When treating people affected by diabetic foot syndrome it seems to be quite common to agree on procedures that are nearly impossible to put action in everyday life. If the patient initially approved the agreement and later notices the impossibility, communication becomes difficult.
Agreements on shoes with critical implications for everyday life
If the affected person receives protective footwear at the expense of the health care system, they should normally wear only these shoes and for every step. That also sounds sensible. Otherwise, how is the protection supposed to come about? But….
After wound closure, often only a pair of protective shoes are available at first. This is also well founded, because the patient may not be able to cope with it. But what will a civilised person do if they may wear only a pair of protective shoes and have the prospect of a second pair only in a few weeks or months? Walking with the same shoes on the street, on muddy ground, in the house and during a visit to a concert? People are forced to try how much can be done without the protective shoes.
And then: The entire collection of beautiful, expensive shoes should go to waste? As a consequence, patients often keep their shoe collection and occasionally wear shoes other than the prescribed protective shoes.
Mobility versus Offloading
An even worse incision in everyday life is the common request to walk “not at all”, “hardly” or “only the most necessary” in view of an ulceration of the foot. It may be pleasant to be spoiled for a week, but afterwards? Social life is to be ended because of a part of the body that you don’t even feel anything about?
Isn’t it important in life to clench one’ s teeth and not to let oneself fall in despair due to an injury or illness?
The requirement not to step on the sick foot is obvious and is usually accepted. However, independence and everyday competence quickly become so restricted that life can no longer be managed as usual. The periods of the restriction are measured in months or years. And there is another good reason to question such instructions: losses in the area of mobility are difficult to rehabilitate at a certain age. The overriding goal of all efforts at the diabetic foot is to maintain mobility.
Consequence: Patients walk on their sick feet. And this may even be a beneficial in a broader context.