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Care cooperative keeps diabetes patients on the move

15 October 2020

PA Hospital patient Michael Geldart was diagnosed with Type 1 Diabetes at age seven. Fast forward forty-eight years to the present day, he says living with the disease hasn’t been without its difficulties.

“Throughout my teenage years I didn’t do the right thing to manage my condition as my parents and doctors suggested. As a result, I got infections in my feet that led to having both my big toes and my left forefoot amputated,” he said. "I have three plates and 15 screws inserted in my right foot too." 

Director Prosthetics/Orthotics & Podiatry Services, Shaun McKay said many patients are unaware of the risk diabetes poses to their extremities.

“When people with diabetes don’t manage their blood glucose levels, they get numbness in their feet and vascular problems that predisposes them to ulceration of the feet and infections that can lead to amputations,” he said, explaining that reduced sensation in limbs means wounds can often go unnoticed.

“Some patients have had foreign objects embedded in their feet for days and haven’t realised until someone else has brought it to their attention,” he said.

“Many patients spend a long time going to their GP for dressings before they are referred to our service to get the right support." 

Podiatrist Mohammed Kola said he and colleagues within the department are dedicated to helping patients heal their wounds so they can avoid permanent debilitation from amputation.

“Diabetic foot infections are a major burden on our healthcare system. Every day for every 100,000 people, four will end up in hospital because of diabetic foot disease, and the estimated direct costs of diabetic foot disease in Australia is $350 million each year.”

Mr Kola said the task of supporting patients to rehabilitate their feet benefited from a multidisciplinary approach.

“We know that working with other health professionals reduces the burden of diabetic foot complications and amputations, so we work closely with the Orthotics and Prosthetics teams to provide orthoses and medical grade footwear to the patient to offload the wound so they can continue to walk on the foot without damaging it again.

“We also run multidisciplinary clinics with Orthopaedic and Vascular specialists to reduce the incidence of hospitalisation, amputation and rehospitalisation due to diabetic foot disease.”

Orthotist at PA Hospital’s Chronic Foot Care Clinic, Sue Foss said catching patients in the early stages of ulceration was key to preventing amputations.

“When I started here 20 years ago, we didn’t have the multidisciplinary clinic we have today. Working together with podiatry, we capture a lot more patients earlier now and give them a chance to offload the wound to save the limb, although patient compliance will always dictate how successful our interventions are. If patients don’t wear the orthoses, they often end up with amputations,” she said.

“Keeping diabetic patients’ moving through adequate wound control is essential as the mortality rate after diabetic foot ulceration and amputation is high, with up to 70 percent of people dying within five years of having an amputation and around 50 percent dying within five years of developing a diabetic foot ulcer.”

For Mr Geldart, who has most recently sought support to manage a new foot ulcer, the experience of accessing care at PA Hospital has been life changing.

“You don’t expect the care, compassion and friendship the staff here have offered to me as a patient,” he said, sharing how staff had made him a special black boot to wear at his wedding on the 26th of last month instead of fitting the usual white plaster cast.

“I got to walk down the aisle with my wife dressed the way I wanted to,” he said. “They are just wonderful people.”

When asked what advice he would give to other diabetics about accessing the service, and keeping their feet healthy, Mr Geldart is frank.

“The main thing is always do as your doctor suggests. I made a mistake when I didn’t. If I can teach someone else what not to do to avoid the complications I’ve had, then that’s a win for me. Diabetes is easy to live with if you do the right thing, but it took my feet for me to learn that.”

Last updated 16 October 2020
Last reviewed 15 October 2020

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