Diabetische Füße und ihre Schuhversorgung [2nd rev. ed.] 9783110219449, 9783110219432

Table of contents :
Frontmatter
Inhaltsverzeichnis
1 Der menschliche Fuß und die Polyneuropathie
2 Diabetische Füße passen nicht in normale Schuhe. Die Längen- und Breitenmaße der Füße älterer Menschen: Eine Datenbasis für die industrielle Schuherstellung
3 Der industriell produzierte LucRo®-Spezialschuh zum Schutz vor Fußgeschwüren bei diabetischer Podopathie
4 Schuh-Einlagen, Fußbettung
5 Erfahrungen mit der Versorgung der diabetischenPodopathieaus Sicht des Kostenträgers
6 Wie steht es um die Passform von orthopädischen Maßschuhen?
7 Praktische Anleitung zur Behandlung und Schuhversorgung des Charcot-Fußes
8 Fußschäden bei diabetischer Polyneuropathie durch handelsübliche Arbeitssicherheitsschuhe
9 Schuhgestaltung bei diabetischer Podopathie: Biomechanische und klinische Aspekte
10 Der Charcot-Fuß – die Magnetresonanztomografie klärt ein altes Krankheitsbild endlich auf
11 Der diabeteskranke Fuß: Zur Pathogenese und Behandlung der diabetischen Podopathie
12 Technische Neuerungen – Der Diabetiker-Schuh der Zukunft
Backmatter

Citation preview

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w—“ ZJ2GNJ+*2L

““

B D

H

1/ 5

Minor 38 %

Fußsohlenlänge

G

Z

C

Ballenweite = 39,5 mm

M

78°

F

1/6

Ballenweite + 24 % des Sechstels = 39,5 mm

Länge 28 cm (42 Stich) mittlere Herrengröße

J

von E – F + 1 m/m = 30,5 m/m N

L

von E – F + 1 m/m = 30,5 m/m

1/ 6

1/3

Ballenumfang 23,7 cm entspricht der Weite 6 Fußsohlenlänge

K 1/3

Brandsohlenlänge

80°

Fußsohlenlänge

1/6

94°

Major 62 %

E

A

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^yy— w—so $+z2Pz-PGNJ,+N2 J2 PN- $xK*KJ2P*,+-JN—

A–B = absolute Brandsohlenlänge A– D = Fußsohlenlänge B – D = absolute Zugabe E – F = Ballenmesslinie C = Schnittpunkt der Ballenmesslinie mit der Brandsohlenmittellinie J = Punkt für die Fersenmesslinie Z = Kleinzehenpunkt CEG = Großzehenwinkel CFH = Kleinzehenwinkel DCE = Ballenmesslinienwinkel CJM = Winkel zur Bestimmung der Fersenrichtungslinie

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23

24

25

26

27

28

29

30

31

32

33

34

35

36

French 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 Size 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 English 1 Size 11⁄2 21⁄2 31⁄2 41⁄2 5 1⁄2 6 1⁄2 71⁄2 8 1⁄2 91⁄2 101⁄2 111⁄2 121⁄2 13 1⁄2 141⁄2 15 1⁄2 16 1⁄2 171⁄2 USA Size

1

11⁄2

2

2 1⁄ 2

3

3 1⁄ 2

4

4 1⁄ 2

5

5 1⁄2

6

6 1⁄ 2

7

7 1⁄ 2

8

8 1⁄ 2

9

10 11 12 13 14 15 16 17 18 91⁄2 101⁄2 111⁄2 121⁄2 13 1⁄2 141⁄2 151⁄2 16 1⁄2 171⁄2

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590 mm

115 mm 70 mm

442 mm

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#zy— q—wo [-*xHyNGz,+*2L z2 PN- ]N*LN,NJ+N PN- D-0š‘NKN2 *2P *2+N- PN2 >N+z+z-,zGH/MN2 “‹t yNJ r LN,*2PN2 >22N-2— ]z-M*šLz2L™ H*-‘N $xK-J++N f “••;— @*-‘N $xK-J++N r• xFœ

^$$˜“ ^$$˜w ?*x%04 yz-M*š

D-0š‘NK

>N+z+z-,zGH/MN

“p“ $[ “uwœ; “tp $[ tuœ; “wt $[ svœ; “••;

pq $[ “vœ; ““s $[ w•œ; pp $[ w•œ; “••;

