New treatment concept for the diabetic foot being discussed

Wounds always appear on certain spots of the diabetic foot. At the symposium two master pedorthists, one orthopedic surgeon and one diabetologist offered new insights in the causes of the wounds and discussed new concepts for the treatment.

If you want to treat wounds on the diabetic foot in a sustainable way, it is crucial to recognize the ­biomechanic causes for their origin – and to treat them, too. Based on this insight, Dr. Dirk Hochlenert and Dr. Gerald Engels together with Dr. Stephan Morbach and their network partners developed the so-called “Entitäten-Konzept” (entities concept).

On 25 March 2017, Dr. Engels and Dr. Hochlenert discussed it at a symposium in Berlin/Germany with two pedorthists specialized in the diabetic foot syndrome. By Annette Switala

The event format chosen to present the entity concept by the publishing house C. Maurer Fachmedien, also publishing foot&shoe, was a special one. The four speakers were constantly on the podium and discussed pedorthic and surgical treatment options for the most current wounds on the diabetic foot that pedorthics has to deal with. The master pedorthists Jürgen Stumpf and Herbert Türk, both well-known experts in the pedorthic treatment of the diabetic foot syndrome, pioneered for the symposium by taking a closer look at and developing the ­entity concept further for pedorthics.

Wounds do not appear by chance

In the preceding years data of more than 50,000 diabetic feet were collec­ted and evaluated in different regional networks for the treatment of the ­diabetic foot syndrome where Dr. Gerald Engels and Dr. Dirk Hochlenert work. As they found out together with their network partners, wounds always appear on certain spots of the diabe­tic foot. This limited number of wounds on certain spots of the feet are the so-called „Entitäten“ (entities) for them.

The appearance of these wounds on certain spots only has biomechanic causes, Engels and Hochlenert are convinced. If you understand the ­respective causes, it is easier to decide which kind of pedorthic and surgical treatment option is most promising in the respective case.

Master pedorthist Jürgen Stumpf (l.) and Dr. Gerald ­Engels are demonstrating spontane­ously important clinical tests that enable us to understand the patho-biomechanics of different entities.

The eight most common entities that pedorthics has to deal with were treated in this lecture. Whether lesions beneath the different metatarsal heads, beneath the tip of the toes, or torsion lesions of the big toe or latero-plantar lesions at the metatarsal head 5 in case of a pes cavus. Hochlenert and Stumpf explained the biomecha­nical background for all entities, before pedorthic and surgical treatment options were discussed.

Jürgen Stumpf presented the whole repertoire of pedorthic treatments that were spiced by practical treatmentexamples by Herbert Türk. Türk also emphasized the understanding of the diabetes adapted footbed that should be the basis of the offloading of the foot. According to him the German diabetes-adapted footbed, especially developed for the treatment of diabe­tic feet, has experienced a paradigm change in the course of time. So now footbeds are no longer manufactured to be completely soft and in a sandwich construction without steps and pelotte. Nowadays also offloading elements are built into the diabetes-adapted footbeds, redistributing pressure on the loadable areas of the foot. The two pedorthists presented what kind of offloading elements are helpful for the presented entities in a detailed way and complemented them with the respective suitable shoe adjustments.

From left: Wolfgang Best (moderation), Dr. Gerald Engels, Dr. Dirk Hochlenert, Annette  Switala (moderation), master pedorthist Herbert Türk and master pedorthist Jürgen Stumpf.Dr. Gerald Engels thrilled the audience with comprehensible and at the same time humorous remarks on surgical options and made clear that some entities, for example lesions on the tip of the toes in case of hammer and claw toes, can be treated easier with surgery than with pedorthic means – and that there are at least surgical treatment methods available in any case if pedorthics reaches its limits. The renowned expert for wound surgery of the diabetic foot showed that in many cases no extensive bone surgery is necessary, but that soft tissue surgery is sufficient in order to cause an inner offloading of the foot. The audience, fully staffed with 60 participants, made use of the ­numerous possibilities to ask questions, to introduce their own experience and to discuss treatment methods. The ­participants were especially thrilled about the lively interdisciplinary interaction between the speakers that made them wish to improve their own interdisciplinary networking. „Thank you so much for this super seminar !!! I would have enjoyed it even more if more medical treatment participants had attended“, one of the participants wished.