magazine - bauerfeind-life.com

Visible mechanical stabilizationMRI study with the MalleoLoc ankle orthosis Page 32

Orthopedics in Olympic sportsElite athletes are highly compliant patients Page 28

Producing quality while maintaining cost efficiencyWide range of applications for Bodytronic ID:CAM Page 40

Targeted pressureTreating venous leg ulcersPage 14

internationalmagazine

Issue 2020 | 2

Spinova® OsteoGREATER STABILITY, GREATER COMFORT, GREATER COMPLIANCE

• OPTIMUM STRAIGHTENING EFFECT thanks to adjustable pressure distribution

• PLEASANT TO WEAR thanks to free abdominal and chest area

• SECURE FIT EVEN WHEN MOVING thanks to elastic, close-fitting pelvic support

* For the non-surgical treatment of acute, stable osteoporotic vertebral fractures, the current guidelines issued by Dachverband Osteologie (DVO; Umbrella Association for Osteology) recommend: “Treatment with a spine-straightening orthosis should be considered to enable low-pain mobilization.”

BAUERFEIND.COM

A BETTER QUALITY OF LIFE DESPITE OSTEOPOROSIS

FOR GUIDELINE- BASED

TREATMENT*

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For months, the coronavirus pandemic has defined our public, professional and private lives. The crisis challenges us, it brings us together, and it focuses our attention on what is essential: our common mission to help patients. I would like to express my admiration for the work you do every single day – often under difficult conditions!

In these times, in particular, the sound provision of medical aids creates important leeway in everyday clinical work: orthoses, for example, can safely bridge waiting times until surgery can take place. Quick and reliable work provided by medical supply retailers and orthopedic businesses guarantees a smooth transition from inpatient to outpatient treatment. This quality-assured follow-up treatment of patients also relieves hospitals. Quality is also expressed in modern service offerings, with, for example, our digital measurement technology providing increased safety and comfort , now in particular when patients can be measured without physical contact.

The sound provision of medical aids is crucial for our society and complies with conservative treatment plans – at any time: during a crisis and beyond. You will see that in this edition of life magazine, where plans for some on-site meetings had to be changed and “masked” people in pictures now reflect our new reality.

We’re focusing on one of the biggest challenges in medicine – professional wound management – and are reporting on the treatment of patients with venous leg ulcers, where compression is one of the supporting pillars of therapy. Join us in finding out more about scientific research on ankle stability diagnostics using an MRI-based methodology that also examines the stabilizing effect of our MalleoLoc orthosis. Meet experts in thrombosis prevention during pregnancy and in guideline-based osteoporosis treatment. Become (more) digital and find out from users of the Bodytronic ID:CAM web application how electronic modeling of customized milled orthoses works. Then take a look at the 2021 Summer Olympics in Tokyo with us, for which athletes continue to train and for which we’ve already started to plan our on-site support again.

I hope you’re inspired by reading these subjects that unite us.

Sincerely yours,

Rainer BerthanChief Executive Officer of Bauerfeind AG

“The coronavirus pandemic focuses our attention on what is essential: our common mission to help patients.”

life magazine 2020/2 3

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Dear readers,

Well-functioning blood circulation in arteries and veins is an essential factor in preventing the development of lower leg ulcers.

14 Treating venous leg ulcers Targeted pressure

16 Non-surgical treatment of venous leg ulcers “Edemas slow down the healing of wounds”

20 Hemodynamics study with CVI patients Compression therapy reduces capillary

hypertension

22 Study on patient education Increasing adherence through information

Focusing on the non-surgical treatment of leg ulcers: targeted pressure – p. 14

4 life magazine 2020/2

CONTENT

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FOCUS

ABOUT THE COVER IMAGE

IMPRINT:

Bauerfeind life magazine Frequency of publication: Three times per yearPrinted on chlorine-free paper

Editor:Bauerfeind AGTriebeser Straße 1607937 Zeulenroda-Triebes, GermanyTel.: +49(0)[email protected], www.bauerfeind-life.com/enMore information about privacy: www.bauerfeind-life.com/en/ds

Authors and editorial board for this issue: Johannes Amon, Jürgen Baden, Kristina Bardele, Petra Blank, Dr. Uwe Berendt , Beatrice Brücher, Silvia Dethloff-Kuntze, Simone Gebler, Kirsten Göpel , Markus Gräßer, Falk Henning, Peggy Kajrjakow, Theresa Klingler, Michael Kießling, Dr. Anselm Koopmann, Mathias Leitloff, Andreas Limbach, Dr. Antje Mark, Nils Oppermann, Christian Teusch

Publisher and editorial office:mk Medienmanufaktur GmbH Döllgaststraße 7–9, 86199 Augsburg, Germany Tel.: +49(0)821-34457-0 [email protected], www.mk-medienmanufaktur.de

Articles whose author is specified reflect the opinions of their author, not those of the publisher.

Reprinting in whole or in part only with written permission of the publisher.

Tokyo: the flame will continue to burn – p. 44

40 Wide range of applications for Bodytronic ID:CAM

Producing quality while maintaining cost efficiency

24 Compression during and after pregnancy A risk-adapted approach is required

26 Accompanying compression therapy during pregnancy

Comfortable relief

28 Orthopedics in Olympic sports “Elite athletes are highly

compliant patients”

32 MRI study with the MalleoLoc ankle orthosis Visible mechanical stabilization

36 Guideline-based osteoporosis therapy Reaching consensus on treatment

Visible mechanical stabilization – p. 32 Consensus on osteoporosis treatment – p. 36

Quality meets cost efficiency – p. 40


CONTENT

3 Editorial

4 Imprint

6 World of Bauerfeind

10 News

48 Contact

50 People

MEDICAL RETAIL

44 The Olympic Games in Tokyo The flame will continue to burn

PLACE TO BE

Welcoming new facesThe German Association of Orthopedic Technology (BIV-OT) represents more than 2,500 medical supply retailers and orthopedic workshops with over 40,000 employees in Germany. In March 2020, a new Executive Board was elected – consisting entirely of Bauerfeind Quality Partners: Andreas Rulitschka (Lower Saxony/Bremen Guild), Lars Grun (Hesse Guild), Albin Mayer (Vice President , Saxony-Thuringia Guild), Alf Reuter (President , Hesse Guild), Joachim Glotz (Baden-Wuerttemberg Guild), Bodo Schrödel (Bavaria Guild), Lars Jäger (Saxony/Thuringia Guild), Thomas Münch (Düsseldorf Guild) and Matthias Bauche (North Guild) (from left to right). †


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WORLD OF BAUERFEIND

Welcome to the team at our new location in Gera. Craftsmanship is required here – when sewing, assembling and textile welding of high-quality products made by Bauerfeind.

Come aboard in GeraBauerfeind is relying on attention-grabbing recruitment in Gera, our new German manu-facturing site, to ensure production can pick up speed. The call for applications on buses and trams is designed to attract about 120 new employees by the middle of 2021. A peek behind the scenes shows that the team is already producing supports and orthoses

for the elbow, hand, back and ankle. At the moment , the Gera production site comprises an area of 2,800 square meters in total. In fall 2020, the capacity will be increased. †

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Bauerfeind is constantly expanding production at the new site in Gera, Germany: more than 30 products are currently made there – others will follow shortly.


WORLD OF BAUERFEIND

LEBEN MIT KNIE-ARTHROSE

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Brochure for patients with osteoarthritis of the knee

Get active to stay active

Even if osteoarthritis of the knee cannot be healed, complaints can be alleviated and progression slowed down. To support patients in getting active early and staying active, Bauerfeind offers a brochure that provides information and motivation: a test helps those affected to assess their osteo-arthritis risk. In addition to information about the condition, readers can receive tips on what they can do themselves in cases of osteoarthritis. Furthermore, they can find out about treatment with supports, such as the GenuTrain A3, or orthoses, such as the GenuTrain OA or SecuTec OA, and learn from personal stories provided by those who are already using such medical products. Physicians and medical retailers in Germany can order the brochure in DIN-long format via the Bauerfeind field service or the Supports and Orthoses Customer Service by calling +49 (0)800-0 01 05 20 or by sending an e-mail to [email protected].

Information, tips and good examples for an improved quality of life, thanks to non-surgical treatment.

Bauerfeind Quality Partner Program

Boost your online visibility

Those looking for information these days access the internet. That is why the online visibility of medical supply retailers is a top priority. As part of the Quality Partner Program, Bauerfeind provides professional support to its partners so they can improve their web presence. Using Google MyBusiness, listings and Google Ads, the medical retailers’ online presence is strengthened. A professionally created Google MyBusiness entry is available at any time and allows customers to get in touch directly with medical supply retailers, look up directions to the required branch or find current opening times. The medical supply retailer’s website can also be found more easily on Google if the company profile is set up with a logo, images and contact details in as many online portals as possible, with consistent and complete information. Medical retailers from Germany who are interested can find further details at werbemittelshop.bauerfeind.de


NEWS

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Bodytronic ID:CAM web application

Milled orthoses in plus sizes

The Bodytronic ID:CAM web application now allows modeling and milling of customized foot orthoses up to shoe size 54. This includes foot orthoses with a length of almost 35 centimeters. Living large can have its challenges when buying shoes. The production of milled foot orthoses also used to have limitations. But thanks to the “plus size” module, treating particularly large feet with milled orthoses is now no longer a problem. Bauerfeind brand ambassador Dirk Nowitzki also has shoe size 54, and he appreciates the comfortable foot cushioning that individually adapted and milled foot orthoses provide. Technicians can now also use two new materials for the design: a soft foam in blue batik and in black. The materials are available in all categories. Access to the web application: idcamrev2.bauerfeind.com

Prescription overview for Spinova lumbar orthoses

Which orthosis helps and when?

The new folder “Mobilizing patients to return to everyday activities” provides a compact overview of treatment with Spinova lumbar orthoses. Based on mode of action and design, it shows which orthosis ideally supports the healing process and gradual mobilization for particular indications. With the orthoses Spinova Stabi Classic, Spinova Support Plus, Spinova Unload Plus, Spinova Immo Plus, and Spinova Immo, the Spinova system covers the entire treatment range of lumbar indications. They stabilize, relieve or immobilize the lumbar spine. Their additional name elements always describe the mode of action: Stabi Classic provides all-round stabilization with corset stays that are arranged in a circular design, Support promotes natural lordosis using a large back pad, Unload relieves using a lordosis-reducing bridging frame, and Immo immobilizes using a torso shell. The degree of stabilization can be adjusted using Velcro straps that can be individually tightened (Spinova Stabi Classic) or the height-adjustable Spinova strap system that applies the regulated force in a targeted way. The additional name element ‘Plus’ represents a modular design that supports multi-level treatment. Fixed elements, such as abdominal or back pads, frames or shells as well as the stays in the back setting device can be removed for gradual mobilization. Physicians in Germany can get the treatment overview of the Spinova system by calling the free Service Hotline on +49 (0)800-0 01 05 20 or by sending an e-mail to [email protected].

Dirk Nowitzki is living it large. No problem for Bodytronic ID:CAM.


NEWS

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VERORDNERFÄCHER

FÜR ALLGEMEINMEDIZINEROrthopädische Einlagen, Bandagen, Orthesen, Kompressionsstrümpfe

2020

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Vena saphena magna

Vena femoralis

Vena tibialisanterior

Vena poplitea

Vena tibialis posterior

Vena iliaca communis

Vena iliaca externa

Vena saphena magna

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oberflächliche Venentiefe Venen

Gesunde Venen transportieren sauerstoffarmes Blut zum Her-zen zurück. Die Venenklappen verhindern ein Zurückfließen des Blutes in die Beine.

