Comprehensive Podiatric Treatment: Procedure, Medical Indications and Costs

What lies behind it

Podologische Komplexbehandlung (comprehensive podiatric treatment) is a defined medical treatment under the Remedy Directive (Heilmittel-Richtlinie) of the Federal Joint Committee (Gemeinsamer Bundesausschuss). It comprises the systematic combination of dermatological and nail therapeutic procedures on the foot. The specialty of podiatry occupies an intermediary role between medical diagnostics and practical therapy. Unlike cosmetic foot care, which primarily pursues care and aesthetic goals on healthy feet, comprehensive podiatric treatment represents an expedient, medically indicated therapy.

From an anatomical perspective, human foot skin consists of several layers. The outermost epidermis, with its cornified zone, the stratum corneum, protects against mechanical stress and the ingress of pathogens. Under continuous pressure or friction, the tissue reacts with accelerated cell division, resulting in local hyperkeratosis. In healthy individuals, this mechanism creates a natural protective cushion. However, if there is structural damage to neural pathways or blood vessels, this protective system breaks down.

Innervation of the foot occurs via branches of the tibial nerve and the fibular (peroneal) nerve. If these nerve fibres are damaged by chronically elevated blood glucose levels or toxic influences, the protective function of pain perception is lost. Affected individuals no longer feel friction, pressure, or minor injuries. At the same time, microcirculatory disorders in the smallest capillaries lead to an inadequate supply of oxygen and nutrients to the tissue. The body can no longer autonomously regenerate damaged skin areas. Deep tissue necrosis often develops unnoticed beneath seemingly harmless hyperkeratotic plaques.

Comprehensive podiatric treatment targets precisely this pathomechanism. By precisely debriding thickened skin layers, pressure on the underlying tissue is reduced. Nail care ensures that the nail plate rests without tension in the nail fold. This effectively prevents the occurrence of ingrown nails and the invasion of fungal spores or bacteria.

Typical signs

Pathological changes in the foot are often heralded by subtle signals. A key indicator of an increased need for treatment is the excessive formation of hardened areas of skin at main pressure points. These include the heel, the plantar areas beneath metatarsal heads one to five, and the undersides of the phalanges. When these cornified areas lose their elasticity, deep skin fissures, known as rhagades, develop. These cracks often extend into the vascularised dermis and form painful portals of entry for pathogens.

Changes to the toenails also require therapeutic intervention. These include onychauxis, a marked thickening of the nail plate usually triggered by recurrent microtrauma from footwear or fungal infections. Such nails often curve in a pincer-like manner or form irregular ridges. Another typical condition is unguis incarnatus (ingrown toenail), in which the lateral nail margin presses deep into the nail fold. This leads to local inflammatory reactions with erythema, oedema, and hypergranulation tissue, medically referred to as granulation tissue.

In differential diagnosis, age-related skin dryness must be distinguished from neurotrophic skin changes. Age-related xerosis cutis usually manifests as fine scaling without deep tissue defects. In contrast, neurotrophic disorders are often accompanied by an absence of sweat secretion due to damage to the autonomic nervous system. The skin appears parchment-like, dry, and displays fissures despite the absence of mechanical load. If peripheral pulses of the dorsalis pedis artery or posterior tibial artery are also absent, an arterial circulatory disorder is suspected. Such findings require an immediate adaptation of the podiatric approach and medical consultation.

Everyday causes

The causes underlying foot conditions requiring treatment are manifold and usually result from an interplay between biomechanical factors and systemic diseases. In daily life, unsuitable footwear acts as a primary accelerant. Shoes that are too tight, too short, or unyielding create concentrated peak pressure points. With every step, the upper material rubs against the tissue, causing the skin to react with excessive hyperkeratosis. Constricting lines from socks or bunched-up insoles can also cause local tissue damage.

Anatomical foot deformities significantly exacerbate this problem. If splayfoot, flat-valgus foot, or pes cavus is present, the natural weight-bearing zones of the foot shift. In splayfoot, the anterior transverse arch collapses, subjecting the middle metatarsal heads to unnaturally high loads and forming painful calluses. In hallux valgus, the head of the first metatarsal pushes medially against the shoe leather, frequently causing bursitis and massive callus formation. Hammer toes and claw toes rub continuously against the dorsal aspects of the toes, leading to painful corns, known as clavi.

Among systemic underlying conditions, diabetes mellitus plays the leading role. Permanently elevated blood glucose levels damage small blood vessels and impair peripheral nerves, resulting in the development of diabetic foot syndrome. Peripheral arterial disease, neurological disorders such as polyneuropathies of various etiologies, and rheumatic diseases also frequently lead to severe foot complications.

An anonymised case study from clinical practice illustrates these connections. Mr M., a 62-year-old patient, has suffered from type 2 diabetes mellitus for over ten years. Due to advanced sensory neuropathy, he did not perceive local pressure in the forefoot area. Only during a podiatric examination was a deep subkeratotic haematoma discovered under an inconspicuous, slightly discoloured callus plaque on the first metatarsal head. Following careful debridement of the hyperkeratosis, tissue damage became visible. Without the timely removal of the cause of pressure, an open ulcer would have developed from this site within a short time.

