October 10, 2023 Ready to take your socks off?

“Diabetes doesn’t care if you’re young, old, thin or overweight,” says 47-year-old Steve Jennings, who lives in lower Hamilton, Ont., and was diagnosed with type 2 diabetes in his early 20s. “You may not experience symptoms for years, but when they do show up, they can be severe, persistent and irreversible.”

Ontario has among the highest rates in the world for diabetes-related foot amputations, with lower Hamilton having the highest rates in the city. Hamilton Health Sciences, together with the Greater Hamilton Health Network Ontario Health Team, launched the Socks Off! campaign in July 2023, with the goal of reducing the number of lower Hamilton residents who are at risk of losing a lower limb to amputation due to diabetes and/or vascular disease.

The campaign, which is aimed at family doctors and other healthcare providers in Hamilton’s downtown core, encourages them to routinely check the bare feet of their patients with diabetes and vascular disease. (That’s why the campaign is called Socks Off!) Steve, who is a patient ambassador for the campaign, shared his experiences with diabetes complications, including a limb amputation, to help raise awareness.

A serious illness

Steve says it can be easy to ignore a diabetes diagnosis, especially for people who aren’t experiencing symptoms. “It wasn’t impacting my lifestyle in any way, so I didn’t take steps to manage it. I was a young man. I didn’t think having diabetes would affect me.”

Ten problem-free years went by, then one night after refereeing a hockey game, Steve noticed a blister on his right foot. Poor circulation—a complication of diabetes and vascular disease—can lead to serious problems from something as simple as a cut or crack in the skin. When a person with diabetes sees any sign of a wound developing, they’re advised to get off their feet completely and immediately, and call their doctor. Unfortunately, Steve didn’t know this. Soon, blisters developed on both his feet, morphing into multiple, limb-threatening ulcers.

“From there, things just got worse and worse,” he says. While his right foot eventually healed, he experienced years of persistent, serious diabetic ulcers on his left foot.

By now, Steve was taking medication to manage his diabetes and trying different treatments, including surgery, to heal his foot, but nothing worked. His foot’s inability to heal (combined with unrelenting, excruciating pain) led Steve and his doctors to make the difficult decision three years ago to amputate his left foot.

If I had known more about diabetes when I was younger, taken my medication regularly and kept a close eye on my feet, things could have been very different. I wish I had taken it more seriously. By sharing my story I’m hoping to help others.

Exhausting options

Steve’s diabetic wound specialist, Dr. Perry Mayer, is helping to lead the Socks Off! campaign. Dr. Mayer is medical director of The Mayer Institute in Hamilton, a centre of excellence in treating the diabetic foot and its complications.

“Dr. Mayer did everything possible over the years to try and save my foot,” says Steve, who spent six years trying treatments that included wearing a special boot called a Charcot restraint orthotic walker (CROW), a total contact cast, and a knee walker to help diabetic ulcers heal by reducing pressure at the wound site.

Before the amputation, Steve underwent surgery for Charcot foot, a complication of diabetes-related nerve damage that causes deformity and can make injuries or infections much more serious. “I went through an extensive reconstruction of my left foot which came with a year of recovery [from the surgery],” he says.

New normal

Before experiencing diabetes complications and an amputation, Steve played baseball and hockey, and also refereed both sports. Diabetes also took a toll on his mental health because he was no longer able to play the sports he loved.

“Mentally it’s extremely hard to go through all this,” says Steve. “I’ve tried skating since my amputation, and it was like I was four years old again and going out on the ice for the first time.”

He plans to try it again, along with sledge hockey, which he has tried before and enjoyed. He has also umpired baseball since his amputation. “Life certainly isn’t over because of the amputation, but it definitely changes how you do things.”

Staying healthy

Steve checks his right foot daily for cuts, blisters, cracks, calluses or other sores that could lead to a serious ulcer and amputation. He also sees Dr. Mayer every six weeks for ongoing monitoring.

People with diabetes may not be aware of foot injuries because they’ve lost feeling in their feet from abnormal blood sugars attacking the sensory nerves. This condition is known as diabetic peripheral neuropathy, or nerve damage. However, by following these three steps every day, 85 per cent of diabetic foot problems can be prevented:

1. Always wear properly fitted shoes, even indoors. Shoes protect your feet from wear and tear or cuts that could lead to infection or amputation.

2. Moisturize your feet every day to keep skin supple, so it’s less likely to crack or break. This helps prevent an ulcer from developing that could lead to a potential amputation.

3. Look at your feet every day, including in between your toes. If you see any sign of a wound developing, get off your feet right away and make an appointment with your healthcare provider.

If you live with diabetes, it’s important to take the initiative and ask your primary care provider for a foot check during your appointments. One recommendation: as soon as you get into the examination room, take off your socks. It’s a reminder for your doctor to check your feet, and it saves time, too.

Photo: Josh Carey, Hamilton Health Services

Reprinted with permission of Hamilton Health Sciences © 2023.

Did you know?

Diabetes is the leading cause of non-traumatic lower limb amputation in Canadian adults. Diabetes Canada is actively advocating about amputation prevention. The Hamilton Health Sciences’ Socks Off! campaign and patient ambassador story support Diabetes Canada’s recommendation for healthcare providers to conduct regular foot checks and provide education on foot care to people living with diabetes.