Die Wadenmuskelpumpe erzeugt durch die Verdickung des Muskels bei Anspannung eine Komprimierung der tiefen Venen, die sich bei entspannter Muskulatur erneut füllen. Die so entstehende Pumpwirkung unterstützt aktiv den Rück-transport des Blutes zum Herzen während der Bewegung, z. B. beim Gehen und Laufen.

Reflux: Krankhaft erweiterter Venen abschnitt mit nicht voll-ständig schließender Klappe – das Blut sackt wieder zurück.

Thrombus: Ein durch ein Blut- gerinnsel verstopftes Blutgefäß führt zu schweren Stauungen und kann lebensgefährlich werden.

Venenerkrankungen

Wirkweise Wadenmuskelpumpe

Bei fortgeschrittenem Venenleiden

Bei mittelschwerem bis fortgeschrittenem Venenleiden

Bei Ulcus cruris venosum

Gesunde Beinvenen

Die konservative Therapie mit medizinischen Kompressionsstrümpfen unterstützt die Venenfunktion.

VenoTrain® soft VenoTrain® impuls VenoTrain® ulcertec

BAUERFEIND.COM

Bei leichtem bis mittelschwerem Venenleiden

VenoTrain® micro

2020 prescription information for GPs

Product knowledge for the white coat pocket

The prescription information for general practitioners is now being published in a new edition for 2020, spe-cially designed to suit primary care provided by general physicians in Germany. On this information card, general practitioners will find a selection of supports, orthoses, foot orthoses and compression stockings that they can prescribe by name for common conditions. The card was updated to now include information about the supports GenuTrain, EpiTrain and LumboTrain (Lady) as well as about the relieving GenuTrain OA knee orthosis. The medical products can be prescribed without burden-ing the practice budget and can be combined with other measures. This prescription information card fits per-fectly in a white coat pocket , features a quick search tab and lists each product along with its indications and the associated medical aid number in the German directory of statutory health insurance schemes. Hard-copy and PDF versions are available free of charge from the Bauerfeind field service, Customer Service Hotlines (see p. 48) or by sending an e-mail to [email protected].

For the consulting room

Anatomical poster showing the venous system of the leg

Using the display, the treating physician can explain to patients with chronic venous disorders the structure and functions of the venous system of the legs and the calf muscle pump. The poster provides information about the development of reflux and clots, and refers to non-surgical treatment using compression stockings to support vein function.

Bauerfeind Doctoral Program

Deadline for applications extended

Young academics can apply for the doctoral prize until August 7, 2020. It is awarded to medical students who would like to do their doctorate in the areas of phlebology, lymphology or related disciplines. Together with the German Society of Phlebology (DGP), Bauerfeind supports new medical talent to increasingly focus research on issues concerning phlebology and related subjects. Each year since 2008, up to two applicants have been supported during the implementation of their projects with 5,000 euros each. The funding amount is shared between the doctoral candidate and the supervising institution. The award ceremony will take place at the annual conference of the German Society of Phlebology in early September. More information is available at www.bauerfeind.de/doktorandenpreis

The information card is compact , handy and lists all important product details.

The poster is a visualization aid for physi-cian-patient consultations.


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NEWS

EpiTrain elbow support

More targeted non-surgical treatment

The new EpiTrain elbow support generation was launched in April. Its highly textured high-low knitted fabric ensures an impro-ved fit and the two-component technology of its Epicon+ Pads provides targeted pain relief and intense proprioceptive stimu-lation. It is used to treat irritation of the elbow, such as epicondylitis, osteoarthritis and tendinopathy.The new high-low knitted fabric extends further over the upper arm’s muscle belly and has a highly textured surface. This increases the area in contact with the skin and ensures that the support remains securely in place during movement , thus allowing compression and massage from intermittent compression to produce their medical effect to the full. The knitted fabric in the crook of the elbow is softer and more breath able. Pads positioned laterally and medially against the elbow and forearm direct the therapeutic pressure around the epicondyles and to the tissue. The viscoelastic material of the new Epicon+ Pads features a second integrated component. This firmer element acts on the muscle-tendon junction and further along the muscle fibers. Flexible massage nubs provide selective stimuli, offering targeted relief for the irritated

insertions of the finger flexors and exten-sors and intense stimulation for the radial and ulnar muscles.

New sizing system, new measuring pointThe sizing system has been revised for the new EpiTrain generation and its improved fit , and scaled to a new measuring point. From now, measurements will be taken around the widest circumference of the forearm. New item numbers apply to the new sizes. For information and advice, please see all international addresses and contact details on page 48/49.

The new Epicon+ Pads relieve the irri-tated insertions of the finger flexors and extensors with two components.

Increased stability for the elbow during lifting, supporting, carrying – the new EpiTrain.

The new EpiTrain: new sizing system, new measuring point

The measuring point has been moved to the widest circumference of the forearm for easier measurement.

Size 0 1 2 3 4 5 6

Circumference (cm) 21 – 23 23 – 25 25 – 27 27 – 29 29 – 31 31 – 33 33 – 35

Optional: additional strap can be ordered separately

Treating venous leg ulcers

Targeted pressure

Chronic leg wounds are a particular challenge for the patient as well as the healthcare professional and the healthcare system. Poor wound healing associated with venous leg ulcers can usually be attributed to impaired blood flow. Venous ulcers are most frequently caused by advanced vein problems. In addition to treating the underlying condition and the wound, compression therapy has an important role to play in cases of venous leg ulcers. During this process, it is not just the expert knowledge of those treating and caring for patients that is essential , but also the consistent self-management of those affected – even after the wound has healed.

The main cause of chronic venous insufficiency – and therefore of venous

leg ulcers – is venous valve dysfunction, resulting in venous reflux.

FOCUS NON-SURGICAL TREATMENT OF VENOUS LEG ULCERS




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A lower leg ulcer is usually characterized by a reduced healing tendency based on a lack of

perfusion. As the most severe form of chronic venous insufficiency (stage-III CVI according to Widmer), venous leg ulcers are the most frequent manifestation at about 49%, followed by arterial ulcerations at 15% and mixed arterial and venous ulcers (16%) where CVI occurs together with peripheral arterial disease (PAD). This means ulcers caused by perfusion problems account for 80% of lower leg ulcers. “Venous leg ulcers can develop over

very long periods until the affected person realizes that external help is needed. When the lower leg ulcer continues to progress with open, weeping wounds that smell , the feeling of shame also increases. This may result in even more time passing before the patient confides in a physician,” reports the surgeon John Hakman, specializing in lymphology and project manager of the “Lymphology and Wound Healing Colloquium” (see box). Professional , interdisciplinary treatment management is then vital to prevent losing even more time. According to John Hakman: “A patient with

a venous leg ulcer often experiences a lot of pain as well as restrictions in joint and general mobility as well as shortcomings in self-care expertise. Eventually, this will have adverse psychosocial effects, with all these factors creating a lot of suffering for the patient.”

Differential diagnostics requiredThe foundation of any ulcer treatment is to obtain a comprehensive medical history as well as a clinical examination that includes precise documentation of the wounds. Furthermore, it is

Non-surgical treatment of venous leg ulcers

“Edemas slow down the healing of wounds”Treating venous leg ulcers caused by impaired perfusion in the lower leg is one of the major challenges in medical practice. In addition to wound dressing management that considers the individual stages of the condition, efficient decongestion forms the basis for treatment success.

The VenoTrain ulcertec stocking system is generally used after the decongestive phase.



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important to differentiate the relevant underlying and secondary conditions as exactly as possible. In addition to the obligatory pulse status and the assessment of peripheral arterial perfusion, the ankle-brachial pressure index is used, sometimes duplex sonography of veins and arteries, and in cases of PAD, MR angiography or CT angiography with subsequent interventional or open arterial revascularization surgery, depending on the duplex sonography findings. After eliminating the causes of the ulcer (arterial revascularization, treatment of varicose veins, etc.), venous leg ulcer treatment is then based on the perfusion conditions. The chronic open wound should always be treated according to individual requirements and the relevant stage. During local treatment , it is first cleaned, deposits or dead tissue removed, if applicable, and then an appropriate wound dressing is applied. To accompany

this treatment , the skin should be cared for and the edges of the wound should be protected.

Decongestion to combat chronificationBut there is a decisive factor in wound healing which, according to Dr. med. Hans-Walter Fiedler, vascular surgeon and lymphologist from Soest as well as co-founder of the Lymphology and Wound Healing Colloquium, is given too little consideration: perfusion. He starts with a definition: “In our Colloquium’s view, perfusion plays a vital role in wound management. It not only includes hemoperfusion but also, in addition to arterial and venous perfusion, most of all local exudate and transudate drainage, aided by a sufficient lymphatic system.” After all , a chronic wound is characterized by pathophysiological damage to all vessels – arterial , venous and lymphatic –

as well as impaired function on a cellular level: “Consequences of the significantly increased volume in exudate are impaired perfusion and drainage in the wound and on its edges as well as cellular dysfunction,” Dr. Fiedler explains. And he continues: “In addition to mechanical insufficiencies based on local damage – for example, caused by blocked or destroyed lymph vessels – dynamic insufficiencies also develop – sometimes as a consequence of the capillary permeability being disrupted. According to Földi, these result in a safety valve insufficiency with fibrotic edema development when all lymphatic compensatory mechanisms have been exhausted. And edemas slow down wound healing, for example, by extending the diffusion distances. If the edema is not treated appropriately in time, the consequence will always be the wound becoming chronic!”

Left: Patient 1, 56 years old, condition after injury to the left lower leg and chronification of the wound, CVI on both sides (r. C3/4, l. C6), edemas on both sides, significant exudate production. Treatment: surgical debridement , local wound treatment , adapted complex decongestive therapy (CDT); later: skin graft and flat-knit stockings. Right: Left lower leg after about 18 months.

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From practitioners for practitioners

Identifying the significant role of the lymphatic system for the treatment of wounds was one of the founding causes of the “Lymphology and Wound Healing Colloquium” in April 2016. Members include (from right to left) John Hakman, Specialist in Surgery from Iserlohn, Peter Nolte, Specialist in General Medicine from Meinerzhagen-Valbert , Dr. med. Hans-Walter Fiedler, Specialist in Surgery/Vascular Surgery from Soest as well as Expert Orthotist Falk Peters, Managing Director of Sanitätshaus Enneper at Südwestfalen Medical-Center in Iserlohn. The Colloquium supports expert knowledge and interdisciplinary cooperation between the different profes-sions involved in the treatment of wounds. For this, the group’s activities include the organization of regular further education events. Contact: John Hakman, Colloquium Project Manager, e-mail: [email protected]


Adapted complex decongestive therapyTogether with his colleagues from the Colloquium, Peter Nolte, Specialist in General Medicine from Meinerzhagen-Valbert , also advocates the early treatment of existing edemas and their professional removal. For the majority of patients with chronic wounds and lymphedema, the method of choice is adapted complex decongestive therapy (CDT). “Its first pillar is manual lymph drainage (MLD) – this includes the edges of the wound and its immediate surroundings. It helps with edema reduction and loosening of local fibrosis as well as improvement of lymphangiomotor function. If required,

intermittent pneumatic compression can also help,” Peter Nolte explains. The second pillar is compression therapy. During the initial decongestive phase, multi-layer compression bandages – ideally lymphological compression bandages – are applied, and the compressive effect can be increased using pressure pads, for example. During the consequent maintenance phase, compression stockings or a compression stocking system is generally used. “Luckily, there are only very few disorders or conditions in which MLD or compression therapy are not possible,” John Hakman adds. Other components of adapted CDT include decongestive physiotherapy, skin care and the application of suitable wound

dressings, good patient education as well as the treatment of co-morbidities. “If appropriately adapted CDT is started in time in cases of chronic wounds, there will be fewer edemas, reduced fibrosis and less exudate. This also means a reduced use of wound dressings and less frequent bandage replacement with quicker healing – leading to lower costs,” Dr. Fiedler summarizes.