When medical evaluation is necessary

Podiatric scope of practice reaches its definite limits when acute, infectious, or ischaemic signs of disease occur. Prompt medical diagnosis and therapy must be initiated upon the appearance of certain symptoms. Podiatrists collaborate closely with general practitioners, diabetologists, dermatologists, and vascular surgeons in these cases.

Clear warning signs, known as red flags, require immediate referral to a physician:

• Sudden onset or rapidly spreading erythema, hyperthermia, and swelling on the foot or lower leg, indicating erysipelas or phlegmon.
• Any form of open wounds, ulcerations, blister formation, or deep fissures with moist or purulent discharge.
• Blackened skin areas, dry necrosis, or exuding tissue breakdown indicative of gangrene.
• Acute rest pain in the feet or legs that worsens upon elevation, pointing to critical limb ischaemia.
• Systemic signs of infection such as fever, chills, or a sudden deterioration in blood glucose control without any other identifiable cause.

Medical risk assessment is frequently guided by established classification systems such as the Wagner-Armstrong classification. This system categorises foot wounds according to their depth and the presence of infection or circulatory disorders. If wounds corresponding to Wagner grades 1 to 5 are present, primary care belongs strictly in the hands of a medical wound care centre. Podiatry performs supportive tasks at this stage within the framework of periwound management but is not permitted to carry out independent wound treatment.

What podiatric treatment can achieve

Comprehensive podiatric treatment is prescribable as a remedy through statutory health insurance. The attending physician uses the official prescription form (Heilmittelverordnung Muster 13). Three primary diagnostic codes serve as indication keys. Code DF stands for Diabetic Foot Syndrome with neuropathy or angiopathy. Code NF covers Neuropathic Foot Syndromes, such as in toxic or hereditary polyneuropathies. Code UI encompasses spinal cord damage and spastic movement disorders leading to tissue damage in the foot.

Prior to every treatment, a thorough diagnostic assessment is conducted. The podiatrist takes the patient history, inspects the skin and nail status, and evaluates footwear. Standardised testing instruments are used to measure sensory function. Protective pressure and tactile sensation are evaluated at defined test points on the plantar surface using the Semmes-Weinstein monofilament, which exerts a defined bending force of 10 grams. The Rydel-Seiffer 128 Hz tuning fork test provides information on vibration perception over the bony prominences of the malleolus and the first metatarsal head.

Following diagnostics, the practical treatment sequence is divided into structured steps:

1. Disinfection and preparation: The foot is thoroughly cleansed using a skin-friendly antiseptic. All interdigital spaces are subsequently inspected for maceration or fungal infection.
2. Debridement of hyperkeratoses: Thickened callus layers are reduced layer by layer. For this purpose, the specialist uses sterile scalpels (blade shapes 10 or 15) as well as specialized gouge blades. The objective is a smooth, pressure-free skin surface without rough edges.
3. Nail therapy: The toenails are professionally shortened and smoothed. Thickened nail plates are thinned down using rotary diamond burs under continuous cooling. The lateral sulcus is gently cleared of debris and hyperkeratosis using a probe and excavator.
4. Finishing and care: Any remaining rough spots are smoothed. Finally, a skin-type-specific care foam formulation is applied and gently massaged in.

State-of-the-art medical devices are utilised. Alongside various scalpel handles and nail nippers, rotary micromotors form the core of the equipment. These devices operate at speeds of up to 40,000 revolutions per minute. They feature either a dust extraction system or an integrated water spray system. The spray system binds fine abrasive dust directly at the source while simultaneously cooling the tissue, thereby reliably preventing thermal damage to the nail bed. Carbide cutters, ceramic grinders, and diamond burrs of various grit sizes serve as practical instruments.

A comprehensive podiatric treatment typically lasts between 45 and 60 minutes. Depending on the severity of findings and individual risk factors, treatment is repeated at regular intervals of four to six weeks. This rhythm corresponds to the natural renewal cycle of human epidermis.

Coverage of costs for statutory insurance patients is regulated upon presentation of a valid prescription for remedies. The health insurance fund covers treatment costs according to agreed remuneration rates. Statutory insurance patients who have reached 18 years of age and are not exempt from co-payments contribute a co-payment. This consists of a fixed fee of 10 euros per prescription plus 10 percent of the treatment costs. For privately insured patients or self-payers, fees depend on the practice pricing structure. Detailed information on billing procedures can be found on the [/en/prices](cost overview) page and in the description of the range of services. Strict guidelines on instrument reprocessing guarantee maximum safety, as detailed in the [/en/hygiene](hygiene standards) section.

What you can do yourself

Professional treatment in the practice does not release patients from daily self-care. In the presence of sensory disturbances in the feet, daily self-inspection must become a firm routine. Because warning signals such as pain are absent, eyes must take over the function of nerves.

