Diabetes-related major and minor amputation risk increased during the COVID-19 pandemic
Background: Along with significant case transmission, hospitalizations, and mortality experienced during the global Sars-CoV-2 (COVID-19) pandemic, there existed a disruption in the delivery of health care across multiple specialties. We studied the effect of the pandemic on inpatients with diabetic foot problems in a level-one trauma center in Central Ohio. Methods: A retrospective chart review of patients necessitating a consultation by the foot and ankle surgery service were reviewed from the first 8 months of 2020. A total of 270 patients met the inclusion criteria and divided into pre-pandemic (n = 120) and pandemic groups (n = 150). Demographics, medical history, severity of current infection, and medical or surgical management were collected and analyzed.Results: The odds of undergoing any level of amputation was 10.8 times higher during the pandemic versus before the pandemic. The risk of major amputations (below-the-knee or higher) likewise increased with an odds ratio of 12.5 among all patients in the foot and ankle service during the pandemic. Of the patients undergoing any amputation, the odds for receiving a major amputation was 3.1 times higher than before the pandemic. Additionally, the severity of infections increased during the pandemic and a larger proportion of the cases were classified as emergent in the pandemic group compared to the pre-pandemic group.Conclusions: The effect of the pandemic on the health-care system has had a deleterious effect on people with diabetes-related foot problems resulting in more severe infections, more emergencies, and necessitating more amputations. When an amputation was performed, the likelihood it was a major amputation also increased.Editor's Note: This Original Article accompanies "Diabetes-Related Amputations: A Pandemic within a Pandemic," by Lee C. Rogers, DPM, Robert J. Snyder, DPM, and Warren S. Joseph, DPM, FIDSA, available at https://doi.org/10.7547/20-248
View more: https://doi.org/10.7547/20-224
ONTARIO’S PODIATRISTS TIPS FOR WINTER FOOTWEAR
It’s that time of year again. Winter arrives with a vengeance and the first thing you want to be sure is you have invested in proper winter footwear.
Here is some basic advice –
Frequently Asked Questions:
What size snow boots should I buy?
You should be able to stick to your everyday shoe size. Many snow boots are designed to just slip on because, more often than not, the sole of the boot and the boot upper are made from the same piece of hardened rubber. This ensures maximum waterproofing and protection against any hidden obstacles or debris.
They’ll likely also have a neoprene, leather or waterproof textile collar too for added comfort. Because they slip on, show boots are generally made slightly larger than other types of footwear to allow you to get your foot in comfortably.
How loose should my snow boots be?
Loose fitting snow boots are a big no-no. Due to the change in how you walk when wearing snow boots, oversized boots are a potential tripping hazard. Any added unsteadiness is definitely not needed when it comes to winter weather. A one-finger width gap down the heel of the shoe is the maximum wiggle room you should leave. The same rules apply for fitting kids’ snow boots, too.
How Should Snow Boots Fit?
Snow boots should hug your foot comfortably, providing both support and insulation. A looser fitting boot will offer greater warmth and comfort but will cause problems when walking longer distances. Snow boots that are too tight will lead to circulation issues and problems walking.
To find the right balance, always fit snow boots while you’re wearing appropriate socks (as in the socks you’ll be wearing when you wear the boots). Make sure you have enough room to wiggle your toes comfortably.
The American Podiatric Medical Association shares tips on Warm & Cozy Feet
APMA offers some advice for keeping feet healthy in common winter scenarios:
Finally—and although this one seems like it should go without saying, it bears spelling out—don't try to tip-toe through winter snow, ice, and temperatures in summer-appropriate footwear.
Ontario’s Podiatrists remind you: Good Health Feet First!!
Markham lawyer dies after being discharged from hospital with foot infection
Man should not have been released during coronavirus pandemic, friend says.
Michael Pierce was sent home from Scarborough Health Network's Birchmount site with a foot infection. He died hours later. Now family and friends are wondering what happened. - Photo by Paul Koziorowski
For Michael Pierce, criminal law was his charity. He got into it for the right reasons and he lived that reality each and every day.
