autonomic regulatory mechanisms of the sweat and sebaceous glands. Diabetic foot syndrome is often associated with peripheral arterial occlusive disease (PAOD). When attempting to classify these people, e.g., in an emergency surgical department, according to the criteria of pain, walking distance or skin condition, incorrect assessments can be made by the treating personnel.

Due to the lack of pain perception the patient is often already in a state of severe infection and existing tissue loss at the time of diagnosis. Rapid intervention, preferably by a multidisciplinary team is necessary (time is tissue). A strict relief concept right from the start in combination with tissue-sparing, at best minimally invasive surgical methods, long-term correction of the existing malposition through tendons or bone surgery is necessary, followed by discharge management, which at best secures the result in the long term.