[Diabetic foot syndrome and its risks: amputation, handicap, high-cost sequelae]

Amputation, Handicap, High Subsequent Costs. Lack of "Outpatient Wards for Diseases Involving the Feet" in German hospitals. A Challenge to Prevention: In consequence of diabetic polyneuropathy, about 25% of all diabetics develop neuropathic foot complications often resulting in amputation (about 30,000 cases in Germany per annum). Suffering and handicaps of the patients, as well as the high costs involved (estimated at 800 million Deutsche Mark per annum) systematic prophylaxis and early identification of patients at risk are imperative. According to experts every second amputation could be avoided if treatment of diabetic foot complications is started as early as possible. To prevent expensive in-hospital treatment, an outpatient clinical treatment may be offered on an interdisciplinary basis (internist, neurologist, orthopaedist, surgeon, radiologist). About 50 "outpatient wards for diseases involving the feet" exist up to now in German hospitals. Appropriate fees, subsidy by sick funds (and if necessary by politicians) and co-operation with general practitioners, internists etc. are indispensable. Other important co-operators are the family doctors. With regard to health care, preventive activities and publicity, co-operation of the local Public Health departments would also be feasible.