A proper podiatric programme has the potential to reduce the number of diabetic patients who face diabetic ulceration and amputation. However, South Africa currently has a shortage of podiatrists. There are only about 45 such professionals in the country’s public health sector, and only one school of podiatry on the African continent.
Podiatrists, being those healthcare professionals who specialise in foot care and the treatment of problems affecting the lower limbs, play an important role in reducing diabetes-related amputations.
One of the complications of living with high blood sugar for a sustained period of time is diabetic neuropathy, which is damage to the nerves as a result of diabetes, according to afact sheet on the disease. This can cause tingling, pain, numbness or weakness in the feet and hands, and when combined with reduced blood flow, increases the likelihood of foot ulcers and limb amputation.
Around the world, a diabetic foot ulcer is reported about once every 1.2 seconds, with 15 to 20% of patients with diabetes developing diabetic foot ulceration, said Pincus. There is an amputation related to diabetic foot ulceration about once every 20 seconds. “Unfortunately, the need for emergency surgery in diabetes is a surrogate of poor diabetic care,” said Kloppers. “Education and access to basic interventions like diet modifications seem limited. We do not have access to podiatrists for ongoing diabetic foot care to prevent these adverse outcomes, nor to an orthotic service post-surgery for shoe modification.”
There is only one school of podiatry in South Africa, and indeed, on the entire African continent, being the podiatry department at UJ, according to Ntuli. The department provides a four-year Bachelor of Health Sciences degree, accepting 37 students into the first year of study each year. Of those, between 25 and 35 graduate.
Brian Anthony Abrahams, a Cape Town resident, said that he has visited a podiatrist and a wound care specialist since he underwent a diabetes-related amputation in 2006. All of the toes on his left foot needed to be amputated after he knocked a toe on a rock after swimming and developed an infection.
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