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wvv “sq ““v “ss

$[ $[ $[ $[

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“•v “ws “•v pq

$[ $[ $[ $[

“tœ; wqœ; wwœ; “vœ;

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“••

q E*š,xKPN2 yNJ PJzyN+J,xKN- '0G’2N*-0/z+KJN

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+N2VxKN2 PN- w—‹u— ƒNKN2— [N- t— ƒNK yGNJy+ FNJ,+ )02 !N-GN+‘*2LN2 P*-xK PJN ,+K˜ GN-2N ƒNKN2Hz//N Lz2‘ z*,LN20FFN2™ (NJG N- 2JxK+ )02 JK- yNPNxH+ (J-P ^yy— q—sœ— Z, N-,xKNJ2+ PzKN- *2(zK-,xKNJ2GJxK™ Pz,, yNJ PN2 'z+JN2+N2 PN- )0-GJNLN2PN2 $+*PJN PJN ?,J02 z2 PN2 u— ƒNKN2 P*-xK $JxKN-KNJ+,,xK*KN yNPJ2L+ (z-N2—^yy— q—“• ZyN2,0 N-,xKNJ2+ z*ML-*2P PN- [-*xHFN,,*2LN2 yNJ PN2 LN,*2PN2 '-0yz2PN2 *2(zK-,xKNJ2GJxK™ Pz,, PJN ?,J02N2 PN- 'z+JN2+N2 *2+N- PNF “—™ u— *2P t— >N+z˜ +z-,zGH/MxKN2 ,JxKN-KNJ+,,xK*KyNPJ2L+ (z-N2— [JN >N,,*2LN2 Kz++N2 J2 PJN,NF ]N˜ -NJxK ,0(0KG JF ]z-M*šLz2L zG, z*xK J2 PN2 $JxKN-KNJ+,,xK*KN2 (JN JF ?*x%06˜ $xK*K (NPN- [-*xHN-KK*2LN2 N-LNyN2 20xK "2+N-,xKJNPN ‘(J,xKN2 PN2 $xK*KN2 y‘(— ]z-M*šLz2L LN‘NJL+— [JN,N Z-LNy2J,,N PN*+N2 Pz-z*M KJ2™ Pz,, PJN yNJ PN2 'z˜ +JN2+N2 LNM*2PN2N2 ?,J02N2 *2+N- PN2 >N+z+z-,zGH/MxKN2 2JxK+ ,/N‘JX,xK M- $J˜ xKN-KNJ+,,xK*KN™ ,02PN-2 NKN- M- PJN EšN PN- yN+-0dN2N2 'z+JN2+N2 ,J2P— ]NJ [Jz˜ yN+JHN-2 FJ+ '0G’2N*-0/z+KJN ,J2P J2 PN- %NLNG *2+N- PN2 >N+z+z-,zGH/MxKN2 PJN ]0PN2-NzH+J02,H-M+N yNJF ]z-M*šLNKN2 N-KK+ *2P 2NKFN2 yNJ ]N2*+‘*2L )02 LNNJL2N+NF $xK*K(N-H PN*+GJxK zy ›t™ p_— ]NJ [JzyN+JHN-2 0K2N =N*-0/z+KJN PzLNLN2 (*-PN2 JF ]z-M*šLz2L 20-FzGN [-*xH(N-+N *2+N- PN2 >N+z+z-,zGH/MxKN2 LNFN,,N2™ (JN yNJ DN,*2PN2 ›wq_— ]NJ DN,*2PN2 (N-PN2 J2 VN”JyGN2 $xK*KN2 KKN-N [-*xH(N-+N *2+N- PNF “— >N+z+z-˜ ,zGH/MxKN2 LNM*2PN2 zG, yNJF ]z-M*šLz2L ›ws_— [JN )0-GJNLN2PN2 >N,,N-LNy2J,,N FJ+ 2zKN‘* JPN2+J,xKN2 [-*xH(N-+N2 JF >N+z+z-,zGyN-NJxK J2 PN2 $xK*KN2 (JN JF ]z-M*šLz2L H22N2 Pz-z*M ‘*-xHLNMK-+ (N-PN2™ Pz,, N, ,JxK zœ *F LN,*2PN !N-˜ ,*xK,/N-,02N2 Kz2PNG+N FJ+ 20-FzG yN,xKzdN2N- $+-*H+*- *2P E*2H+J02 PN- E*š˜ ,0KGN2LN(NyN™ yNJ PN2N2 PN- [-*xH *2+N- PN2 >N+z+z-,zGH/MxKN2 LN-J2LN- J,+ zG, yNJ [JzyN+JHN-2 FJ+ '0G’2N*-0/z+KJNn yœ yNJ zGGN2 ‘*- [-*xHFN,,*2L yN2*+‘+N2 $xK*˜ KN2 *F ,+z--N™ *2VN”JyGN $xK*KN LNKz2PNG+ Kz+ 2*- J2 VN”JyGN2 $xK*KN2 (z- PJN [-*xHyNGz,+*2L *2+N- PNF “— >N+z+z-,zGH/MxKN2 KKN- zG, yNJF ]z-M*šLz2L ›ws_œn xœ yNJ PN- ™™-NLJ02 0M J2+N-N,+77 J2 PN- )0-GJNLN2PN2 $+*PJN *F NJ2N -NGz+J) L-0šN

