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Z Orthop Unfall 2014; 152(5): 517-533
DOI: 10.1055/s-0034-1382978
Refresher Orthopädie und Unfallchirurgie
Georg Thieme Verlag KG Stuttgart · New York

Diabetisches Fußsyndrom und diabetische neuropathische Osteoarthropathie (DNOAP)

Update der konservativen und operativen TherapieDiabetic Foot Syndrome and Diabetic Neuropathic Osteoarthropathy (DNOAP)An Update of Conservative and Surgical Therapy Methods
S. G. Hofstaetter
Klinikum Wels-Grieskirchen, Abteilung für Orthopädie, Fuß-Kompetenz Orthopädie
,
K. Trieb
Klinikum Wels-Grieskirchen, Abteilung für Orthopädie, Fuß-Kompetenz Orthopädie
› Author Affiliations
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Publication History

Publication Date:
14 October 2014 (online)

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Zusammenfassung

Das rechtzeitige Erkennen von einem diabetischen Fuß oder einem Charcot-Fuß kann eine langen Leidensweg für den Patienten, hohe Arzt- und Krankenhauskosten und letztendlich eine Amputation ersparen. In den letzten Jahren haben sich durch neue Technologien bei der Wundbehandlung, der interventionellen radiologischen Gefäßoptimierung, der orthopädietechnischen Versorgung und der chirurgischen orthopädischen Versorgung von diabetischen Füßen viele gute Behandlungsmöglichkeiten ergeben. Trotzdem bleibt es ein große Aufgabe für den niedergelassenen ärztlichen und pflegerischen Bereich sowie für die Krankenhausträger, diesem in Zukunft noch wachsendem Problem Herr zu werden. Dieser Refresher soll das Bewusstsein für den diabetischen Fuß (= DFS) und die diabetische neuropathische Osteoarthropathie (= DNOAP) am Fuß schärfen, diagnostische Schritte aufzeigen und dem behandelnden Arzt wichtige Therapiemöglichkeiten anbieten. Des Weiteren ist es wichtig, diese beiden klinischen Erkrankungsbilder klar abzugrenzen und die Therapie entsprechend einzuleiten. Der interdisziplinäre Zugang von Internisten, Radiologen, Orthopäden, Dermatologen, plastischen Chirurgen und Orthopädie-Schuhtechnikern ist für ein gute Therapiebegleitung und der Vermeidung der Unterschenkelamputation Voraussetzung.

Abstract

A diabetic foot or Charcot foot diagnosed in time can reduce a lot of problems for the patient, lessen high medical expense, and last but not least prevent an amputation. Good treatment options of the diabetic foot result from new technologies in wound management, angioplastic vessel improvement and optimised orthopaedic aids. Nevertheless it stays a challenging issue for practitioners and medical and health care as well as hospital owners to master this problem which will be even growing in the long run. This article intends to raise the awareness for the diabetic foot and the neuropathic osteoarthropathy, and furthermore illustrate diagnostic steps and offer therapeutic options. After distinguishing the diabetic foot from the Charcot foot a selective therapy for each entity has to be initiated. An interdisciplinary approach of specialists in dermatology, radiology, orthopaedic and internal medicine, plastic surgery and orthopaedic shoemaking is essential for a good therapeutic monitoring in order to avoid the amputation of the lower leg.

Key words

Diabetes mellitus - diabetischer Fuß - Charcot-Fuß - Wundmanagement - Orthese - Amputation - Arthrodese

Key words

diabetic foot - Charcot foot - orthesis - wound management - amputation - arthrodesis
 

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