In some provinces one lower limb amputation occurs every day as a result of a diabetic foot ulcer, with the frequency varying across Canada. Many of these amputations could be prevented with proper care and access to supports.
In recognition of World Foot Health Awareness Month, Diabetes Canada has released new reports that address the benefits of government funding of amputation prevention devices that relieve pressure on foot ulcers to help healing. Diabetes Canada estimates that increased government funding for such specialized devices could save provincial health-care systems millions of dollars annually.
“For people with diabetes, lower-limb amputation is considered to be one of the most feared and debilitating consequences of the disease,” says Dr. Jan Hux, president of Diabetes Canada. “Devices that relieve pressure on foot ulcers reduce the risk of amputation, but the up-front cost can be a barrier for people who need to use them. In addition to improved screening and foot care, Diabetes Canada recommends that governments fund these devices to help diabetic foot ulcers heal properly and prevent unnecessary amputations.”
Diabetes Canada and Wounds Canada are working together along with other key patient and health-care organizations, researchers and frontline clinicians in an effort to bring this urgent issue to the attention of governments. Jointly, the organizations were pleased with the Government of Ontario’s recent funding announcement and are encouraging other provinces to follow Ontario’s leadership in this area.
“The high number of amputations is a strong indication that we are not meeting the needs of our patients,” says Mariam Botros, CEO of Wounds Canada. “Amputation prevention is certainly not rocket science. A few key changes to our health systems will help persons with diabetes, many of whom lack both sensation and inflammatory signs in their feet—key warning signals that there is a problem—get the early, and appropriate, care they require to keep their limbs and live healthier, more productive lives. Comprehensive and integrated care for this vulnerable group should be a priority.”
Devices such as total contact casts, custom braces and orthoses significantly improve healing of foot ulcers, but cost up to $2,500 and so are not widely used due to issues of affordability. There is also a need for improved foot screening, education, and access to diabetes supports and foot care specialists. A well-defined referral pattern and care pathway is also needed to ensure patients are supported appropriately based on their risk level.
Canadians have seen the rates of both heart attacks and strokes in persons with diabetes decrease over the past decade because of improved reporting, smarter funding and better management strategies. With a few key changes in support of amputation prevention, up to 85 per cent of diabetes-related lower limb amputations could be prevented, significantly lowering rates in this area as well.