q—t [J,H*,,J02

“•“

EGxKN xz— wt xFwœ *2+N- zGGN2 M2M >N+z+z-,zGH/MxKN2 Kz2PNG+N™ (K-N2P PJN J2 M-KN-N2 "2+N-,*xK*2LN2 2zxKLN(JN,N2N [-*xH-NP*H+J02 P*-xK PN2 ?*x%06 $xK*K z*M PN2 $/J+‘N2P-*xH ™™/NzH /-N,,*-N77œ J2 NJ2N- (N,N2+GJxK HGNJ2N-N2 ™™-NLJ02 0M J2+N-N,+77 “ xFwœ *2+N- PNF “— 0PN-— w— >N+z+z-,zGH/MxKN2 yN‘0LN2 (z-— [JN ?,J02N2 PN- 'z+JN2+N2 *2+N- >#@ “™u *2P t ,J2P PzKN- )N-F*+GJxK 2JxK+ z*M PN2 $JxKN-KNJ+,,xK*K ‘*-xH‘*MK-N2™ ,02PN-2 F,,N2 NKN- zG, )N-z2GzL*2L,˜ yNPJ2L+ LNG+N2™ ‘— ]— zG, E0GLN 2N*-0/z+KJ,xK yNPJ2L+N-™ J2PJ)JP*NGGN- 'z+K0G0LJN2 PN- E*šM0-F™ ˜M*2H+J02™ 0PN- ˜F0+0-JH y‘(— PN, ]N(NL*2L,zyGz*MN,— [JN,N N-,+N "2+N-,*xK*2L )02 ^-yNJ+,˜$JxKN-KNJ+,,xK*KN2 yNJ [JzyN+JHN-2 Kz+ 'J˜ G0+˜\Kz-zH+N-— BK-N ^*,,zLNH-zM+ J,+ P*-xK NJ2N %NJKN )02 ?JFJ+z+J02N2 NJ2LN˜ ,xK-2H+o Pz J,+ ‘*F NJ2N2 PJN HGNJ2N EzGG‘zKG™ PJN ,+z+J,+J,xKN ^2zG’,N2 *2FLGJxK FzxK+— ƒ*F z2PN-N2 H022+N PJN N”/N-JFN2+NGGN Z-M0-,xK*2L PN- !N-GN+‘*2L,*-,z˜ xKN2 2*- J2PJ-NH+ z2 DN,*2PN2 N-M0GLN2— $xKGJNšGJxK ,J2P >N,,*2LN2 JF $xK*K 2*NJ2LN,xK-2H+ FLGJxKo M- PJN >N,,*2L )02 $xKN-H-M+N2 y‘(— @-zM+NJ2(J-H*2LN2 zF E*š-xHN2 J,+ yN-Kz*/+ HNJ2N #NxK2JH )0-Kz2PN2— [JN >N,,*2L PN- )N-+JHzGN2 ]0PN2-NzH+J02,H-M+N 'NP0yz-0L-z/KJNœ J,+ ‘(zNGNH+-02J,xK FLGJxK™ J,+ zyN- FJ+ FN+K0PJ,xKN2 '-0yGNFN2 yNKzM+N+— ZJ2 '-0yGNF PN- NGNH+-02J,xKN2 'NP0yz-0L-z/KJN J,+ PJN +NxK2J,xK *2P yJ0FNxKz2J,xK yNPJ2L+N !z-JzyJGJ++ PN- >N,,N-LNy2J,,N— >J+ PJN,N2 ZJ2,xK-2H*2LN2 Gz,,N2 ,JxK PJN Z-LNy˜ 2J,,N PN- P’2zFJ,xKN2 [-*xHFN,,*2LN2 PN220xK zG, CJ2(NJ,N Pz-z*M (N-+N2™ Pz,, PJN ,+z--N $xK*K,/J+‘N J2 $JxKN-KNJ+,,xK*KN2 PNF ^y(JxHNG2 PN, !0-M*šN, yNJF DN˜ KN2  JPN-,+z2P N2+LNLN2,N+‘+ *2P PJN [-*xHyNGz,+*2L J2,yN,02PN-N z2 PN- ]N*LN˜ ,NJ+N PN- D-0š‘NKN2 N-KK+— !N-GN+‘*2LN2 P*-xK PJN,N @02,+-*H+J02,FN-HFzGN PN, H02)N2+J02NGGN2 $JxKN-KNJ+,,xK*K, H22N2 2*- PzP*-xK )N-FJNPN2 (N-PN2™ Pz,, PN#-LN- ,NJ2 Dz2LyJGP ™™,/02+z277 ,xKFN-‘J2P*‘JN-+ y‘(— *2yN(*,,+ 2PN-+ (z, 2*yNJ N-KzG+N2N- $xKFN-‘,N2,JyJGJ++ (zK-,xKNJ2GJxK J,+ ›v“_œ 0PN- Pz,, JKF PJN 2PN˜ -*2L PN, Dz2LyJGPN, PzP*-xK z*MLN‘(*2LN2 (J-P™ Pz,, NJ2N ]zGGN2-0GGN *2+N- PN?z*M,0KGN z2LNy-zxK+ (J-P ›u™ t™ wt_— [JN, J,+ JF J2P*,+-JNGG LNMN-+JL+N2 ?*x%06˜ [JzyN+JHN-,xK*K PN- EzGGn N2+,/-NxKN2PN $JxKN-KNJ+,,xK*KN FJ+ ]zGGN2-0GGN M- 2N*˜ -0/z+KJ,xKN E,,N ,J2P ‘*- ƒNJ+ 2JxK+ J2P*,+-JNGG LNMN-+JL+ N-KG+GJxK™ ,02PN-2 2*zG, >zšz2MN-+JL*2L— [JN )0-GJNLN2PN2 "2+N-,*xK*2L,N-LNy2J,,N F,,N2 z*ML-*2P PN- HGNJ2N2 EzGG‘zK˜ GN2 ‘*-xHKzG+N2P J2+N-/-N+JN-+ (N-PN2™ yNL-2PN2 INP0xK ‘*FJ2PN,+ PJN yNJPN2 M0G˜ LN2PN2 EN,+,+NGG*2LN2o “œ ^-yNJ+,˜$JxKN-KNJ+,,xK*KN yNKJ2PN-2 z*ML-*2P JK-N- LN˜ 20-F+N2 @02,+-*H+J02,)0-LzyN2 $+zKG‘NKN2Hz//N *2P $+zKGNJ2GzLN JF $xK*Ky0˜ PN2œ PJN E*šzy(JxHG*2L yNJF DNKN2 *2P N-KKN2 PzP*-xK PJN [-*xHyNGz,+*2L z2 PN- ]N*LN,NJ+N PN- D-0š‘NKN2n PJN,N, '-0yGNF yN,+NK+ M- “•‹t•; PN- #-LN- *2P H22+N P*-xK NJ2N LN2PN-+N @02,+-*H+J02 PN- ?z*M,0KGN ^2y-J2L*2L NJ2N- ]zG˜ GN2-0GGNœ FJ2JFJN-+ (N-PN2— wœ =JxK+ M*šM0-FLN-NxK+N $xK*K,/J+‘N2™ PJN ‘*PNF 20xK z*, *2VN”JyGNF >z+N-JzG $+zKGœ yN,+NKN2™ MK-N2 yNJ /-PJ,/02JN-+N2 'N-,02N2 ‘* !N-GN+‘*2LN2 PN- $NJ+N2VxKN PN- D-0š‘NKNn PJN,N, '-0yGNF H22+N P*-xK 2PN-*2L PN, ]-z2P,0KGN2*F-J,,N, FJ2JFJN-+ (N-PN2—