“He would drive to clients' homes at 1:30 a.m. if they needed him, he would work on cases 60 hours in three days, only closing his eyes for a few hours – even if clients burned him and didn’t pay him, he’d still work hard for them,” said Mustafa Sheikh, Pierce's grieving law partner.
But it wasn’t just his work ethic or huge heart that left Sheikh in daily awe. Pierce was also a genius who put his Christian faith front and centre.
Unfortunately for Pierce, according to Sheikh, he may not have been given the same respect in death as he gave to those around him in life.
That’s because, as Sheikh tells it, Pierce died only hours after being sent home from Scarborough Health Network's Birchmount site, a place he went to seek help.
Now, Sheikh said, the Pierce family are looking into a wrongful-death suit against the hospital, alleging that even with COVID-19 rules in place, Pierce should have been kept in hospital – and if he was, he might still be here.
Pierce's condition began in early March when the lawyer, who resided and worked in Markham, developed a nasty foot infection from split skin at the back of his heel.
“There was pain and discomfort and it was affecting his walking,” Sheikh said.
After the courts shut down at the end of March, the 38-year-old, who was five feet nine inches tall and weighed around 300 pounds, decided to go into hospital.
“They told him, ‘It’s bad and not healing,’ and gave him antibiotics,” Sheikh said, adding they further diagnosed Pierce with diabetes and scheduled an appointment with a specialist.
Between that day and April 14, Pierce's condition worsened, including a loss of vision, severe pain and hallucinations, according to Sheikh.
On April 14, Pierce's mother, Patricia, drove him back to the Birchmount hospital, but because of COVID-19 rules she was not allowed inside.
Pierce was discharged later that day and was visited by a nurse at his Markham home around 7 p.m., Sheikh said, at which point he was given an injection.
One hour later, his heart stopped beating.
Sheikh added that Pierce's family has been told it will take between 10 to 12 months for a report on his death.
“He was young, he had issues, but nothing that should have caused his death,” Sheikh added. “He went to the hospital a second time because it wasn’t working. He was in so much pain, there’s no way he should have been discharged.”
He added that he believed without COVID-19 rules, the hospital would have kept him in the hospital for observation.
“Why would they send a nurse two hours later?" he asked. "It doesn’t make any sense."
Since Pierce's death, Sheikh has put his law partner's mother in touch with some personal injury lawyers and has encouraged them to seek damages as part of a wrongful-death suit against the hospital.
In response, Leigh Duncan, the communications representative for the hospital, cited patient confidentiality as far as releasing any information about why Pierce was released or just how bad his condition was.
“Our hearts go out to Mr. Pierce’s family and we are sorry to hear of his passing,” she wrote in an email to Yorkregion.com. “We are unable to comment on this specific case out of respect for patient privacy. We are committed to supporting a patient’s transition out of the hospital and discussing what recovery may look like so they know what to expect. We are committed to exceptional care and safety for all of our patients, at all times.”
As for his own pain, Sheikh said he continues to struggle through it.
“I lost my best friend. He was such a good soul, I’m devastated,” he said. “I feel like I lost a little piece of myself. There’s all these what-ifs – I just feel as though this could have been avoided. He was so innocent.”
He said what has remained with him since Pierce’s passing is the idea that a man can die in this way in Canada in 2020.
“They say our medical system (in Canada) is so good,” he said. “But this is about someone falling through the cracks. It’s hard to see someone of his calibre not get the medical attention he deserved.”
Dr. Jim Hill, president of the Ontario Podiatric Medical Association, said that he's been trying to convince the Ontario government for some 20 years that hospitals should have access to a podiatrist, yet the province is so behind the rest of the world – and even other parts of Canada – that the profession isn't even taught in Ontario. That means doctors at Scarborough Health Network, like all other hospitals in Ontario, do not have a podiatrist with whom to consult.
WHAT YOU NEED TO KNOW ABOUT NOVEL CORONAVIRUS (COVID-19)
Feb 26 2020 | Sinai Health Foundation
Ontario has only had a few confirmed cases of novel coronavirus (COVID-19) but the amount of media on the topic would suggest we should be worried. Can you provide some perspective?
As this is a new virus, it takes some time for scientists to learn about the symptoms it causes and how it spreads. It’s understandable for people to experience worry in a situation like this where we don’t have all these answers right away.
