Diabetic foot syndrome: Good advice can save feet
Good skin care should be part of your daily routine. This is especially important for people with diabetes to prevent diabetic foot syndrome. / © Adobe Stock/Edler von Rabenstein
According to figures from the Robert Koch Institute, a total of 7.2 percent of adults aged 18 to 79 were diagnosed with diabetes mellitus in 2024. A further 2 percent are likely to have undetected diabetes (1).
The complications of diabetes mellitus affecting the foot are collectively referred to as diabetic foot syndrome (DFS). They arise from various pathomechanisms and carry a high risk of amputation (2). Their prevention requires a specific preventive strategy, and their treatment requires consistent diagnostics and interdisciplinary therapy.
In Germany, approximately 70 percent of all major amputations occur in people with diabetes – currently about 5,000 per year (3). More than 85 percent of all minor amputations, i.e., amputations below the ankle, also affect people with diabetes – approximately 30,000 per year (3). Such amputations not only have dramatic consequences for those affected, but also cause considerable costs for the healthcare system.
It is therefore important to identify people with diabetes mellitus and an increased risk of foot complications, to prevent diabetes-associated foot lesions (ulcers), and to avoid amputations in cases of already occurring tissue damage and/or infections (2).
Preventing diabetic foot lesions requires regular self-examination and specialist examination of particularly vulnerable patients, such as those with polyneuropathy and/or peripheral arterial occlusive disease (PAD). Since many people do not take the risk seriously or no longer notice the affected limbs as a result of the disease (so-called body island atrophy), it cannot be assumed that they will undergo these examinations on their own or visit a doctor's office. Others avoid seeing a doctor for professional or social reasons.
Regular foot checkups at the doctor's may be annoying, but they are absolutely necessary for people with diabetes. / © Shutterstock/Image Point Fr
It is therefore helpful to discuss risk factors and prevention with people with diabetes mellitus in the pharmacy. Important topics include the quality of metabolic control, possible pathological foot changes, polyneuropathy or peripheral arterial disease, previous foot problems, foot lesions, or amputations, as well as the frequency of self-examinations and specialist foot examinations. Wearing appropriate footwear and the possibility of complex podiatric treatments should also be addressed.
The general prevention strategy of the DFS includes self-inspection and regular specialist medical examinations, the frequency of which depends on the risk classification (Table 1), as well as targeted training and general and specific measures.
The pharmacy team can advise patients on how they can contribute to the prevention of possible diabetic foot complications:
- Inspection of the feet, if necessary using a mirror, daily cleaning with lukewarm water and mild soap,
- daily rubbing with a foot care cream,
- Proper blunt nail care and removal of calluses or appropriate care during regular podiatric consultations and
- Wearing socks and shoes suitable for diabetes.
Patients with increased or significantly increased risk should receive specialized training in a diabetes specialist practice. Patients, family members, and all those involved in treatment should be informed about the necessary measures, the individual risk, and the defined treatment goal.
Regular podiatric examinations and, if necessary, treatment are advisable. Appropriate protective footwear should be prescribed by a specialist according to the patient's individual risk status and checked regularly.
| Risk category | Findings | Examination interval (months) |
|---|---|---|
| 0 / low | no polyneuropathy, no PAD, no foot lesions so far | 12 |
| 1 / increased | sensory polyneuropathy | 6 |
| 2 / increased | sensory neuropathy and signs of PAD and/or foot deformities | 3 |
| 3 / greatly increased | previous ulcer | 1 to 3 |
Table 1: Recommended medical check-up intervals depending on the risk category (2); PAD: peripheral arterial occlusive disease
Pharmacy staff can specifically address the possibility of a diabetic foot ulcer when regularly dispensing dressings to people with diabetes. The discussion should include referral to a specialized diabetic foot center and, if necessary, examination and treatment at a specialized diabetic foot facility or vascular center. When changing dressing regimens, potential delays in wound healing can be addressed.
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