Monitoring the woundPatients with venous leg ulcers still need stamina for professional decongestion. “After decongestion of the wound edges has been completed, i.e. the surroundings of the wound in the broadest sense, to aid exudate management , and having established low-germ, damp wound conditions, granulation can be expected to start around the edges of the wound five to seven days later,” John Hakman reports from his own experience. If healing doesn’t progress as desired, several parameters need to be checked: “Are there any signs of an infection? Is another debridement needed? Are the decongestive measures sufficient? Sometimes, surgery is required to relieve pressure on the venous system,” the surgeon explains.

Preventing recurrencesOne aspect is very important to Falk Peters, who is also a Colloquium member and managing director of Sanitätshaus Enneper medical supply retailer at Südwestfalen Medical-Center: “Treating venous leg ulcers is a long-term project that patients must be educated about and motivated for again and again.” Plus, those affected should also consistently continue their compression therapy once the venous leg ulcer has healed. At about 50 per cent , the rate of recurrence for venous leg

Venous leg ulcers

A venous leg ulcer (VLU) is a sub-stance defect in the tissue. This defect extends from the dermis to the subcutis and usually occurs in the lower third of the lower leg, in the area of the medial malleolus. Particularly high blood pressure in the veins and skin capillaries caused by vein problems in this area is responsible for its development. This increased pressure is often the result of a defect in the venous valves, for example, following deep vein throm-bosis (post-thrombotic syndrome), but it can also develop in cases of obesity, restricted joint mobility or heart valve disease. Because of the high hydrostatic pressure in

the large leg veins, pressure in the venous (post-)capillary vessels also rises, from which – owing to conges-tion-induced damage to the capillary membranes – proteins and inflam-matory cells increasingly permeate the tissue, resulting in fibrosing edema, i.e. lymphedema with typical inflammation. At the same time, more capillary vessels and initial lymph vessels are damaged and, over the long term, their structure changes due to fibrotic microangiopathic processes; as a result , the tissue no longer receives the required nutrients because of excessively long, impass-able diffusion paths, and the skin cells die over time.

Patient 2, 67 years old, has been suffering from venous

leg ulcers on both ankles for six years. The picture shows

the left edematous ankle. The wound produces exudate, it smells and hurts a lot. The area surrounding the wound

shows severe fibrosis, and local lymph drainage is impaired.

The treatment includes debridement of the wound

and protection of its edges, adapted CDT and mobilization

of the patient.

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Stocking selection based on the treatment phase

The type of compression garment is always based on the treatment phase and the individual patient’s needs. If the patient has an active venous leg ulcer (VLU), phlebological or lymphological compression bandages are used during the initial decongestive phase, i.e. for severely congested extremities with a high degree of wound exudation. A suitable compression stocking should be chosen for the maintenance phase. Depending on the edema situation and individual anatomy, a flat-knit , custom-made compression stocking, such as the VenoTrain curaflow, can be used.

Systematic compressionIn most cases, an ulcer compression stocking system is used for VLU. The VenoTrain ulcertec consists of

an overstocking and a liner. The liner, which also secures the wound dressing, provides continuous, low-level compression during periods of rest , thus assisting the wound healing process by applying basic compression, even at night. The overstocking, with its patented special knit , ensures a high level of working pressure during movement and is easy to put on and take off. To ensure targeted treatment , the system is available in two sets with different compression strengths around the ankle: VenoTrain ulcertec 39 (moderate) and VenoTrain ulcertec 46 (strong). When the venous leg ulcer has healed, long-term, consistent compression therapy is recommended to prevent recurrence.

1 Klare WR., Eder S.: Erfolgreiches Therapiekonzept des Ulcus cruris. Deutsches Institut für Wundheilung (2008). In the guidelines “Medizinische Kompressionstherapie der Extremitäten mit Medizinischem Kompressionsstrumpf (MKS), Phlebologischem Kompressionsverband (PKV) und Medizinischen adaptiven Kompressionssystemen (MAK)” – AWMF registration number: 037/005 – Chapter 3 states that compression therapy is indicated to prevent the recurrence of venous leg ulcers.

ulcers during the first year after healing is still quite high at the moment.1 Long-term compression therapy significantly contributes to maintaining a state without venous leg ulcers as well as achieving more quality of life in general.The expert orthotist attaches a lot of importance to the right medical product being prescribed. In order to avoid mistakes when prescribing a product – with the agreement of the patients – his

team contacts the physicians, if required, to coordinate the process in good time. “If there are delays during treatment , everyone involved can quickly become frustrated, thus jeopardizing successful healing,” Falk Peters explains. The members of the Colloquium believe that networking during the treatment of venous leg ulcers also makes a considerable difference. Interdisciplinary collaboration between physicians, medical

supply retailers, physiotherapists and nursing care services ensures a high level of patient independence and constant updating and adjusting of treatment needs. “Good treatment of venous leg ulcers always means teamwork as well ,” John Hakman summarizes. †

Left: The VenoTrain ulcertec stocking system is used during the maintenance phase.Right: After twelve months, the venous leg ulcer has healed completely. The patient is no longer in pain and demon-strates good mobility.

The VenoTrain ulcertec with patented rhomboid knit ensures continuous

therapeutic pressure. Slight transverse extension makes the overstocking easy

and painless to put on.



life: With intact vessels, tensing the calf muscles supports blood flow into the smallest vessels as well as venous return flow to the heart. But what happens in the long term with patients suffering from chronic vein problems?Dr. Oelert: In our currently published, clinically experimental pilot study1, we have been able to show for the first time that activation of the “calf muscle pump” triggers an excessively fast pressure increase at capillary level in patients with a backlog of blood in the veins caused by CVI. We were also able to prove that compression therapy in the form of a well-adjusted compression stocking can prevent an excessively fast pressure increase in the smallest capillaries. The significance of the healthy capillary bed’s elasticity for the regulation of microcirculation, i.e. the exchange of essential nutrients and oxygen as well as removal of harmful substances and CO2, was not known until then. High capillary pressure can, therefore, potentially lead to increased damage and even the destruction of the smallest capillaries. This microangiopathy manifests itself, for example, in a comparative decrease in capillary numbers and in other morphological damage, such as microthrombosis in the minute vessels of the skin. Clinically, this damage can be reflected in patients with chronic venous insufficiency, for example, in the form of known skin changes, such as

hyperpigmentation, hardening of the skin or even painful venous ulcers.

What effect do compression stockings have in this case?Dr. Oelert: We were able to show that a well-adjusted medical compression stocking significantly increases the time needed to reach the maximum capillary pressure when the CVI patients’ muscle pumps were activated. Increasing damage, such as a reduction in skin capillaries, can therefore be scaled back or at least compensated. This allows us to assume that the clinically proven effect of compression stockings helps to improve blood flow in the smallest vessels.

How were you and your team able to prove this?Dr. Oelert: We conducted the study in an air-conditioned clinical laboratory under strictly standardized conditions. The patients were seated, with the foot to be examined fixed on a special microscopy table to exclude movement artefacts. The capillary pressure was then measured in a capillary loop in the nail fold of the big toe, using specifically developed measuring micropipettes made of glass. We uniformly recorded the capillary pressure in accordance with the “servo-null” method.Patients had CVI proven by duplex ultrasound. Two patients also demonstrated clinically venous ulcers, and three patients had skin abnormalities in the form of lipodermatosclerosis. A blood pressure cuff was attached around the calf to standardize and simulate the

muscle pump: the blood pressure cuff was inflated to 60 mmHg within two seconds and left like that for exactly 60 seconds. We then used computer-aided measurements to record the exact pressure curves and evaluated them in a standardized way. At the same time, patients’ ECG readings, skin temperature, blood pressure and heart rate were recorded for the duration of the examination. We conducted this study with and without compression stockings, for example, to analyze the progression of the pressure curves up to the maximum pressure point in the smallest nail fold capillaries of the big toe. We used the VenoTrain ulcertec compression stocking in our study. The result of the evaluation was that the capillary pressure in the capillary loops increased much more quickly without compression stockings than with compression stockings, i.e. on average by 5.65 mmHg/s. With compression stockings, the average increase was 2.47 mmHg/s. The duration up to the maximum capillary pressure with compression stockings was 23.40 seconds on average and was therefore significantly slower. Without compression stockings, the average time up to the maximum capillary pressure was 11.35 seconds. For the very first time, we were able to provide clinical evidence with this study showing that treatment with compression stockings prevents a rapid pressure increase in the smallest capillaries. Medical compression stockings help improve blood flow in the smallest vessels and thus can substantially support healing of venous ulcers in a purely mechanical way.

Hemodynamics study with CVI patients

Compression therapy reduces capillary hypertensionIn patients with chronic venous insufficiency (CVI), movement triggers a pressure increase in the capillaries of the feet and can damage the smallest vessels in the long term. Dr. med. Anja Oelert , Specialist in Skin and Venereal Diseases, et al. proved that compression stockings are able to significantly reduce capillary hypertension.

1 Oelert A. et al.: Medical compression stockings reduce hypertension of nailfold capillaries at the toe of patients with chronic venous insufficiency, Clin Hemorheol Microcirc. 2018;69(1–2):115–121.



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How did the patients respond to the stocking? Dr. Oelert: The CVI study patients felt that the stockings were very pleasant and praised their high degree of wearing comfort. It is one of the few compression stockings that can also be used by patients with painful venous ulcers. That’s why it was particularly suitable for our study.

Which quality requirements should compression stockings meet to counteract the high ambulatory blood pressure in the capillaries?Dr. Oelert: The consistent contact pressure of 36 mmHg, i.e. com-pression class 3, was particularly important to us. VenoTrain ulcertec has this contact pressure and therefore significantly prevents venous reflux from proximal to distal , that means it reduces the pathological increase in capillary pressure to a large extent. And, as mentioned before, it’s an advantage that patients with venous ulcers can wear this stocking, i.e. patients with clinically very advanced venous insufficiency. †

Top: Dr. med. Anja Oelert is a practicing specialist in skin and venereal diseases in Heidelberg, Germany.

Left: The capillary pressure is measured in a capillary loop in the nail fold of the big toe, using a measuring micropipette made of glass. The best entry angle for the pipette relative to the level area of examination is about 50°.

“The compression stocking significantly increased the

time needed to reach the maximum capillary pressure.”

Dr. med. Anja Oelert



life: What is the main problem when treating patients with venous leg ulcers?Kerstin Protz: It’s a major challenge to develop awareness of the condition itself. Those affected often believe that their leg wound was caused by a specific incident , such as bumping into a shopping cart or by an abrasion. They don’t know that the cause is an underlying vascular problem, such as chronic venous insufficiency in this case. We need to educate our patients to develop an understanding of the condition and, based on this, compliance with the treatment.