“•w

q E*š,xKPN2 yNJ PJzyN+J,xKN- '0G’2N*-0/z+KJN

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folgenlose Ausheilung des Osteoödems (Pfeil)

verspätete Entlastung

geschlossene Frakturen Charcot-Fuß

Defektheilung

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Neuropathie Prädisposition

Minimal-Trauma äußere Einwirkung

Ulkus Verletzung

Heilungsstörung weitere Schädigung (Druckbelastung, Infektion)

Gangrän weitere Schädigung (Thrombose)

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110

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vollständige Coriumläsion: ~ Grad IIb

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partielle Coriumläsion: ~ Grad IIa

80 70 60

Schmerzempfindung

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E*šLN,xK(- p™ wt™ v“™ vw™ vs™ vq™ up™ “•t™ “•r™ ““w™ ““t™ “u“ E*šG2LN “q™ wv‹wt E*š/VNLN ts ‹ /0P0G0LJ,xKN ]NKz2PG*2L vr E*š,0KGN r E*š*F-J,, “s Dz2L-2 “s™ “v•™ “vs™ “vr™ “u• DNPxK+2J, v DNKLJ/, ru‹rs™ “wu DNKJ-2 w™ v™ s™ r™ “t™ “s DNK/-0yN2F0PNGG sv™ sp™ rp DNGN2H)N-,+NJM*2LN2 up DN,xK(- q™ qp™ pw™ “•r DN,xK(-,-J,JH0 v• DN(JxK+ wt DJ/,yJ2PN2 rq™ “ut DJ/,F0PNGG sw DJ/,)N-yz2P rt CzGG*” -JLJP*, pq CzGG*” )zGL*, “r™ st Cz*+,xKPN2 q™ “s CJGM,FJ++NG tp™ su™ “““™ ““t CJGM,FJ++NG)N-,0-L*2L tp CJGM,FJ++NG)N-‘NJxK2J, vq™ tt™ ““t C0xK-J,JH0/z+JN2+N2 wp™ v“™ vt™ vs™ vq™ up™ ““t™ “u“ C’/N-,+KN,JN2 s BFF0yJGJ,z+J02 “wu‹“wr BFF*2,*//-N,,J02 “u“ B2P*,+-JNz-yNJ+N- wv B2P*,+-JNLJM+N s B2MNH+J02N2 “vs™ “u“ @J2PN- wv @20xKN2)N-GN+‘*2L “vr @-/N-LN(JxK+ “r™ wv™ uu @-/N-L-šN “r™ wv™ wt @-/N-,xKNFz r @0F/z-+FN2+,’2P-0F “vr @02+zH+VxKN ur ?2LN2,HzGJN-*2L “u ?2L,LN(GyN “t™ uu™ tv™ rr ?2L,LN(GyN,++‘N ut™ tw™ tv ?z,+z*M2zKFN uu ?z,+)N-+NJG*2L t“™ “•q™ “•p ?NJ,+N2 “w™ wt™ qr ?NJ,+N2M0-F “•™ “w

?N/-z “““™ “vq ?’F/KPNF “wv >zL2N+-N,02z2‘+0F0L-zXN “wv >zš,xK*K sv™ “ut ‹ 0-+K0/PJ,xKN- s“™ sv‹ss™ sq™ sp >z”JFzGP-*xH ps >NPJ‘J2/-0P*H+ vu™ tp >NPJ‘J2/-0P*H+LN,N+‘ ““t >N+z+z-,zGH/MxKN2 vv™ uu‹t•™ sw™ pq‹“•“™ “•t™ “•q >JH-0z2LJ0/z+KJN “vp >JGJ+-,+JNMNG wu >J++NGM*šM-zH+*- “w• >J++NGM*š-0GGN tw™ rs™ pp >0PN,xK*KN vu™ vq™ “•t™ “““™ ““t >2xHNyN-L,HGN-0,N “vw >’NGJ2,xKJxK+ u™ s >’NG0,N™ M*2JH*G-N “vq =NH-0,N2 “vw =N-)N2Mz,N-2 u‹s =N-)N2,xKFN-‘N2 s =N-)N2,JL2zGN “t™ “s =N*-0/z+KJN wt™ “u• ‹ KN-NPJ+-N “vq