Some Assembly Required: Foot Care for Persons with Diabetes in Ontario, Canada.

Abstract

There is a compelling need to institute a paradigm change in the care of the feet of peoplewith diabetes. The CanadianDiabetes Association has estimated the direct cost of diabetes in 2014 for Ontario, Canada, to beCAN$5.8billion, and it is expected to goup to $7.6 billion by 2024 (1). Of themany complications of diabetes, only stroke care is more costly than care of diabetes-related foot ulcers (DFUs) (2). The cascade of diabetes-related foot problems typically begins as callouses, which give rise to ulcers, then move on to infections, complicated wounds, amputations and rehabilitations, resulting in more days in hospital than all the other diabetes-related complications combined (3). “Differences in amputation rates among and within countries,” affirm leading experts, “are less related to insufficient resources or types of comorbidities than to attitudes and systems of healthcare organization” (4). Multidisciplinary teams have conclusively demonstrated their effectiveness in reducing the complications resulting fromDFUs (5,6).