Daily care should follow a clear sequence:

1. Daily visual inspection: Inspect your feet every evening under good light for erythema, pressure spots, blisters, or small cracks. Use an unbreakable hand mirror or place a mirror on the floor to inspect the plantar surface and heels.
2. Gentle cleansing: Wash your feet daily with lukewarm water. Water temperature must not exceed 37 degrees Celsius and should be tested beforehand using a bath thermometer or your forearm. Bathing times exceeding three minutes should be avoided to prevent skin maceration.
3. Careful drying: Dry your feet thoroughly with a soft towel, paying special attention to the interdigital spaces. Remaining moisture encourages the growth of cutaneous fungi and bacteria.
4. Targeted skin care: Apply a moisturising cream foam with a urea content of 5 to 10 percent daily. The urea reservoir binds moisture in the stratum corneum and restores elasticity. Consistently omit the interdigital spaces when applying cream.

When selecting socks, seamless and non-constricting cuffs should be chosen. Natural fibres such as cotton or wool ensure effective moisture transport. Socks should be changed daily and washed at a minimum of 60 degrees Celsius. Before putting on shoes, feel the interior with your hands to check for foreign objects such as small stones, bunched-up insoles, or protruding seams.

Common mistakes

In clinical practice, typical care errors caused by a lack of awareness are frequently observed, which can lead to severe tissue damage. The use of sharp instruments in a domestic setting poses the greatest risk. Callus rasps, razor blades, cuticle knives, or pointed nail scissors do not belong in the hands of high-risk patients. Reduced pain perception or motor impairment means a brief slip can cause deep incised wounds, which quickly become infected due to impaired circulation.

Another critical error is the use of over-the-counter corn plasters or caustic solutions for callus removal. These preparations usually contain highly concentrated salicylic acid. The active agent does not differentiate between cornified and healthy tissue. In thin or sensitive skin, the acid penetrates deep layers and causes chemical burns. Extensive, deep ulcerations frequently form beneath the macerated tissue.

Excessive foot baths also carry risks. Soaking feet in hot water for extended periods deprives the skin of its natural protective lipids. The stratum corneum swells significantly, facilitating pathogen invasion. Bath additives containing harsh soaps or synthetic fragrances further dehydrate skin and increase the risk of allergies.

Finally, improper trimming of toenails often leads to painful complications. Rounding nail edges deep into the lateral nail fold promotes ingrowing of the regenerating nail plate. The hard nail edge presses into the soft tissue of the nail wall region during walking. Painful inflammation and granulation tissue develop, requiring extensive corrective intervention.

Current state of research and clinical context

Evidence supporting the benefits of structured podiatric care in high-risk patients is well documented in medical literature. Numerous international studies demonstrate that integrating qualified podiatrists into the care system can drastically reduce the incidence of severe foot complications. Combining regular debridement of pressure points, professional nail care, and educational measures effectively prevents primary ulcerations and recurrences [1].

Clinical studies indicate that regular removal of hyperkeratotic tissue reduces plantar pressure at critical weight-bearing points of the foot by up to 30 percent [2]. Because elevated local plantar pressure is considered the primary cause of neuropathic ulcer development, professional callus debridement represents a highly effective preventive measure. Health economic models and observational studies further confirm that establishing podiatric care structures can reduce major amputation rates in diabetic patients by 40 to 60 percent [3].

Clinical practice guidelines therefore unanimously emphasize the importance of comprehensive podiatric treatment. The German National Care Guideline for Type 2 Diabetes (Nationale VersorgungsLeitlinie Typ-2-Diabetes) recommends regular inspection and risk-adapted foot care by trained specialists from the diagnosis of peripheral neuropathy or vascular disease onward [4]. Continuous care closes gaps in provision between specialist appointments and makes an important contribution to preserving mobility.

Treatment in Memmingen

Professional care oriented to the latest medical standards requires experience and specialized qualifications. At FREITAG® Podologie GmbH in Memmingen, the health of your feet is the central focus of all therapeutic measures. The practice is located at Kempterstr. 25 in 87700 Memmingen and covers a wide catchment area including the city of Memmingen, the entire Unterallgäu region, the Allgäu, and parts of Upper Swabia (Oberschwaben).

Under the direction of Helga Maria Freitag, state-recognised podiatrist and sectoral practitioner of podiatry (sektorale Heilpraktikerin für Podologie), the practice offers the complete spectrum of medical foot care. As a specialist in cryotherapy, she combines classical podiatric procedures with modern therapeutic approaches. The practice team works closely with local general practitioners, diabetologists, and orthopaedic surgeons to ensure seamless care.

Whether you hold a prescription for remedies from your physician or wish to receive preventive comprehensive care as a self-paying patient, a structured treatment process and the highest hygiene standards are guaranteed across all premises. If you have questions regarding prescribability or would like to schedule an appointment, please feel free to use the registration form on our contact page or enquire directly on site about our range of treatments.