Mom left with gaping hole in foot after suspected wart revealed to be cancer
A mother in England who first went to the doctor for what she thought was a painful wart on the sole of her foot was left with a gaping hole after she was diagnosed with malignant melanoma that set off a years-long cancer battle.
PODIATRY DEVICE TAKES TOP PRIZE AT NORTHEAST OHIO INNOVATION CONTEST
A team of Kent State researchers took top prize at the Burton D. Morgan Foundation’s LAUNCHTOWN SOARTM Competition, held at Baldwin Wallace University in April, beating teams from Case Western Reserve University, Cleveland State University, and the University of Akron.
Their winnings ($7,000) will allow the team to further develop a device which could solve an age-old problem for diabetics.
The device, called a “Shear Force Mat,” represents a breakthrough for physicians seeking to understand the formation of plantar ulcers — one of the most prevalent and dangerous problems facing diabetic patients.
DERMATOLOGY OF THE LOWER LIMBS SYMPOSIUM
The Order of podiatrists of Québec and the Université du Québec à Trois-Rivières are happy to work together in preparation for the next dermatology symposium. It will take place at the UQTR campus in Trois-Rivières on Saturday November 17th 2018.
Dr. Ashfaq A. Marghoob, a reputable American dermatologist whom specializes in dermoscopy will cover the following topics: dermoscopy evaluation of the nails and of the plantar aspect of the foot.
Dr. Bernard Cohen, an exceptional dermatologist specialized in pediatric dermatology will discuss the following subjects:
For more Information & Registration
The OPMA and its members salute the B.C. podiatrists for taking proper foot health care to the public.
Free foot care pilot project in Abbotsford, B.C. showing positive signs for patients.
The Globe and Mail
by Megan Devlin
Dr. Scott Schumacher poses for a photograph at his podiatry practice in Surrey, B.C., on Jan. 6, 2018.
DARRYL DYCK/THE GLOBE AND MAIL
...The program in Abbotsford, about an hour's drive east of Vancouver, is studying the impact of providing a free foot clinic to vulnerable patients in the dsialysis unit. Poor circulation paired with neuropathy, a lack of sensation in the feet, means these patients are prone to developing open wounds and infections that put them at risk for amputation.
Initial results from the three-year study indicate the free care has reduced the number of leg amputations by half, echoing larger studies from the United States that have shown access to foot care reduces leg amputation in diabetics.
However, the clinic's future is in doubt. Funding from the BC Renal Agency, which is overseen by the Provincial Health Services Authority, for the three-year project ended at the end of 2017, though the renal agency recently provided additional funding to keep the clinic open until March.
Dr. Scott Schumacher, a podiatrist who specializes in diabetic wounds and works at the foot clinic, said there's no question the clinic is saving patients' legs – while also saving the health-care system money...Click Here to Read the Full Article
"Putting Your Best Foot Forward Act" Cristina Martins, Toronto MPP.
Toronto MPP Cristina Martins (Davenport) tabled her “Putting Your Best Foot Forward Act” today, October 17, 2017, in the Ontario Legislature. The Bill will make changes to the Occupational Health and Safety Act and “prohibit employers from requiring an employee to wear footwear that is not appropriate to the protection required for their work."
The President of the Ontario Podiatric Medical Association, James Hill stated: “Clinical evidence demonstrates that wearing high heeled shoes causes a much higher incidence of bunions, musculoskeletal pain and injury than those who do not wear high heels.”
OPMA applauds this Private Member's Bill for advancing workers' foot health in Ontario.
Click image to view full news
Tej Sahota on CH Morning Live Promotes healthcare.
Hartley Miltchin, DPM, on behalf of The Ontario Podiatric Medical Association appeared on TORONTO’S NUMBER ONE MORNING SHOW, BREAKFAST TELEVISION on CITY TV to promote FOOT HEALTH AWARENESS MONTH.
Dangers of Pedicures
CBC INVESTIGATES | Worker with open sore, reuse of disposables among recent problems found at Manitoba nail salons
Follow the full story at CBC.ca
Learn more about the growing dangers of pedicures and some helpful "Stay Safe" tips in an installment of CTV's "Customer Alert".