Looking at the whole patient

Patients suffering from lymphedema or lipedema are also often affected by foot problems. This is something the experts in orthopedic shoe technology at Orthopädie-Schuhtechnik Tasch in Erfurt have noticed. They naturally have an eye for this.

Patients with lymphedema or lipedema visit the Erfurt branch of Orthopädie-Schuhtechnik Marco Tasch almost every day to have compression products made. This is what the medical retailer has specialized in, in addition to the standard services of an orthopedic shoe technology expert. Many of them leave the medical retailer with a recommendation for the physician because orthopedic foot orthoses are needed – or vice versa: patients requiring foot orthoses are advised to speak to their physician about their edema. Annemarie Müller, Branch Manager, is the one providing recommendations. When she hands out products, she explains that she “looks at the whole patient.” The experienced orthotist has realized during the course of her professional career that one in three patients – usually women – with lymphedema and lipedema has other problems with her musculoskeletal system. The reason for this is that the edema changes body statics, which can result in incorrect heel-to-toe movement, thus affecting gait. Common consequences also include misalignments of the leg axis and pelvis as well as arch decreased, splay, skew, high-arched or flat feet and shortening of the muscles in the lumbar spine and hips. In these cases, orthopedic foot orthoses can help and reduce symptoms. They support the foot muscles, positively influence body statics, improve heel-to-toe movement and distribute the weight more evenly across the foot. 

“We need a lot of information from the patient to select the right product that fits precisely,” Annemarie Müller explains, “and we take a lot of time to gather this information.” The advantage is that both during the foot scan for a foot orthosis and when measuring the circumference for compression products, the legs and feet are not covered by clothes. This allows Annemarie Müller to get a good impression of the condition of the skin, a tendency for developing edema or the presence of foot misalignments. “During the measurement process, I will then ask about the exact symptoms,” the branch manager explains. “From these discussions and what patients tell me, I can often conclude whether there are problems with the feet.” When patients lie down, she can also see the soles of their feet and can palpate for abnormalities under the skin. Annemarie Müller always performs a pressure test with her hand on the patient’s leg. If an indentation remains, the patient may suffer from lymphedema. Ultimately, the physician will make the appropriate diagnosis. It is important to have this pointed out early because at the beginning in particular, lymphedema is not easily visible. Early treatment can slow down the progression of the condition and prevent unnecessary suffering for the patient. 

Heel spurs caused by inappropriate mechanical stress

Lisa Rehe, too, is affected by a combination of two diagnoses. She is visiting the historical building in Erfurt’s town center this morning to try out her orthopedic foot orthoses. The 33-year-old has been wearing compression stockings since 2016. “Although Lisa has lymphedema and lipedema, the palpation reveals that her lipedema is more pronounced. She also has slim feet,” Annemarie Müller explains. The VenoTrain curaflow flat knit stocking with compression class 2 supports the Erfurt-born patient throughout the day. Because she is very active, she appreciates its breathable material with a high microfiber content. “And it alleviates the discomfort,” she confirms as she skillfully puts on the stockings. Like always, she has brought her own gloves – a huge help that Annemarie Müller recommends to all her customers. 

Last summer, Lisa Rehe suddenly felt pain in her feet. The medical diagnosis: a bilateral calcaneal spur, probably as a consequence of increased strain on the plantar fascia. Her heel alignment is not ideal, and she also has skew and splay feet, as Annemarie Müller discovered after a foot scan and a detailed palpation examination. 

For edema patients, she generally recommends supporting foot orthoses with soft cushioning in the heel area. In Lisa Rehe’s case, she chose the ErgoPad redux heel, an orthopedic foot orthosis specifically designed to combat chronic heel and ankle pain as well as heel spurs. “Relieving the pressure-sensitive area at the back is very important. The foot orthosis also supports decreased foot arches, one of the causes of discomfort,” Annemarie Müller explains the design of the new foot orthoses to her long-term patient before they disappear in the sneakers. “They fit and feel nice,” says the trained office manager, and she is pleased after taking a few steps. If required, Annemarie Müller could have adjusted the foot orthoses using her own grinding machine. This is also part of the service in the four branches of the orthopedic shoe technology store which, in addition to Erfurt, have become established in
Mühlhausen and Heiligenstadt in Thuringia and in Bad Hersfeld, Hesse. 

The foot orthoses significantly contribute to Lisa Rehe’s quality of life because she enjoys walking and cycling, when her pain permits it. “I used to play football, too, but I stopped after my third torn cruciate ligament,“ she reports. 

