'Appalling' lack of services leading to amputations: Podiatry NZ

Podiatrists play a crucial role in helping to prevent diabetes-related amputations. Photo / Jason Oxenham

Diabetics are having legs and toes amputated because of an "appalling" lack of services, an organisation representing health workers says.

Podiatry NZ is calling for action after a Herald investigation found services in some areas buckling under a growing number of diabetics, with years-long delays and Kiwis in their 30s losing legs.

Diabetes now causes close to 1000 amputations a year, despite research showing most are preventable through early and fast access to preventative services such as podiatry care.

Jennifer Pelvin, chief executive of Podiatry NZ, the profession's membership organisation, said there were about 16 podiatrists working in hospitals and employed by DHBs.

There are 20 DHBs. Pelvin said she knew of cases where diabetics were ultimately sent for amputations because there was no other service available.

"It's pretty appalling ... they just got sent straight to the hospital for amputations. That's because there was no appropriate hospital programme to see these people."

Podiatrists who work outside of a hospital setting are called community podiatrists. In areas like Auckland, when patients are at serious risk - often because of a foot ulcer - a community podiatrist will send them for hospital-level podiatry and other care.

Pelvin said in some areas that referral option doesn't exist.

"When we talk to [community] podiatrists from some regional areas, they have no connection back into the DHB, because they are not running a foot clinic in that DHB. So they don't know where to send patients."

The podiatrist (both community and hospital) to population ratio is about 1:12,000. In Australia and the United Kingdom it's around 1:5000.

Asked what that difference meant, Pelvin said: "more amputations".

Podiatry NZ wants action to increase the number of podiatrists, including a new training school in the South Island (currently the only school is in Auckland), better internship and training particularly for those towards the beginning of their career, and immigration changes to quickly bring in senior podiatrists.

Amputation is a rare complication of poorly controlled diabetes. Over the long term, too much glucose in the blood can damage nerves in the feet and legs, and, without sensation, small injuries like blisters can go unnoticed. Reduced immunity means they can fester, and amputation is a last resort to stop infection.

Podiatry NZ chief executive Jennifer Pelvin says urgent changes are needed. Photo / supplied

Foot ulcers precede about eight in 10 diabetic amputations. The other cause is a condition called ischaemia - restricted blood flow, which starves body tissue of oxygen, causing it to blacken and die.

Podiatrists treat wounds, arrange special footwear or boots to relieve pressure. Surgeons can also be called in to open blocked arteries, or fix deformities and muscle imbalances that cause uneven weight bearing and skin to rub away.

In a three-part investigation, the Herald found lengthy delays for podiatry care that in some cases were linked to deaths. Briefings to the Health Minister show services for diabetics in some areas are at or beyond capacity, and vital preventative measures such as an annual foot check aren't being done.

There are bright spots: some DHBs have made changes including boosting podiatry care and have prevented hundreds of amputations. However, amputations in other regions have increased.

Health Minister David Clark has said amputations are "suffered by far too many New Zealanders", and diabetes and obesity are some of the "largest and most difficult health challenges we face as a nation".

Official strategies to reduce amputations and other diabetic complications will take time to show results, Clark said in the statement, and wider efforts to curb obesity were being considered. The Herald is seeking a fuller interview.

Pelvin said services were already failing, and she knew of podiatrists working in their own time, rather than turning needy patients away.

"I'm aware of one podiatrist who is employed for four days a week. She actually goes to work five days a week, because she feels overwhelmed."