In your opinion, how do patients respond to complying with compression therapy?Kerstin Protz: A lot of patients find it difficult. Especially in the beginning during the decongestive phase, bandaging that is often quite thick, slips out of place easily and means shoe problems, is often rejected. Each carer also uses short-stretch bandages differently, which can cause patients to be irritated. You then hear statements like: “But yesterday, your colleague did it differently and with less pressure!” Compliance with medical compression stockings that are used during the maintenance phase and for prevention also needs to be improved.

The prerequisite for patient adherence is that the affected person understands the reasons, the benefits and the proper execu-tion of the necessary treatment measures. Only an educated patient can be engaged in a meaningful way as an equal partner in the treatment process. In order to achieve this, patients should know the factors that contribute toward the condition, how compression therapy works, which self-care options are available, and much more. Patient brochures can help with this. If they are designed appropriately and convey the relevant topics and expert knowledge in a way that is easy to understand, bro-chures will improve patients’ satisfaction and treatment compliance. However, such

brochures must never be used alone, but as a part of the educational process.

In a study1 published in 2019, you showed that patient brochures can support the work of treatment and nursing staff. Which topics were investigated in this study?Kerstin Protz: In that study, we examined whether and how 136 German and Austrian patients with venous leg ulcers undergoing compression treatment would benefit

from the use of a brochure. The case group completed a patient questionnaire after reading the brochure2, the control group answered the questions without having read the brochure. The patient questionnaire included six questions to assess their subjective knowledge related to compression therapy. This tested theoretical and practical knowledge about mode of action, products, and how they’re used. Thirteen pure knowledge questions followed about the impact of compression therapy, risk factors for venous disorders, self-care measures, options for self-management , use of donning and doffing aids, skin and material care and exercise to support vein function. The patients were

also asked how long they had been suffering from venous leg ulcers.

What is your main conclusion?Kerstin Protz: I’m pleased to report

that , overall , patients gained significant knowledge in all specified areas by reading the brochure. 98.5 per cent of patients from the case group knew, for example, that compression therapy improves wound healing, whereas 56.9 per cent of control group patients didn’t know that. The fact that compression therapy prevents the recurrence of wounds was correctly stated by only 32.4 per cent from the control group. In the case group, however, four

Study on patient education

Increasing adherence through informationWhen treating venous leg ulcers, the patient’s self-management plays an important role. Wound expert Kerstin Protz, whose tasks include being the project manager for wound research at Hamburg-Eppendorf University Hospital , Germany, investigated how patient brochures can contribute to this.

“Only an educated patient can be engaged in the treatment process in a meaningful way.”

Kerstin Protz


Kerstin Protz is, among other things, a member of the executive board at “Wundzentrum Hamburg e. V.” and a member of the advisory board at “Initiative Chronische Wunden (ICW) e. V.”.


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Effects of compression therapy and risks of venous disorders

Answers provided by patients with brochure patients without brochure

What are the effects of compression therapy?

Slimmer, decongested legs

Pain

Restriction of blood flow

Improved wound healing

Prevention of wounds recurring

What may increase the risk of venous disorders?

Inherited factors

Sunshine and heat

Frequent sitting for prolonged periods

Active lifestyle

Underweight

Varicose veins

out of five people knew. Perhaps another example: most patients in the case group knew that people wearing compression stockings should regularly remove calluses on their feet (86.8 per cent) and cut their finger and toe nails (85.3 per cent), while 83.8 per cent from the control group didn’t find either of those particularly important. Given the fact that only one pair of medical compression stockings is reimbursed every six months in Germany, that’s quite an important factor. The results of our study show that education using a brochure helps patients understand how necessary measures relate to treatment goals – in this case, compression therapy. If patients recognize these correlations, they will comply with treatment measures much more effectively.

Which findings surprise you?Kerstin Protz: The numbers we obtained during the study relating to the duration of venous leg ulcers were shocking: more than 40 per cent of patients surveyed had their ulcers for more than seven months, more than 25 per cent even had them for seven to twelve months, and more than 13 per cent for over a year. These are relatively long durations that also restrict the quality of life of those affected as well as their compliance with the treatment. These figures suggest that a lot still needs to be done about the treatment of this condition. †

100%79.4%

30.9%7.4%

2.9%5.9%

98.5%44.1%

80.9%32.4%

86.8%36.8%

89.7%48.5%

94.1%67.6%

8.8%0%

4.4%7.4%

95.6%61.8%

The brochure helps patients understand

how necessary measures relate to treatment goals.

1 Protz, K. et al: Education in people with venous leg ulcers based on a brochure about compression therapy: A quasi-randomised controlled trial. Int Wound J. 2019 Dec; 16(6): 1252-1262.

2 “Kompressionstherapie einfach – tragbar”, provided by Wundzentrum Hamburg e. V., 2018, download at www.wundzentrum-hamburg.de



life: Why is thrombosis more common in pregnant women?Prof. Schleußner: In the first place, this is related to hormonal changes. Pregnancy is a hypercoagulatory condition, which makes sense from an evolutionary perspective. The biggest risk during pregnancy and child birth – even today – is dying from a hemorrhage. Hormonal changes, an increased estrogen level in particular, result in an increase in the production of coagulation factors in the liver, while, at the same time, anticoagulant factors decrease. Furthermore, the vascular wall changes. Not only because there are more coagulation factors and the docking points for them on the vascular walls are more active; but the muscles of the peripheral vessels also become wider, the tone of the blood vessels decreases. This, in turn, results in slower blood flow. During the later stages of pregnancy, venous reflux from the lower extremities also becomes more difficult because the growing uterus presses on the inferior vena cava. The impaired return of the blood, in turn, expands the vessels etc. These factors, which were already specified by Virchow – slower blood flow and changes in the vascular walls as well as in blood composition – are the fundamental reasons why the risk of

thrombosis is about six times higher in pregnant women. The most dangerous time, apart from the actual childbirth, is the postpartum period. Changes in the hormone balance, loss of blood during childbirth and a changed blood composition as well as being bedridden, especially after a Cesarean section, among other factors, contribute to the fact that in the first six weeks after childbirth, there are, numerically speaking, as many thromboembolic events as in the nine months before. And we haven’t mentioned the individual risk factors yet that these women may also bring to the equation.

What other risk factors are you thinking of?Prof. Schleußner: One critical factor is age. When I was a young physician, the average age of mothers at the time of childbirth was 23 years. Today, it’s 32. In addition, women are also more frequently affected by other personal

risk factors with increasing age, such as varicose veins or previous thromboembolic events. Another risk factor that has hugely increased is being overweight. In Thuringia, almost one in four pregnant women is currently overweight , about one in six is obese. Hormone treatment to support fertility and artificial insemination

double the risk of a thromboembolic event. And then there are congenital or acquired thrombophilic risk factors, such as the Factor V Leiden mutation, antiphospholipid syndrome or disorders affecting the regulation factors protein S and protein C.

How should pregnant women and physicians respond to a higher risk of thrombosis?Prof. Schleußner: Women should be as active as possible and drink a lot until childbirth. One reason is that the kidneys are supplied with more blood, and more urine is generated. Physicians need to consistently treat women with particular combinations of risks. If a pregnant woman has varicose veins or edema, for example, compression therapy should definitely be initiated.

When would you specifically recommend the use of medical compression stockings?Prof. Schleußner: On the one hand, to treat symptoms when women suffer from heavy, painful legs or edema. This is the case for quite a number of women toward the end of pregnancy in particular. They then don’t just benefit from the stockings for their well-being but also for thrombosis prevention.On the other hand, I’d recommend it for all those who have the relevant risk factors: whether it’s a family history of thrombosis or a prior thrombosis, thrombophlebitis, varicose veins, pre-eclampsia or a congenital coagulation disorder, such as a Factor V Leiden mutation. I then

Compression during and after pregnancy

A risk-adapted approach is requiredDuring pregnancy, the risk of a thromboembolic event increases. Why this is the case and when medical compression stockings are indicated during pregnancy is explained by Prof. Dr. med. Ekkehard Schleußner, Director of the Obstetrics Department at Jena University Hospital , Germany.

“In the first six weeks after childbirth, there are, numerically speaking, as many thromboembolic events as in the nine months before.”

Prof. Ekkehard Schleußner


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recommend that they wear compression stockings from the beginning of pregnancy.It’s very important that , with some combinations, medical compression stockings are an essential part of thrombosis prevention, but they’re not sufficient by themselves – for example, in pregnant women where several risk factors accumulate, such as a medical history of thrombosis with an unknown origin and a Factor V Leiden mutation, varicose veins or obesity. In these cases, additional injections of low-molecular-weight heparin are needed. Taking acetylsalicylic acid, for example, isn’t enough to prevent thrombosis! The approach must therefore always be adapted to the risk. An advantage during this process is when you have a good network of colleagues from other disciplines, such as phlebologists, internists, rheumatologists, etc. who you can discuss potential risks with.

What do you bear in mind when prescribing compression stockings?Prof. Schleußner: During pregnancy and postpartum, I will definitely prescribe thigh-high stockings with a closed toe and compression class 2, or suitable compression pantyhose. On the first prescription, two pairs can be specified straight away, which I think makes a lot of sense. After all , the women should wear these stockings every day – preferably until eight weeks after giving birth. Prescribing compression stockings doesn’t have an impact on the physician’s budget , by the way. †

According to Prof. Dr. med. Ekkehard Schleußner, slower blood flow and changes in the vascular walls as well as in blood composition are the fundamental reasons for the increased risk of thrombosis in pregnant women.


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Information required on the German prescription:

• Medical aid number• Diagnosis/indication• Product name• Number of stockings (units/pairs)• Compression class (Ccl)• Length or stocking style• Additional features (fastening)• Specifications for custom-made solutions (if applicable)• Short reason for choice of product , where a particular product is named

on the prescription2

An increased blood volume, dilated vascular walls, a heightened risk of thrombosis – there are many

reasons why experts recommend medical compression stockings from the twelfth week of pregnancy at the latest. A study1 finds that , in the early stages of a pregnancy, wearing medical compression stockings can even reduce nausea and vomiting – about as effectively as the approved pills available for these symptoms.

Special design for pregnant womenThe VenoTrain micro compression stocking is available for pregnant women in a pantyhose version with an extra wide expansion zone for the growing baby bump.

Accompanying compression therapy during pregnancy

Comfortable reliefDuring pregnancy and the postpartum period, medical compression stockings support the venous system, which is subjected to additional strain, and help prevent thrombosis.

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This means that the uterus and therefore the development of the baby will not be restricted, yet the veins and lymph vessels in the thigh and the lower leg are pleasantly compressed and relieved. Thanks to its soft knitted fabric with a microfiber content , the VenoTrain micro is comfortable to wear and thus helps the expectant mothers’ well-being. The VenoTrain soft is a little more durable and is available as custom-made maternity pantyhose. The fine knitted fabric is spe-cially designed to gently massage the skin and stimulate blood flow.In order to support compliance with wearing compression pantyhose, it helps to prescribe them early so that pregnant women can practice putting them on while their belly doesn’t restrict their

mobility quite as much. In addition, compression class 1 stockings can generally be prescribed in Germany for mild vein problems without a pronounced tendency to edema formation and are included in the insurance coverage. The products are exempt from budgetary constraints and prescription benchmarks. Better adherence is often achieved with stockings from a

lower compression class because they are more comfortable to wear and easier to put on, thanks to the reduced pressure. However, there are also different materials within the compression classes, leading to different levels of elasticity. These can also have an effect on treatment success. That is why the product name can be specified in the prescription in Germany.2 †

1 Mendoza, E. et al: A randomized crossover trial on the effect of medical compression stockings on nausea and vomiting as well as fatigue in early pregnancy, published in vasomed 3/2017.