Measuring after lymphatic drainage 

Not all patients visiting the medical retailer are as mobile as this young woman. That is why Annemarie Müller also takes measurements for compression products at patients’ homes or in the physiotherapy practice, if required. The reason for the latter is because measurement after lymphatic drainage or complete decongestion is best for patients. After all, the stocking should exert pressure on the leg. If the leg has not been fully decongested when the measurement is taken, there is a risk that the stocking will be too big and may slip. During home visits, the specialist can check how those affected get on with their product: “At home, patients put on their stockings while sitting on the couch,” the orthotist has noticed. “They sit much lower there than on a chair in the practice. So you shouldn’t be surprised why it’s not working as well at home.” During home visits, she can check the correct fit to ensure that the stockings do not crease and the seam at the heel is in the right position. “If possible, I ask the patient’s partner to join us during donning, and I show them how they can help. Only when the stocking fits perfectly will it be worn regularly. And that is crucial!” Accordingly, Annemarie Müller is out and about in her company car a lot, which her clients clearly appreciate: “Some even keep a little knee cushion ready for me,” she says, laughing. 

Information to take away

Annemarie Müller has noticed that the category of patients currently being treated at Orthopädie-Schuhtechnik Tasch because of lymphedema or lipedema is changing. Firstly, more men are visiting the store because they have developed edema following radiotherapy. Secondly, the subject of lipedema has come more to the fore on social media, on Instagram for example. “We’re therefore looking after increasing numbers of younger patients.” These patients undergo surgery more often and subsequently look for compression products as well as foot orthoses. Experience has shown: once they have tried these products, they feel good, they wear them regularly and ask for follow-up products. It is therefore all the more important to look at the feet during every examination, as has been the case at Tasch for a long time.

Lisa Rehe has said good-bye – her follow-up check will be in two weeks. This is also noted in her personal service logbook that all customers receive at reception. In addition to contact details and opening times, it includes appointments for check-ups, instructions for use and information on how to care for the product. “We like to give our customers something they can read at home at their leisure,” says the 33-year-old branch manager. During an extensive first appointment in particular, including examination and measurement, they are given a lot of new information which they have to process. They may also feel nervous or insecure. But the five-strong team in Thuringia’s regional capital has a tried-and-tested solution for this: “We laugh a lot!” Laughing is known to be beneficial for your health and reduces stress. That is helpful for both parties because the experts in the store and the workshop have a lot to do even though the company barely advertises. Instead, they favor quality over quantity. “We get a lot of customers via word-of-mouth because patients realize that we’re not gunning for sales but we look at each patient as a whole, even though we specialize in orthopedic shoe technology,” Annemarie Müller says and she adds: “You have to do your job well and enjoy it. Then it doesn’t even feel like work.”

Orthopedic foot orthoses: a suitable product for every foot 

ErgoPad redux heel

Ideal in cases of chronic heel and ankle pain as well as heel spurs. It relieves the pressure-sensitive heel area with every step and ensures rapid and lasting pain reduction. At the same time, the fan design in the orthotic core ensures the inflamed, painful tendon insertion at the sole of the foot is relaxed. The orthopedic foot orthosis softly cushions the painful heel and relieves the plantar fascia. It guides and supports the foot when walking.

ErgoPad weightflex

It supports the foot arch in a transverse and longitudinal direction as well as the heel-to-toe movement in cases of skew feet, flat feet or splay feet. With the integrated “weightflex-X”, the specifically developed core supports the foot’s torsional ability and optimizes the gait pattern. It is available in soft, medium and strong versions and fits in nearly any type of shoe – even with heels.

ErgoPad ID milled orthoses

Custom-made milled orthoses are suitable for targeted, indication-specific foot care. Depending on the configuration of the foot orthoses, they can be used in comfort, leisure and sports shoes. The unique products are modeled using the Bodytronic ID:CAM system solution. They are manufactured specifically for each individual foot using CAD milling technology based on digital measurement data.

TRIactive

The foot orthosis features load-adapted zones and supports the foot arch in cases of flat, splay and skew feet to help with pain caused by strain as well as secondary effects. Featuring various densities, its functional cushioning that connects like a jigsaw puzzle is aimed at specific movement patterns. The foot orthosis consists of a cushioning, a supporting and a guidance zone. The TRIactive is available in the versions “run”, “play”, “walk”, “golf” or “heel” as well as “OA” for treating osteoarthritis of the knee. Suitable for running, indoor exercise, ball sports, walking, hiking, and golf, as well as for long periods of standing during everyday activities.

Images: Bauerfeind, Frank Steinhorst