Diabetic Foot Syndrome

Classification of the Diabetic Foot Syndrome

The Diabetic Foot Syndrome (DFS) results from diabetes mellitus and involves a whole series of various symptoms. The cause of a diabetic foot syndrome can be either a neuropathic or an ischaemic foot, or a combination of both.

If it is the former, the nerves are damaged because of a permanently heightened blood glucose level which is weakening the muscles and causing the ligamentous apparatus to collapse.

Diabetic patients experience symptoms such as, for example, numbness, pressure points on the foot's sole and/or the toes as well as dry and vulnerable skin. Manifesting ulcers can become chronic wounds which only heal poorly, if at all.

In the case of an ischaemic foot, the arterial blood flow is interrupted. This may lead to the death of entire tissue areas.

Generally, wound treatment is an essential part of DFS therapy as the wounds' ability to heal is often impaired. This may result in amputations of the extremities after incorrect weight-bearing on the foot.

The cause of DFS must be considered when treating diabetic feet as each therapy differs from the other in many ways or is even contraindicated.

Moreover, the correct assessment of the existent risk group is essential for avoiding (further) injuries and to ensure the proper treatment of each individual patient.

In this website you will find DIABETES therapeutic shoes for risk groups II, III and VII. You can see which risk groups and wound stages each DIABETES therapeutic shoe is especially recommended for in the product information in the paragraph Indications on each shoe page. Our specifications are based on the classifications below.

GO BACK

Risk Groups of the Diabetic Foot Syndrome*

Risk Group 0	Diabetes mellitus without peripheral neuropathy (PNP)/peripheral artery disease (PAD)
Risk Group I	Same as risk group 0, with foot deformity
Risk Group II	Diabetes mellitus with sensory neuropathy caused by PNP/relevant PAD
Risk Group III	Condition after plantar ulcer
Risk Group IV	Same as risk group II with deformities or disproportions
Risk Group V	Diabetic neuro-osteoarthropathy (DNOAP) (LEVIN III)
Risk Group VI	Same as risk group II with partial foot amputation
Risk Group VII	Acute lesion

* according to "AG Fuß: Arbeitsgemeinschaft Diabetischer Fuß der Deutschen Diabetes Gesellschaft" (Working group on the diabetic foot in the German Diabetic Society) (as of 25th February 2006)

Wound Stages of Diabetic Feet**

	Grade 0	Grade 1	Grade 2	Grade 3	Grade 4	Grade 5
A	Pre- or post-ulcerative lesion	Superficial wound	Wound up to level of tendons or capsule	Wound up to level of bones and joints	Necrosis of parts of foot	Necrosis of the entire foot
B	With infection	With infection	With infection	With infection	With infection	With infection
C	With ischaemia	With ischaemia	With ischaemia	With ischaemia	With ischaemia	With ischaemia
D	With infection and ischaemia	With infection and ischaemia	With infection and ischaemia	With infection and ischaemia	With infection and ischaemia	With infection and ischaemia

** according to Wagner (grade 0-5) and Armstrong (stage A-D)

Classification of the Diabetic Foot Syndrome According to Wagner		Armstrong's Stages of Diabetic Foot Syndrome
Grade 0	Pre- or post-ulcerative foot	Stage A	Neuropathic foot without infection
Grade 1	Superficial wound, but affected skin and subcutaneous tissue	Stage B	Neuropathic foot with infection
Grade 2	Wound up to the level of tendons or capsule	Stage C	With ischaemia
Grade 3	Wound up to level of bones and joints	Stage D	With infection and ischaemia
Grade 4	Necrosis of parts of foot
Grade 5	Necrosis of the entire foot

Shoe Treatment

Risk Groups II and III

For the treatment of diabetes mellitus with sensory neuropathy caused by PNP/relevant PAD and/or a condition after a plantar ulcer, usually, a therapeutic shoe with a custom-made foot othotic or an orthopaedic shoe modification is used. That is why we offer an insole blank or insole set for all DIABETES therapeutic shoes, which can be adapted to relieve plantar pressure points. The insole can be used as an temporary measure until the patient-specific, custom-made foot bed has been made. In addition, the DIABETES therapeutic shoes offer sufficient space to allow a thick insole/foot orthotic to be used, without constricting the foot. Should more space be required due to bandages, foot malpositions/deformities or others, the inner volume can be adjusted, a wider shoe version can be selected or the (inner) material can be further modified.

Risk Group VII

Recommended therapeutic shoes for lesions usually are relief, bandage, interim and orthosis shoes with a diabetic foot orthotic or an orthopaedic shoe modification. The shoes we offer for this treatment - especially the WIDE version - provide sufficient space for an individual foot orthotic as well as for additional bandages and/or orthoses that the patient wears. Due to the hook and loop fasteners, the wide shoe versions and the adaptable (inner) material, the shoes can also provide targeted relief in non-plantar areas. Additionally, the rigid sole design and the tall shaft ensure stability and security during stance and gait.

GO BACK