2 See guidelines for medical compression therapy, AWMF registration number 037/005.

Pregnant women who chose the soft, easy-care VenoTrain micro can use the online

configurator “VenoTrain micro Stylist” to see how their maternity pantyhose

will look in different colors.


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life: What are your responsibilities when you take care of the squad in terms of sports orthopedics?Dr. Pachutani: We ask the athletes about their medical history, current and older injuries, problems caused by excessive strain and surgery they may have had. Which medical products do they use and what does their return-to-sports strategy look like? We get a lot of information from the joints’ range of motion, muscle balance and by checking the function of the

myofascial system. Based on our knowledge of specific movements during the particular sport , we can detect silent excessive strain to provide advice on prevention. It’s beneficial that we have come to know these elite athletes really well over the years, thanks to our continuous support , and that they’re highly compliant patients. They really want to avoid missing out on training because of injury. In addition to the annual examination, there are weekly office hours for acute problems. My specialism is

myofascial syndromes, so I can treat some of the athletes myself and encourage them to do their own exercises.

How do you use supports and orthoses for treatment?Dr. Pachutani: From the comprehensive range that Bauerfeind provides us with as a service partner of Stiftung Deutsche Sporthilfe, I recommend the Loc orthoses for short-term immobilization for acute injuries or following surgery. This mainly applies to

Orthopedics in Olympic sports

“Elite athletes are highly compliant patients”Orthopedist with a sporting past: Dr. med. Maren Pachutani works at Bonn Community Hospital , Germany, – cooperation partner of Rhineland Olympic Training Center – and she helps with the annual basic examination of the team athletes. The former modern pentathlete examines and advises competitive athletes if they have any problems or to ensure injury prevention so they stay healthy during training and competitions.

The German pentathletes are in a great mood: with two gold, one silver and one bronze medal , the Germans were the most

successful team at the 2017 World Championships in Cairo. Accompanying them: Dr. med. Maren Pachutani (bottom right).

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the ankle, knee and hand. Following ankle sprains, I use Train supports for treatment , depending on the diagnosis, either straight away after mild sprains or following immobilization. With feelings of instability or for sports with a high recurrence rate, I like to use the stabilizing support of the MalleoTrain Plus. I also regularly use the AchilloTrain for achillodynia as a supporting measure to go with active movement exercises. And for younger athletes with problems in the area at the front of the

knee, the GenuPoint patellar tendon support provides effective relief.

Do these measures also apply to your favorite sport , modern pentathlon?Dr. Pachutani: Those who have been doing pentathlon for many years are less prone to injury and excessive strain than many other athletes. They have well-balanced muscles and excellent stamina from the running and swimming. Fencing helps pentathletes with quick reactions,

and shooting with concentration. During training and competitions, they deliver their performance in all disciplines all in the same day, in any weather. That’s how resistance and immune defense are constantly strengthened. As a physician for the German Association of Modern Pentathlon, I’ve been helping at national and international competitions for more than 12 years. Luckily, no athlete has got into a serious medical situation during that time.


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But injuries do happen, don’t they?Dr. Pachutani: The highest risk, especially in a competition, is show jumping on an unknown horse that is randomly picked. The entire range of injuries associated with high-speed sports is possible there. Fortunately, serious injuries are rare. But broken bones in the extremities or the shoulder girdle do happen. During cross-country running and fencing, there’s always a risk of sprains. After it happened to me several times as a youngster, I was told I wouldn’t be able to continue competitive sports. One of my predecessors, the physician for the association then, treated me with an ankle orthosis, similar to today’s Loc system, and gave me stabilization exercises to do. I wore the orthosis consistently, so the injuries healed and my stability returned. Nowadays, part of regular training for the ankle always includes preventive stabilization and proprioception exercises. Athletes prone to supination injuries wear, temporarily or for the long term, activating and gently bracing supports, such as the MalleoTrain or MalleoTrain Plus.

How do athletes respond to these products?Dr. Pachutani: Very positively. Athletes prefer practical and quick solutions. Free, comprehensive treatment is ensured, thanks to the long-standing cooperation between Rhineland Olympic Training Center and Bauerfeind. When we as the cooperating orthopedists determine a medical need, athletes can be quickly treated with supports, orthoses, compression stockings and foot orthoses, all without red tape. This is coordinated by the Olympic Training Center’s HEIMSPIELE agency and Bauerfeind’s head office, supported by a local medical supply retail partner. Some athletes can’t even imagine training without medical products once they’ve received them. Elite athletes have an outstanding body awareness. The proprioceptive stimulation signals them – this is probably different for each individual and depends on the sport as well – that they can feel stable and that they’re fully ready to perform.

And what is that like with modern pentathlon?Dr. Pachutani: Modern pentathlon has changed over time and is always being updated a little – but it’s not becoming less

challenging. We have all sorts of people among our athletes. This means that a highly personal approach is needed from us, the physicians. We do have modern imaging techniques now, as opposed to years ago, but they’re not very helpful when a functional problem can’t be visualized. Or if the problem isn’t where it hurts. In such cases, the most effective sports medicine requires what has always been available to us physicians: our trained senses. It’s also important to be brave enough to ask a colleague for a second opinion.

How has the sporting side of pentathlon developed?Dr. Pachutani: In my day, a competition took place over four days. Shooting was a discipline for the individual , the running competition took place over 2,000 meters with everyone starting together. All of that was very unattractive for spectators. The change to a one-day event , the laser run and splitting the fencing into a preliminary round and final , helped to establish a transparent , very high-profile version of the sport. In my opinion, modern pentathlon is still one of the most remarkable sports that produces great athletes in the Olympic spirit. †

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Versatility is key: swimming, fencing, horseback riding, but also running and shooting – which is now carried out as a laser run in combination to increase the appeal to spectators – place varied requirements on athletes.

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Modern pentathlon

In one competition, this multi-faceted sport includes swimming, fencing, show jumping, and a laser run, which is a cross-country run that has been combined with shooting since 2009. Modern Pentathlon first took place in the 1912 Olympics in Stockholm, initially only for men. Since the 2000 Olympics in Sydney, women have also participated.

Dr. med. Maren Pachutani during the squad examination, with pole vaulter Torben Blech.

A sports orthopedic network

In July and August 2021, ath-letes from all over the world will compete against each other in various disciplines at the Summer Olympic Games in Tokyo. Until then, every day is all about training and qualification for the competi-tive athletes. That includes sports orthopedics support at Olympic Training Centers (OTC). Squad athletes are treated quickly and with expert advice, and supported to ensure injury prevention. Bauerfeind has been the official service partner of Deutsche Sporthilfe since 2013 and helps around 4,000 athletes who are supported by the foundation. The manufacturer of medical aids organizes the supply of products, which also includes adapting products to individuals. For this, Bauerfeind involves over 1,200 quality partners from the medical retail industry. Bauerfeind also supplies a team of its own orthotists to take care of the athletes. They look after individual athletes as well as entire teams, before and during big sporting events: Olympics here we come!


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Diagnosing an unstable ankle is challenging and has its limitations and flaws in practice, in particular

when it comes to mechanical instability. That is a reason for the generally high level of research interest – in medicine as well as in kinesiology. A potentially powerful parameter is the size of the contact area between the ankle’s cartilage surfaces. The higher their dynamic congruency, the more stable the joint. The measurable congru-ency changes during lateral opening, but has not been investigated much in connec-tion with instabilities and injury mecha-nisms. The same applies to the question to what extent ankle orthoses can influence joint congruency.Against this background, Freiburg University Hospital’s Clinic for Orthopedics & Trauma Surgery and Freiburg University’s Institute for Sports and Sports Science started a new scientific study in November 2019. They focused on two key issues: “We are investigating to what extent our newly developed MRI procedure can provide reliable, quantifiable information about the ankle, and its mechanical instabil-ity in particular,” Dr. med. Markus Wenning from Freiburg University Hospital explains. His research partner PD Dr. Dominic Gehring from Freiburg University adds: “In addition, we’re checking to what extent quantifiable evidence can be provided for the stabilizing effect of the MalleoLoc orthosis.”

New dynamic measurement procedureThe foundation and measurement back-ground for the current study is an innova-

tive MRI procedure that has been devel-oped by the researchers and tested in a pilot study for mechanical diagnostics of ankle instability. Using high-resolution 3D imaging, the joint congruency is measured across the cartilage contact area (CCA), horizontally, laterally and medially in the area of the talus, fibula and tibia. The innovative approach: all measurements are taken in the neutral position using an arthrometer system in a functional posi-tion in plantar flexion and supination, i.e. with the foot being lowered and rotated and subjected to strain. “The equinus foot

position with inversion engages the injury mechanism and, under controlled condi-tions, triggers the opening of the lateral ankle,” Dr. Dominic Gehring explains. “Using 3D imaging provided by the dynamic MRI, we are able to depict the pathology of joint instabilities much more precisely than with two-dimensional X-rays or stress ultrasound images,” Dr. Markus Wenning adds. “This method also enables us to quantify the instability because we can collect standard values.” This could be used to complement the clinical examination, allowing us to objectify and, most importantly, reproduce

MRI study with the MalleoLoc ankle orthosis

Visible mechanical stabilizationA study is being conducted in Freiburg, Germany, on ankle stability diagnostics. A new MRI procedure shows changed joint congruency in the neutral position and when controlled strain is applied, with and without wearing an orthosis. This is the key to quantifiable mechanical instability. And it makes room for additional evidence relating to the stabilizing effect of the semi-rigid MalleoLoc orthosis.

Preparation for the measurement at Freiburg University Hospital: a foot wearing the MalleoLoc is subjected to strain using an arthrometer slide.


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the diagnosis of mechanical instabilities. In particular, the differentiation between mechanical and functional instability is vital for subsequent treatment. The results can then supply important criteria to inform the decision whether surgery, an orthosis or sensorimotor training should be chosen.

Test subjects with stable ankles versus unstable ankles50 subjects are taking part in the con-trolled, randomized joint study con-

ducted by Freiburg University Hospital and Freiburg University. Their selection included comprehensive screening related to functional and mechanical instability. “The goal was to identify two groups. One healthy group, i.e. people without any problems at all , that can serve as a control group with stable ankles and as reference for standard values. And one group with restricted functionality and indications of mechanical instability,” Dr. Dominic Gehring reports.

Detailed analysis: the MRI procedure shows the changing joint congruency between the cartilage surfaces as a parameter of stability.

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The test subjects underwent various functional stability tests, such as the Y balance test , and documented their subjective feelings of stability during everyday activities and exercise using a questionnaire. Screening equally included manual tests on the ankle where talus shift and talus tilt were clinically assessed in terms of stability or instability, as well as stress sonography that was used to check the degree of the joint opening with the help of imaging.

Arthrometric measurements using MRI with and without an orthosisDuring the 3D MRI scan, the test subjects’ joint congruency is measured, using a pneumatically operated arthrometer, with the foot being in the neutral position and in a functional position under controlled strain. In this device, pneumatic cylinders ensure that a simulated weight load of up to 50 kilograms, depending on the joint position, is applied axially to the foot. Afterwards, the test subject slowly enters the MRI together with the arthrometer slide. The measurement takes about six minutes. The screen then displays the three-dimensional image of the joint , which is visibly opened in a functional position and shows reduced contact areas. “In test subjects with stable ankles, this is usually about 30 per cent , according to our initial assessment ,” Dr. Markus Wenning notes. “Patients with unstable ankles, on the other hand, can lose up to 90 per cent of their contact area in a functional position.” The laxity that can be recognized during this process makes the forced position in the arthrometer easier for those with unstable ankles than those with stable ankles, who sometimes get irritated. The simulated injury mechanism, however, never reaches the actual strain threshold but always remains at a pain-free, physically and ethically justifiable level. The study design’s additional measurement conditions include the comparison with and without the MalleoLoc orthosis in the MRI to enable an enhanced assessment of the effects of external stabilization for therapeutic intervention.

