‘Always check your feet’, Elvis warns after infected toes amputated – Sydney Morning Herald

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Foot amputations are on the rise among Australians with type 2 diabetes as new research shows a 57 per cent increase across the country over a decade.
Lower limb amputations rose year-on-year, from 1717 in 2010-2011, to 2699 in 2018-2019, the study by Baker Heart and Diabetes Institute showed. Overall, more than 20,000 people with type 2 diabetes became amputees over the decade.
Elvis Fields needed two of his toes amputated after they became irrevocably infected.Credit:Wolter Peeters
Type 2 diabetes can cause damage to the nerves in the feet and affect blood and circulation, which makes it harder for cuts and sores to heal, increasing the risk of foot ulcers and amputations.
The rate of so-called “lesser amputations” (where the toe or part of the foot is removed) accounted for the rise in the rates of amputations overall, increasing from 73 per cent to 83 per cent of all amputations among people with type 2 diabetes over the study period.
The rate of major amputations (above the ankle) was stable, the research funded by Diabetes Australia Research Project showed.
Diabetes-related foot ulcers and lower limb wounds account for 10,000 hospital admissions in Australia every year, national data shows.
Diabetes Australia Group chief executive officer Justine Cain said 85 per cent of diabetes amputations are preventable if problems are detected early.
“Many people living with diabetes aren’t aware of their increased risk of foot problems,” Cain said.
Professor Stephen Twigg is an endocrinologist and clinical lead of Foot Forward, a website that offers people with diabetes advice about how to look after their feet. He said Australia’s ageing population was a contributing factor to the rising rate of amputations, given the greater risk of nerve damage and arterial disease the longer that people live with type 2 diabetes.
“But it’s not the only explanation,” he said. “This is quite a significant increase.”
Elvis Fields, 65, remembers walking through the dry dirt of Lightning Ridge in north-west NSW in temperatures well above 45 degrees in 2000. His thongs kept slipping off, so he’d scuff his feet to get them back on, pushing the rubber between his toes.
“In a few days, they got really badly infected. I came back to Sydney, and they tried to save them, but they couldn’t,” he said.
Fields needed two toes amputated. He also developed Charcot foot – a diabetes complication that has left his foot deformed.
“It drove me into major depression,” he said.
“Getting around is really difficult. I used to go swimming at the beach, but I don’t go any more because it’s too hard to walk on the sand.”
It took a few years for Fields to come to terms with the amputations, but he got there, he said. His message to other with type 2 diabetes, “Always check your feet.”
The study found men were more likely to need amputation than women, and national data shows Aboriginal and Torres Strait Islander people have a fourfold higher rate of amputations.
Separate NSW data shows poorer people outside metropolitan cities were at greater risk than city dwellers with better access to specialised diabetes care.
Twigg urged anyone with type 2 diabetes who developed a foot ulcer to seek a referral to a specialist high-risk foot service. He said all type 2 patients should have their feet checked annually.
The study involved more than 1 million people with type 2 diabetes and more than 70,000 with type 1, and was published in the journal Diabetes Care.
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