LOWER-LIMB PRESERVATION STRATEGY
CorHealth Ontario (CorHealth) is excited to announce its Lower-Limb Preservation Strategy (LLPS) with the following goals:
Foundational components of the LLPS are the Ontario Framework for Lower-Limb Preservation, an evidence-informed best-practice roadmap, and accompanying Change Package of ideas, tools and resources. For more information and to view and download LLPS resources, please visit our CorHealth LLPS website.
CorHealth is engaging with demonstration programs from across the province to test implementation of the LLPS. We invite you to attend a provincial webinar to learn more about joining us to save lower-limbs. Please forward this message to your lower-limb preservation colleagues and networks and invite them to join you.
Every year in Ontario approximately 1200 people have a major lower-limb amputation that arises from complications of vascular disease and/or diabetes, with annual direct health care costs of approximately $70-105 million.
Successful implementation of organized, integrated lower-limb preservation efforts has shown tremendous reductions in amputation rates (up to 85%), saving millions in health care dollars, and most critically, providing standardized best-practice lower-limb saving care to patients and communities.
NOTICE TO PATIENTS AND THE PUBLIC ABOUT THE "PODIATRIC CAP"
Because of legislation passed over three decades ago, since July 1993 no new podiatrists have been able to be registered to practice in Ontario. No other health profession in Ontario has ever been restricted in this way. It's highly discriminatory and it makes no sense, particularly in today's world when we are facing real human resources deficits in the health professions. It also makes no sense because more podiatrists could keep more people out of hospitals and, thereby, help solve "hallway medicine" and long waiting lists for hospital care that the Ford government claims to want to fix. Since about 60% of podiatrists' patients are 55 years of age or older, the impact of the growing lack of podiatrists is felt particularly by seniors. Nursing homes, retirement homes, home care and supportive housing for seniors are constantly complaining that they can't find enough podiatrists to take care of their residents and patients.
Due to this podiatric cap (as it's called) the podiatry profession is getting smaller and smaller in Ontario and will soon disappear entirely. Today, Ontario has the lowest ratio of podiatrists to population compared to anywhere else in the developed world . The time will soon come when you will lose your podiatrist and will not be able to find another . Time to fix this very difficult situation is rapidly running out.
JOIN CMPA FOR THEIR NOVEMBER 2021 VIRTUAL CONFERENCE
JULY 5TH IS NATIONAL INJURY PREVENTION DAY
NOT registered yet? There's still time!
Join CPMA & Wounds Canada For Their 3rd Annual Limb Preservation Symposium
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.