Evidence from imaging to treatment decisionsThere are good reasons why the MalleoLoc is being examined as a treatment measure using these innovative MRI-based stability diagnostics: “A previous study already

showed the evident effectiveness of the semi-rigid MalleoLoc in secondary injury prevention. With our current procedure, we are able to visualize the mechanical component of its effect and measure it using the parameter of joint congruency,” Dr. Dominic Gehring explains. He was in charge of the study on the ankle orthosis in dynamic stability tests using a tilting plate that was controlled at random and over which the test subjects had to walk. It proved that the MalleoLoc reduces inversion angles and inversion speed. In the critical moment of twisting an ankle, this can contribute to preventing recurring structural damage during the supination trauma. The tilting plate spontaneously and quickly triggered the opening of the ankle during walking. In the current study, the strain is applied in a fixed (static) position during a much longer period, based on the MRI sequence of about six minutes.

First results and outlookThe measurement series of the Freiburg study are almost complete. “Thanks to the images, we’re optimistic that our MRI procedure works for diagnostics,” the two study directors report. “It is able to depict the clinical manifestation of mechanical instability very well , and it’s a quantifiable tool that delivers reproducible results,” Dr. Markus Wenning summarizes. The pilot study showed that healthy test subjects with stable ankles lose around 30 per cent of joint surface contact when subjected to strain. Those with unstable ankles, however, lose between 60 and 90 per cent of contact area. “If our follow-up study confirms these findings, it may be possible to categorize patients with a congruency loss of more than 50 per cent as mechanically unstable,” the orthopedist explains. “Even if we need to bear in mind that this ankle instability is, in addition to purely mechanical factors, a dynamic process that doesn’t allow a dichotomous categorization within the meaning of 100 per cent stability or instability. The clinical relevance of this potential cutoff value must , of course, be investigated in other studies.” In line with the objective of the study, the data they just collected could be used as initial standard values that allow a valid quantification of the relationship between mechanical instability and the loss of contact area. “We can also measure the stabilizing effect of the MalleoLoc and verify it

Study director Dr. med. Markus Wenning, Department for Orthopedics and Trauma Surgery, Freiburg University Hospital , and clinician scientist in the Berta Ottenstein program supported by Freiburg University’s Medical Department.

Study director PD Dr. Dominic Gehring from the University of Freiburg’s Institute for Sports and Sports Science.

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MalleoLoc: safe and perfect in an MRI

Based on its asymmetric plastic splint , the MalleoLoc provides mechanical stabilization. It is positioned slightly in front of the lateral malleolus and behind the medial malleolus. It is secured using a Velcro strap system wound around the foot and lower leg in a figure of eight. This design guides the ankle into a position that is secured by bones and has been proven to reduce supination movements. At the same time, the MalleoLoc pro-vides excellent freedom of move-ment and allows for a natural heel-to-toe movement , as plantar flexion and dorsal extension are not restricted. Its plantar guide additionally stimulates the dorsiflexor muscles during move-ment. Sensorimotor function is influenced positively, and active stabilization is achieved, which minimizes the risk of subsequent injuries. The MalleoLoc was perfect for the Freiburg study because of its proven effectiveness during dynamic processes and its special design: the flat orthosis stabi-lizes the ankle even without a shoe, it allows the foot to be lowered in plantar flexion and doesn’t have any ferromagnetic parts that may affect the MRI.When subjected to strain in a functional position, the ankle opens laterally, and the cartilage

contact areas (CCA) decrease.

In the neutral position, the congruency of the cartilage contact area (CCA) is high.

using imaging. Previous images show an influence on the joint congruency, and we’re expecting noticeable differences with and without the orthosis in our analysis,” Dr. Dominic Gehring believes.The results will be made available during the year. The validation of the MRI-based diagnostics also offers additional potential for the research on the root causes of individual symptoms. Syndesmotic and other periarticular insufficiencies that don’t just focus on the upper ankle can’t yet be depicted with current procedures.

Further studies and complementing measurements in other joint positions can enlighten this topic, just like a combination of a classic gait analysis and imaging techniques to display joint congruency could provide new insight in kinesiology. †


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life: What are the challenges for a physician when treating osteoporosis? Prof. Kurth: Osteoporosis is a slowly developing condition that becomes clinically noticeable only when symptoms arise. These symptoms are usually fractures in the typical areas, which need to be taken very seriously. The challenge for us physicians is the “case finding”. That means exploring which individual patient has what kind of risk of suffering from an osteoporotic fracture. The evaluation of various risk factors is different for every patient , and it governs the treatment. And for surgeons in particular, the challenge is to reconstruct destroyed bones – despite poor bone quality. But the follow-up treatment of geriatric patients after treating the fracture in the hospital is also far from satisfactory: if more than 50 per cent of patients with a typical osteoporotic fracture still don’t receive guideline-based, fracture-reducing drug treatment , there’s something wrong with our healthcare system.

What exactly does “guideline-based” mean and what does the S3 classification stand for in the DVO’s osteoporosis guidelines? Prof. Kurth: Guidelines provide recommen-dations on how a certain condition should be diagnosed and treated. They describe a path of actions for making individual deci-

sions for the benefit of the patient. Good guidelines are based on the latest scientific findings, and their recommendations can be implemented in everyday medical practice. All over the world, there are now uniform standards for the creation of guidelines. In Germany, the Association of the Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fach-

gesellschaften, AWMF) coordinates their deve-lopment. They divide guidelines into four categories: S1, S2k, S2e and S3. S3 guidelines are the most reliable, but also the most complicated to create, and they generally need to be renewed every three to five years. The committee is staffed with representatives from different specialist areas, and knowledge is systematically collected and assessed. And there

is a structured procedure for deciding on a standardized recommendation if there are different opinions within the com-mittee.

What do you advocate as a member of the guideline committee?Prof. Kurth: As an orthopedist and trauma surgeon, I find the development of integrated treatment models for the prevention of osteoporosis-related subsequent fractures very important. These Fracture Liaison Services (FLS) have a clear structure for the surgical treatment of an osteoporotic fracture and follow-up care that are gathering increasing evidence.

Guideline-based osteoporosis therapy

Reaching consensus on treatmentThe osteoporosis guidelines published by Dachverband Osteologie (DVO) e. V., the German osteology umbrella organization, will be updated this year. life spoke to orthopedist and trauma surgeon Prof. Dr. med. Andreas Kurth, first Chief Executive Officer of the DVO, about their significance.

Interdisciplinary coalition

Founded in 2000, the Dachver-band Osteo logie e. V. (DVO), the German osteology umbrella organi zation, unites all profes-sional medical and scientific associa tions in Germany, Austria and Switzerland focusing on bone disorders. In order to improve patient treatment – mainly those with osteopo-rosis – the DVO relies on three pillars: the first pillar is the evidence- based development of guidelines for all relevant ques-tions relating to diagnosis and treatment. The second pillar is the certified further education of physicians on the subject of bone conditions according to a three-level model as an “expert in general osteoporosis manage-ment”, “expert in specialist osteo porosis management” and “DVO osteologist”. The third pillar is the establishment and certification of “Osteology Spe-cialist Centers”.For more information, please visit dv-osteologie.org

“If more than 50 per cent of patients with osteoporotic fractures don’t receive guideline-based treatment , there’s something wrong with the healthcare system.”

Prof. Andreas Kurth


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What changes will the update of the guidelines in 2020 include? Prof. Kurth: The risk factors for osteoporotic fractures have significantly increased over the last few years. To ensure that patients aren’t disadvantaged during the assessment of their individual fracture risk, we must correctly evaluate all these scientifically proven factors and make them available in a risk algorithm. This has become very complex, stretching the algorithm that has been tried and tested for years reaches to its limits, and we’re doing all we can to create a digital risk calculator. It will be available as an app and a web-based solution. The guideline committee developed the scientific basis using international literature. At the

moment , a validation of the current risk factors is being carried out with the help of a large study group. That’s another important evolutionary step in guideline work. Otherwise, not much will change at

the moment , which we feel is a positive thing. That shows that even recommendations from 20 years ago are still valid today, based on evidence.

What role does non-surgical treatment play in cases of osteoporosis? Prof. Kurth: It’s one of the main pillars of therapy. In addition to basic treatment by substituting calcium and Vitamin D,

physical activity, in particular, plays a vital role in the prevention of subsequent fractures. There is close interaction between bones and muscles. Strengthening of muscles also

leads to an improvement in bone quality. If the fracture risk is significantly increased, active anti-osteoporotic treatment must be initiated.

What does treatment focus on?Prof. Kurth: It depends on the individual’s baseline condition, which can vary widely. Take, for example, a patient with COPD on cortisone treatment; a 77-year-old with prostate cancer, hormone deprivation therapy and multiple vertebral fractures; or a 91-year-old woman with a painful pelvis fracture who doesn’t remember any traumatic event ... If there are osteoporotic fractures, they usually have to be treated surgically, with the goal of restoring functionality and mobility. In cases of vertebral fractures, the primary goal is: pain reduction. That can be achieved with an orthosis or minimally invasive surgical intervention. Treatment with the right medication is a must for almost all the patients described.

Are there differences in treatment between early stages and advanced stages?

Prof. Dr. med. Andreas Kurth, Head of the Department for Orthopedics and Trauma Surgery, Kemperhof, Mittelrhein Community Hospital in Koblenz, Germany, is a member of the DVO’s osteoporosis guideline committee, and, since 2015, has been the first Chairman of the association.

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“In cases of vertebral fractures, the primary goal is pain reduction. That can be achieved with an orthosis or minimally invasive surgical intervention.”

Prof. Andreas Kurth


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Prof. Kurth: The guidelines don’t differentiate there. The “case finding” – that is: which patient has a high or higher risk of suffering from a fracture – provides a threshold level. If a fracture probability of 30 per cent is exceeded, effective treatment with anti-osteoporotic medication must be initiated. Studies from the last two years show that for high-risk patients, osteoanabolic treatment should be favored over anti-resorptive treatment. If the risk is below 30 per cent , basic treatment with calcium, Vitamin D, and physical activity should be recommended.

When are orthoses recommended that straighten the spine?Prof. Kurth: The general rule for all osteoporotic vertebral fractures is that both non-surgical treatments with orthoses as well as surgical procedures are available. Treating osteoporosis with orthoses is just one of many elements used and an efficient measure to improve the situation in cases of existing kyphosis in the thoracic and lumbar spine. The purpose of these orthoses is usually a restriction of mobility in the affected sections of the spine while, at the same time, training the supporting and stabilizing muscles. This can reduce acute problems and pain caused by collapsed vertebral bodies and fractures. To appropriately account for the character-istics of multilocular pain symptoms as well as for the general changes in cases of oste-oporosis, targeted selection of the orthosis type is required: rigid orthoses should only be used for as long as absolutely needed. For non-operable osteoporosis patients who suffer from severe pain and for whom medication isn’t effective straight away, dynamic orthoses are an important option. The same applies to patients with multiple previous osteoporotic fractures, a high risk of subsequent fractures and significant misalignments.

What are the differences between the orthosis types?

