Hamilton saw 93 diabetes-related foot amputations in 1 year. New campaign seeks to reduce numbers

Lower limb amputations (LLAs) in Hamilton connected to diabetes are happening at an alarming rate, with the city recording 93 diabetes-related foot amputations for the fiscal year 2021-2023.

According to Hamilton Health Sciences (HHS), the current rate of LLAs is 20.3 per 100,000.

Fifty-seven of the total number of LLAs for the same period were in lower Hamilton, where the rate is even higher — 34.5 per 100,000.

Dr. Fadi Elias, a vascular surgeon and assistant professor at McMaster University, is part of a campaign called Socks Off,  launched by HHS, together with the Greater Hamilton Health Network (GHHN), with a goal to reduce the number of residents who lose a foot to amputation due to diabetes.

The campaign will push more primary health-care providers to add foot checks to routine visits by patients.

"The rates that are in Hamilton are well above local areas, and the rates in Ontario and Canada are well above developed countries with publicly funded health-care systems," Elias told CBC Hamilton.

"If you look at areas in Europe that have similar publicly funded systems, our rates are double in comparison."

Why are the numbers so high?

Dr. Elias said the high rates of LLAs is directly related to the high rates of diabetes, smoking, blood pressure and cholesterol present in the city's population.

As well, he said a number of these patients are between 50 and 70 years old, who may have had more challenges with health care as Hamilton developed over the years.

As is the case in several parts of Ontario, he said access to primary care and access to specialists can be limited. 

Some 'really young' patients

Dr. Elias said some patients that have diabetes "are really young … into their 20s and 30s," with Type 1 diabetes being most common in that age group. 

"I do have patients that end up with amputations that are younger and these are patients with Type 1 diabetes, which actually occurs in younger patients specifically," he said.

"One that comes to mind was, like, 24, he had diabetes and he was a heavy smoker. Despite all the medication that we were able to offer — we did a number of surgeries to try to get better blood flow down the leg — the amount of tissue loss was so significant they ended up with an amputation."

Amputation 'changed everything': patient

Dr. Elias said losing a leg presents "a huge challenge" for people and can be "devastating" for patients, adding that hospitalization and recovery can take months. It also takes over a year to get the strength and recovery required to be fitted with a prosthetic.

Bernard Dupuis, 67, knows first-hand what it's like to have a leg amputated.

The Welland resident — a Type 2 diabetes patient — said seven years ago a piece of hot steel the size of his thumbnail fell in his boot while working and burned his right foot.

He said he would soak the area in warm water and put on a Band-Aid but the wound kept "getting bigger and deeper." Within six months it had covered the bottom of his foot, he said.

"I fought for a good four to five years. I tried every medication and dressing [but] at the end I was getting so much infection, I was in the hospital every two months," Dupuis told CBC Hamilton.

"It then affected my kidney [and] I had to make the decision to get rid of the leg, it was just too much."

Dupuis said getting the amputation "changed everything," adding that "it was really hard on my wife."

He said he ended up staying home for an entire year during the height of the COVID-19 pandemic because his rehabilitation centre was closed.

"Some days are really depressing … it's really hard mentally some days," Dupuis said.

But he said things have been gradually improving and he's now able to drive again. He's also been working reduced hours as a security guard.

Check your feet daily: Diabetes Canada

Maria Campbell, director of government relations for Ontario at Diabetes Canada, believes the Socks Off campaign "is a fantastic initiative" that will "help with screening for foot ulcers and complications" for those who are at higher risk.

"I think it's also going to be a great education tool for people with diabetes that proper foot care is an integral component of diabetes management," Campbell told CBC Hamilton.

Campbell is urging people with diabetes to have their feet checked daily for cuts, cracks, bruises, blisters, sores or any type of infection or unusual markings.

"People should be working and consulting with their health-care providers … to look [at] the best methods for care — whether it's through devices like insulin pumps or CGM's [Continuous Glucose Monitoring], or whether it's through medications or whether it's through access to information on … food consumption."

In 2023, 30 per cent of Ontario's population, or nearly 2.4 billion people, live with Type 1 or Type 2 diabetes or are at the pre-diabetes stage, according to Campbell. 

"Over the next decade, Ontario is facing a 25 per cent increase in diabetes prevalence," Campbell said.

In April, the Ontario legislature passed a motion to develop a framework on chronic diseases, with a focus on diabetes

Campbell said Diabetes Canada will work closely with Ontario Health to identify priority areas, one of which the organization hopes will be screening and lower limb care.

Elias said the decision was made to launch the Socks Off campaign because early detection can make a huge difference.

"We do the surgery, then there is success rate, but the goal is to talk at a much earlier stage — a preventative perspective — and that happens at the level of the primary care," he said.

"Patients with diabetes have decreased sensation in their feet, so the diabetes and the high sugars affects the nerves in the feet and so a small cut or a small injury to the foot that would normally be painful for an individual, provides no feedback and no pain to people with significant diabetes, and so this small injury may go unnoticed and that can lead to larger problems, larger sores that can get infected.

"We want to identify those small cuts early so that you can treat them … so that a small cut doesn't lead to significant infection or tissue loss or limb loss," he added.

Elias said the Socks Off campaign is currently slated to last one year and is supported by Ontario Health.