Please choose one
Easy choice right? Not for the Government of Ontario Canada. The vast majority of the 2,000 amputations that occur per year in that country would be preventable with common offloading practices (total contact casting*). Doris Grinspun, CEO of the Registered Nurses’ Association of Ontario was assured three years ago by government ‘premieres’ that they would begin to cover such procedures … that’s three years or 6,000 legs or $420,000,000 ago. “We’re willing to pay for the amputations but we’re not willing to pay for the prevention,” offered Grinspun.
Cost and human suffering aside, mortality rates jump significantly after an amputation especially in older patients, diabetes further increases mortality rates. In one rather grim study** 390 patients that had undergone lower extremity amputations were reviewed, of the patients with diabetes “the median time to death was 27.2 months“.
So if you are suffering from diabetic neuropathy and experience a diabetic foot ulcer and happen to be living in Ontario Canada you need to get your affairs in order. But there is hope as The Ontario Health Technology Advisory Committee is currently assessing total contact casting to treat foot ulcers, check back in three years.
*total contact casting is considered “The Gold Standard of off-loading”. A comparison of the three major off-loading methods (total-contact casts (TCCs), removable cast walkers (RCWs), and half-shoes) reinforces this point. The proportions of healing for patients treated with TCC, RCW, and half-shoe were 89.5, 65.0, and 58.3%, respectively. A significantly higher proportion of patients were healed by 12 weeks in the TCC group when compared with the two other modalities.
**Mortality and Hospitalization in Patients After Amputation
Off-Loading the Diabetic Foot Wound
A randomized clinical trial