Prof. Kurth: We differentiate between passive and active spinal orthoses. A passive orthosis can be compared to a support corset that primarily provides relief. Active orthoses, on the other hand, are designed to contribute to active correction and encourage better posture, in addition to providing support. They provide stability and support when vertebral fractures or pain make everyday movements difficult – and they straighten the spine and strengthen the muscles. In cases of collapsed vertebral bodies in the lower thoracic spin associated with the common wedge-shaped deformation, a reclining orthosis with a 3-point effect (e.g. according to Bähler-Vogt) is usually indicated. There are recommendations indicating that the affected vertebral body shouldn’t be higher than T8. The use of a hyperextension orthosis is limited even if there are asymmetric osteoporotic fractures or if an instability must be assumed in several affected vertebrae. Activating and dynamic torso orthoses have been developed in order to support physical activity and to encourage the correct posture in patients when standing, which also contributes to prevention. They consistently counteract increased kyphosing of the thoracic spine and should already be used in cases of painful early-stage osteoporosis with initial kyphosis. These orthoses are put on like a backpack. The torso’s range of motion is only slightly

DVO’s 2017 Osteoporosis Guidelines

The guidelines provide clear recommendations on prevention, diagnosis and treatment in med-ical practice for post-menopausal women and for men. They were pub-lished in the professional magazine “Osteologie” (Georg Thieme Verlag), and, in 2018, received the Thieme Osteology Award for an article that “significantly improves the quality of treatment and quality of life for a growing patient group”. In 2020, an update is due. Please find the long version of the evidence and consen-sus-based osteoporosis guidelines at dv-osteologie.org/ osteoporose-leitlinien.

Model depicting osteoporosis of the spine. The bone tissue

loses its density, the spaces in between increase.

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restricted, the freedom and mobility of the arms support important muscle functions. They promote active posture correction during the remineralization phase, which usually takes a long time.

What should patients know about treatment with orthoses?Prof. Kurth: The general rule is: when being provided with the correct product , patients should be pain-free or at least feel less pain after the orthosis has been put on. This goal must be checked by the carer and the physician. If patients mention pain when moving with the orthosis, the correct fit must be checked.

I know from my experience that it’s really important to discuss the use of an orthosis with patients. They must be educated about its purpose and the duration of its use, which is usually eight to twelve weeks. For older patients in particular, it may be difficult to put on an orthosis and uncomfortable in the long term. That’s why the patient’s preference must always be considered when indicated treatment is decided. An orthosis that disappears in the cupboard after a few days can’t help. †

Strengthening bones together

The DVO and its expert associations have joined forces with pharma-ceutical companies and medical technology manufacturers, forming OSTEOLIGA. The goal of this initia-tive is to raise public awareness of osteoporosis, to improve treatment and to strengthen expert net-working and exchange in Germany. Bauerfeind has been a member and supporter since 2016 and is active within this network as a manu-facturer of spine-straightening orthoses. For more information and material , such as the eight-page “white-coat pocket version” of the DVO’s guidelines, please see osteoliga.de

The methodological background of guidelines: S classification

S 3 Evidence and consensus-based guidelines

Representative panel , systematic research, selection, literature review, structured approach to reaching consensus

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S 2e Evidence-based guidelines Systematic research, selection, literature review

S 2k Consensus-based guidelines Representative panel , structured approach to reaching consensus

S 1 Recommendations on actions provided by groups of experts

Reaching consensus using an informal procedure

Using bone densitom-etry (bone mineral

density assessment), osteoporosis can be

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Wide range of applications for Bodytronic ID:CAM

Producing quality while maintaining cost efficiencyThe Bodytronic ID:CAM web application is a modern and adaptable tool for orthotists modeling customized milled orthoses. It offers a wide spectrum of design options, reproducible results and significant savings potential – three users report on their practical experiences in life.

We use Bodytronic ID:CAM every day. We’ve been using it since its launch in 2016 to make customized

milled orthoses. With its predecessor software GloboCAD, too, we had many years of experience. And as a Bauerfeind Quality Partner, we were involved in its further development ,” says Tino Sprekelmeyer,

Managing Director of Sprekelmeyer GmbH Orthopädie-Schuhtechnik und Sanitätshaus, an orthotist and medical supply retailer. At his locations in Osnabrück and Hagen am Teutoburger Wald, Germany, he mainly treats children, athletes and osteoarthritis patients with orthopedic shoes and foot orthoses. “Of course, we cover the entire

range of indications, but we have developed a specialist focus,” Tino Sprekelmeyer explains, who is the third generation to run the long-established company and currently makes more than 200 pairs of foot orthoses per month with his 24 employees. “More than two thirds of those are milled orthoses, because that is the most


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personalized way to treat patients.” He also uses Bodytronic ID:CAM to support the modeling process. “During everyday work, this system is like a practical , digital tool box for me. And thanks to its further development into a web application, I can now use it on any computer with internet access, without being tied to a specific location.”

Options for any requirementThe transfer of the measurement data – whether from a 2D foot scan or 3D digitization of foam imprints – is very simple, thanks to the appropriate interfaces. When modeling a foot orthosis, Tino Sprekelmeyer uses the model and module library, as needed, where elements can be freely modified to create the required topography. The modifications include arch supports, different pads or available intarsia as well as the almost infinitely variable range of soft cushioning materials. “Using predesigns makes modeling foot orthoses with the Bodytronic ID:CAM easier and quicker. We’ve saved Bauerfeind templates with our own input for commonly recurring indications in the library, meaning they’re always at our fingertips,” Tino Sprekelmeyer explains. The fact that the software cannot replace the user’s professional expertise is important for the expert orthotist to point out: “Of course, in the end, every foot orthosis is only

as effective as the model created in the program based on professional know-how. But the web application does help with various profiles.” From the “Basic” module for the easy configuration of less customized foot orthoses using ready-made macros, to the “Professional” mode in which all parameters can be set by the user: different patients can be supplied with varying effort in a reproducible way. The “Advanced” profile also offers users the option to include feedback from Bauerfeind technicians. Tino Sprekelmeyer summarizes: “You could say: Bodytronic ID:CAM helps shift the boundaries of digital modeling. I also save costs by using the extended Bauerfeind workbench. That means we can produce customized foot orthoses that comply with high quality standards, while also maintaining cost-efficiency.”

All data available at all times“In my opinion, the 100 per cent reproducibility of the foot orthosis is the biggest advantage of the web application,” says Andreas Hempel , Managing Director of Hempel GesundheitsPartner GmbH in Berlin. “All the saved data is available at all times for subsequent treatment. For the same foot condition, we can produce identical foot cushioning with the right quality at the push of a button.” This is a huge advantage for patients as well as for the company that , with 18 locations in the greater Berlin

area and a total of 200 interdisciplinary employees, offers a wide service portfolio and high degree of specialization in the individual specialist fields. He demands a lot of commitment , speed and, most importantly, reliability not only from his team but also from the products he makes for his customers – this includes more than 100 milled orthoses per month. “We’ve been working with the Bodytronic ID:CAM for about two years, and for more than one year, we’ve been using the diabetes module for about 10 per cent of our foot orthoses,” Andreas Hempel says, explaining that , based on the scanned foam imprint , they are producing individually modeled foot orthosis base layers as a foundation for diabetes-adapted foot cushioning. Together with the relevant cushion layer and a top cover, the expert orthotists can precisely adapt the foot orthoses to patients’ needs. Andreas Hempel and his sister Sonja are the fourth generation to run the family business. When the maintenance costs of their own milling system became too expensive, they decided to outsource the milling to Bauerfeind and to digitalize the modeling of foot orthoses.

“We treat skew feet , flat feet and splay feet , and we create heel lifts with all sorts of designs. It works brilliantly,” says Martin Roth, Managing Director of Schuhorthopädie Roth GmbH.

Like a digital tool box, Bodytronic ID:CAM helps with the customized modeling of milled orthoses.

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No need to search the warehouseThe fact that Hempel’s specialists now use electronic lasts as a foundation, also saves a lot of storage space, compared with the previous use of wooden or casting lasts, and makes work much easier. Andreas Hempel: “It’s immediately available for subsequent treatments, and you don’t have to go searching in the warehouse among many other kinds of lasts. Thanks to the technology, we are also able to make changes more quickly and

don’t have to go to the machine first.” He also sees advantages when documenting invoices for the payers. The last data record can be created digitally and provided to the payer quickly. The web application doesn’t just make the work in an orthotist company easier. The treatment process is now also faster and cleaner for patients, because plaster cast impressions can be avoided in most cases. Much to their appreciation, reports Andreas Hempel: “We win patients over

with compelling product quality and speed. Our customers are simply amazed by the digital opportunities.”

No-risk introduction Irrespective of the size of the company or number of branches, the Bodytronic ID:CAM can be used in various ways as an online solution and is suitable for orthotists with all kinds of specializations and range. Schuhorthopädie Roth GmbH in Oberasbach, Franconia, also relies

Different profiles allow users to select the level of interaction when modeling milled orthoses.

Basic*: Transfer of required customer data and some minimum specifications. Bauerfeind carries out the rest of the process, from modeling through to manufacturing of the customized milled orthoses.

Advanced: Modeling based on customer data using a range of predefined basic models (predesigns) that can be modified as required. Bauerfeind manufactures the customized milled orthoses after carrying out a check.

Professional: Modeling based on customer data using a range of predefined basic models (predesigns) that can be modified as required. Bauerfeind manufactures the customized milled orthoses without checking them beforehand.

* The “Basic” profile is not available in the “Foot orthoses adapted for people with diabetes” category.

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“Thanks to its further development into a web

application, I can now use the Bodytronic ID:CAM on

any computer with internet access, without being tied

to a specific location,” says Tino Sprekelmeyer, Managing

Director of Sprekelmeyer GmbH Orthopädie-Schuhtechnik und

Sanitätshaus.

Three profiles for different manufacturing levels


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on the web application. “We use milled foot orthoses for most indications. With Bodytronic ID:CAM, we can, for example, perfectly model the base layers for diabetes-adapted foot cushioning. We treat skew feet , flat feet and splay feet , and we create heel lifts with all sorts of designs. It works brilliantly. We integrate everything via the application and have it milled as we need it. The milled orthoses will then turn out exactly as planned. In the end, the final fine tuning that we take care of is fitting them into the shoes,” explains Martin Roth, Managing Director of Schuhorthopädie Roth GmbH since the beginning of the year. With his 25 employees, he has specialized in the provision of foot orthoses and special shoes as well as supports and compression stockings. Like Tino Sprekelmeyer and Andreas Hempel , he is leading a traditional company into modern times.

Quick inductionThanks to the intuitive operation of the web application and training provided by the Bauerfeind field sales team, the introduction of the Bodytronic ID:CAM was quick and without any difficulty. “Of course, if requested, we still manufacture products layer by layer – some older patients don’t want to break with their habits. But we now use the software solution for the majority of products,” Martin Roth says. He adds:

“It delivers premium, reproducible quality. If customers were happy with their foot orthoses, I can make exactly the same again. Our customers’ response is really positive. They are pleased with modern technology, and this gives us additional encouragement.” Currently, the company models about 150 milled orthoses per week. “It’s not much more than before but it’s certainly easier,” Martin Roth highlights. “Rather than having to go through storage for everything, we’re getting the picked goods just-in-time. That saves a lot of money because I don’t have to store shoe size 34 a hundred times. I receive what I need.” And thanks to quick delivery times – currently 48 hours for conventional milled orthoses – this is much easier and quicker than before.

Starting without an investment riskAnother aspect is pivotal for Martin Roth: using the free web application. He was able to find out about the functionality himself, without any risk: “We didn’t have to invest anything, except in a graphics card for the PC, to be able to use the 3D data more effectively. If our tests hadn’t gone well , we would no longer use this tool.” But he’s convinced of the powerful program as well as of the advantages of Bauerfeind milling foot orthoses: “It works, so I continue to order.“ †

“In my opinion, the 100 per cent reproducibility of the foot orthosis is the biggest advantage of the web application,” highlights Andreas Hempel , Managing Director of Hempel GesundheitsPartner GmbH.

Made-to-measure quality

The Bodytronic ID:CAM system solu-tion creates benefits for providers and patients by offering digital pre-cision and versatile design options, combined with excellent specialist advice and practical experience provided by qualified personnel. For each new product , the user takes into account the current foot status and can compare treatments based on data stored in the system, ensuring optimized quality that satisfies the highest professional requirements.

Link to the web application: idcamrev2.bauerfeind.com


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The Olympic Games in Tokyo

The flame will continue to burn


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The 2020 Summer Olympic Games in Tokyo will take place in 2021. The coronavirus pandemic forced the organizers to postpone the event. Now, preparations for the Games are in full swing where Bauerfeind will support athletes as a partner. A glance at the Japanese metropolis.

The traditional torch relay had to be canceled. The

Olympic flame that was taken from Greece to Japan was

made accessible in Fukushima in a small lantern under strict

safety measures.


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What will happen with the name “Tokyo 2020”?

“Olympiad” describes the four years between the Games. In a way, the Games are the crowning conclusion of this period. Tokyo 2020 therefore describes the celebration of the 32nd Olympiad. It was thus agreed that the name of the event “Olympic and Paralympic Games Tokyo 2020” would remain the same, even though it will take place in 2021. By the way: the Games for the 33rd Olympiad will be hosted by Paris in 2024.

Masses of people, neon signs, Japanese characters – Tokyo seems overwhelming at first glance, a city of superlatives.

Though the term “city” really needs to be redefined here. Divided into 23 districts and merged with the cities of Yokohama and Kawasaki, the metropolitan region of Tokyo is the biggest conurbation in the world with 35 million inhabitants. Japan’s capital city has a lot to offer those who set out to explore it – from modern architecture to traditional temples, from cherry blossoms to karaoke. The vista from the Skytree, Tokyo’s viewing platform at 450 meters in the Sumida district , the second largest building in the world, allows a great overview in good weather. An evening walk along Tokyo Bay presents an amazing photo opportunity with the Rainbow Bridge that , illuminated with radiant colors, leads to the offshore island of Odaiba. The Shibuya Scramble Crossing – one of the most renowned traffic junctions in the world where all pedestrian traffic lights turn green at the same time – lets visitors experience the vibe of the city.The idea was for another highlight in summer 2020: after 1964, Tokyo was getting ready to host the Summer Olympics for a second time. 33 disciplines at 42 competition sites, including newcomers baseball/softball , karate, sport climbing, skateboarding and surfing. More than 11,000 athletes competing for medals in 339 events, celebrating together and turning the venue into a melting pot of cultures.

An unexpected emergency stopBut since the beginning of the year, coronavirus has changed everything, meaning the New National Stadium in the Shinjuku district is now empty, and the Olympic Village on the island of Harumi in Tokyo Bay is waiting for athletes from all corners of the earth in vain. ‘Faster, higher, stronger’ will have to wait. “It's the taking part that counts” has been replaced by staying home. Until the last moment , everyone had hoped that the pandemic would subside. Until the last moment , everyone involved ensured the Games could be carried out. But the virus brought everything to a halt. On March 24, Prime Minister, Shinzo Abe, asked the IOC to postpone the Games of the XXXIInd Olympiad as well as the subsequent Paralympic Games. In close consultation among IOC, Organizing Committee, the city of Tokyo and the Japanese government , and with the involvement of the 206 National Olympic Committees, athletes, sponsors and broadcasting agencies, a new date was found and communicated: Tokyo 2020 will now start a year later on July 23, 2021.Humanity is currently in a dark tunnel , and the postponed Games are a beacon of hope, the Olympic flame a light at the end of this tunnel , IOC President , Thomas Bach, commented on the postponement. The athletes’ responses were mixed: on the one hand, there was disappointment about the postponement of this career highlight that many have been looking forward to. On the other hand, they

These play an important part during the planning phase for 2021: the New National Stadium (top left), the Press Center at Tokyo Big Site (bottom left).

Rainbow Bridge (top right), Skytree and temple grounds (bottom right) are imposing highlights in the skyline of Tokyo megametropolis.


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understood that this situation makes neither the actual event in Tokyo possible nor the training and qualification conditions. “With the coronavirus pandemic spreading and the associated health risks for all involved, this is the only way to go,” was the message in a statement from the German athletes. “The international sports community reacted with understanding. Now everyone is trying to prepare for 2021. Us, too,” says Jörg Ritzerfeld, who runs the Olympics Project as Head of Marketing Bauerfeind Sports. The preparations that were in full swing to supply athletes on-site with medical products, were stopped, and planning started for the coming year. Jörg Ritzerfeld: “The Japanese Organizing Committee confirmed the information during the night after the announcement and asked at the same time if we would continue our partnership.”

Laying the foundations nowNow that the countdown for 2021 has started, the organizers have a huge project on their hands. Tokyo had the goal of being the city that is best prepared for the Games, and the city wants to prove that this coming year. The challenges to achieve this goal are vast. The global sports date calendar has to be reorganized and events brought closer together. Major international sports events compete for spectators, viewing figures and the associated advertising revenue used for their funding. Some of the Olympic sports venues are temporary and now have to be secured for the coming year.

The Makuhari trade fair site in the Chiba Prefecture, for example, that will host events such as fencing and taekwondo, was booked for five months this year. In a comparable period in 2019, more than 350 events took place there. The situation is similar at the Tokyo Big Site trade fair center, from where 25,000 accredited media professionals will send messages and images all over the world. This shows the difficulties for the organizers, as does a glance at the Olympic Village. With its residential buildings, it will become a new part of the city after the Games. Occupation of the units, some of which have already been sold or rented, will now be delayed by a year. All this won’t be cheap, but the organizers are confident that they will be able to manage to keep the additional amount in the single-digit billions. Advertising partners, suppliers and employees – everyone will have to change their plans. But they all agree: cancelling the event would have caused more damage. Christophe Dubi, Executive Director of the IOC for the Olympic Games said to the media: “A postponement is never ideal , but at least we have all the conditions in place to deliver the best event possible, so we have a lot of confidence that we are going to deliver great Games next year.”

Go for Gold in 2021Good for the athletes: those who have already qualified, will remain eligible to take part. The qualification period has been extended until July 2021. Solutions for automatic eligibility are in progress,

such as for current world champions who will be redetermined in the meantime. The organizers’ motivation to exceed the expectations of the participants and spectators is high. The world can look forward to top-class Olympic Games. So how about visiting Tokyo in 2021? †

What about the mascot?

The Japanese words “mirai” (future) and “towa” (eternity) put together form the name of the big-eyed Olympic mascot. According to its creators, Miraitowa stands for learning from the past to develop new ideas. The ability to reinvent oneself is now also required from the organizers of the Olympic Games.

Waiting for the Games – the five rings in front of the New National Stadium are a popular photo motif.


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Addresses at a glanceWith numerous subsidiaries and distributors around the world, Bauerfeind has a strong global presence. It employs modern logistics solutions to ensure that its high-quality products, which are manufactured exclusively in Germany, always reach its trading partners quickly. In total , around 2,100 employees worldwide work for the success of the company and with patient well-being in mind. †

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BAUERFEIND.COM

THE BENEFITS OF VenoTrain® MEDICAL COMPRESSION STOCKINGS

• Improve the function of the venous valves when transporting the increased volume of blood back to the heart• Help to prevent the formation of edema and reduce already existing edema• Alleviate the symptoms of pregnancy-related varicose veins, thus reducing pain due to tired, heavy legs

Effectiveness proven by researchIn the early stages of a pregnancy, wearing compression stockings canreduce nausea and vomiting about as effectively as the approved pillsavailable for these symptoms.*

* Mendoza, E. et al.: A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy. Int J Womens Health. 2017; 9: 89 – 99. Published online 2017 Feb 22.

MEDICALCOMPRESSION STOCKINGS

during and after pregnancy

life: What challenges do you see for the businesses you represent in the next five years? Does the coronavirus situation represent the dawn of a new era?Alf Reuter: The coronavirus pandemic has created an unprecedented situation. We can now clearly see what value our businesses have: they are crucial to our healthcare system. When we can’t help, there are significant consequences. And we don’t even have to refer to the very obvious problem of oxygen supply that our members have to ensure in the field of domestic care. It also applies to hospital discharge management and pre-operative and post-operative care. Once the coronavirus pandemic is over, people will have to rethink the provision of medical aids. Definitely. Which projects have you made your personal priority?Alf Reuter: I enjoy rolling up my sleeves, bringing people together and focusing their

energy. That’s what I’m doing now. The coronavirus has accelerated everything: people have to resolve differences quickly – otherwise you can’t move forward. Everyone has to pull together.Our association is well prepared for this. Not many trade associations are as connected with politics and the related associations from the field of medicine and industry as we are. But we still have to connect more among ourselves. Strengthening communications in all directions is therefore one of my priorities. Do these times also accelerate digitalization in the medical aid industry? Alf Reuter: We can now see what opportunity digitalization provides, even at a process level. Things that were rather uncommon in our association, are now completely normal: one video conference

follows the next. We will also soon notice something else in our field of expertise: which processes can be “contact-free” and which can’t. To give a practical example, taking an imprint without physical contact , for instance, has become even more important. In your opinion, will craftsmanship still play a role in the future?Alf Reuter: Staying within the concept of the coronavirus crisis: if an institute were to launch a vaccine or drug against the virus – this would certainly not make physicians superfluous. The same applies to us: we are pleased with every opportunity that allows us to improve patient care and customer service. If we can develop and use better materials, better manufacturing methods, etc., this will expand our field. We will still have to decide how we can treat patients and exactly which technical option will solve their individual problems. †

BIV-OT President Alf Reuter

“Everyone has to pull together”Since March 10, 2020, Alf Reuter has been the new President of the German Association of Orthopedic Techno logy (BIV-OT). In these turbulent times, he relies on one thing most of all: good professional networks.

BIV-OT President Alf Reuter. The expert orthotist is a managing shareholder at OTZ – orthopädietechnisches Zentrum – Lichtenau GmbH in Hessisch Lichtenau, Germany.


PEOPLE

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BAUERFEIND.COM

THE BENEFITS OF VenoTrain® MEDICAL COMPRESSION STOCKINGS

• Improve the function of the venous valves when transporting the increased volume of blood back to the heart• Help to prevent the formation of edema and reduce already existing edema• Alleviate the symptoms of pregnancy-related varicose veins, thus reducing pain due to tired, heavy legs

Effectiveness proven by researchIn the early stages of a pregnancy, wearing compression stockings canreduce nausea and vomiting about as effectively as the approved pillsavailable for these symptoms.*

* Mendoza, E. et al.: A randomized crossover trial on the effect of compression stockings on nausea and vomiting in early pregnancy. Int J Womens Health. 2017; 9: 89 – 99. Published online 2017 Feb 22.

MEDICALCOMPRESSION STOCKINGS

during and after pregnancy

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