Undiagnosed diabetes was a factor in my lower right leg amputation, and when I was entered into hospital, I had an extremely high blood sugar level. The doctors and nurses told me they had never seen such a level. In Australia, diabetes is the most common non-traumatic cause of amputations, and that is why an upcoming episode of The Limb Shift podcast will be dedicated to exploring this critical condition.
On Christmas Eve in 2015, Peter Stringer walked around all afternoon and evening in bare feet on bitumen in Adelaide. Because he had unmanaged diabetes-related neuropathy, he could not feel the bottom of his feet. Reflecting on that fateful night and his failure to notice the danger, he told me:
“I’ve been running around all afternoon and evening in bare feet on bitumen, and didn’t realize I had no feeling in the bottom of my feet. And it wasn’t until about one a m I went into the house and dad freaked out because I was leaving footprints of blood all over the carpet.”
Peter did not go to the doctor initially. When the exact same thing happened at his sister’s house on New Year’s, he finally decided to look at what was going on with his feet and found big blisters and burns. Still, he decided he did not need to see a doctor and could fix it himself. He performed a nightly routine of rubbing Salvon over his feet, bathing them in salt water, and wrapping them up in bandages.
Eventually his left foot healed, but his right foot did not. After falling severely sick, feeling like he had the flu, and noticing his toes turning black on his right foot, his father noticed and insisted on taking him to a doctor immediately. The doctor took one look at his foot and told him to go straight to the hospital. Transferred to the Royal Adelaide Hospital by ambulance, Peter was wheeled into emergency surgery on Australia Day in 2016.
He came out of that operation missing the middle three toes of his right foot. He later found out that if he had not gone to the hospital when he did, he would have been dead in probably seventy odd hours from sepsis. He stayed in the hospital for two weeks, undergoing two more operations, including a guillotine amputation that removed his big and little toes, leaving him with just his heel and half his foot.
Months later, when facing the prospect of further infections and a below-the-knee amputation, Peter read The Complete Guide for Amputees cover to cover and accepted the situation, noting, “I’ll be fine. Life goes on. It’s all good.”
When ulcers appeared on his second foot in 2020, he chose to bypass lengthy treatments and requested a direct below-the-knee amputation rather than wearing a boot for months and risking his job. When a doctor argued that he did not understand how life-changing an amputation could be, Peter recalled:
“And I just threw the blanket over my leg off my stump, and I went, really? I’ve been there. I don’t want to have the whole thing done again. I said, I know other bilateral amputees and I know it is more difficult, but this is my decision.”
Tanya Hosch, a prominent figure in social justice for Aboriginal and Torres Strait Islander matters, experienced a similar journey in Adelaide. In 2020, in the middle of the COVID-19 pandemic, she was diagnosed with Charcot foot related to diabetes. Describing the sudden and shocking impact of the condition, she noted:
“In twenty twenty, in the middle of Covid, I was diagnosed with a condition I’d never heard of called Charcot foot related to diabetes. And the first course, of course, of treatment is to stop weight bearing immediately. I got a terrible shock when this all came about. I’d never heard of it. In fact, I’d previously been diagnosed with plantar fasciitis, which was a misdiagnosis.”
To save her leg, she sought a second opinion and found a surgeon in Adelaide open to working with her towards a foot reconstruction. That process took about two years of intensive surgery, spending most of her time on a knee scooter or in a wheelchair, with moments in moon boots and lots of casting that had to get changed every week.
When Charcot developed in her ankle, leaving her with the prospect of a right leg three to four centimetres shorter than her left and the inability to walk around the house or on the beach without shoes, she decided to proceed with an amputation. Reflecting on her swift decision-making process, she explained:
“And so for me, that made it really clear. So I said to my surgeon, I think it’s time that we amputate. And I took a weekend to make the decision, told her on the Monday and had the amputation on the Friday.”
Medical experts provide crucial context on how these devastating conditions develop and why they are so prevalent. Associate Professor Peter Lazzarini, a podiatrist by background who serves as a principal research fellow in Brisbane and is a world expert in diabetes-related foot disease research, explained the underlying mechanism behind diabetic foot ulcers:
“Once you get that nerve damage, you get a higher chance of developing trauma without being able to feel it. And it’s often just normal, everyday trauma… without that gift of pain, they, they don’t feel that inflammation, that inflammation is just allowed to continually build up just by everyday walking over a long period of time.”
Lazzarini also noted the striking gender statistics, stating that studies consistently show two-thirds male and one-third female patients, explaining that males tend to have slightly more risk factors along the pathway, taller statures that stretch nerves, higher smoking rates, and a tendency to adopt a “she’ll be right mate” mentality that leads them to ignore painless wounds.
Dr Rob Commons, a medical doctor who previously worked as a junior doctor in Darwin where he managed foot infections alongside his wife (who was a surgical trainee) and later practiced in regional areas like Ballarat, shared his clinical perspective. He noted that patients frequently present late and detailed the specific microbiological challenges of diabetic foot infections:
“With diabetes, there’s a often a broader array of bugs of, of bacteria. So there’s bugs called gram negative bugs and anaerobes. And this can make, it can make it harder to treat because you can’t often, if it’s been there for a little while, you can’t just treat with the standard narrower antibiotic.”
Commons also discussed the clinical shift in treatment over the last ten to fifteen years, noting that while infections were once treated with prolonged intravenous courses, studies on bone and joint infections have shown that shorter courses and oral antibiotic tablets are often just as effective, though offloading pressure remains critical.
Dr Sue Radd, a specialist in lifestyle medicine and nutrition who runs culinary medicine cookshops within her clinic’s teaching kitchen and authored the award-winning book Food as Medicine: Cooking for Your Best Health (which was awarded Best Health & Nutrition Cookbook in the World for 2016 by Gourmand in France and showcased at UNESCO headquarters in Paris) as well as Food as Medicine: Cooking to Prevent and Treat Diabetes, offered an inspiring message of hope regarding disease progression:
“That’s old thinking. That’s what we used to think, you know… We now have really good scientific evidence that people have much more power in their fork and their spoon than they ever could have imagined… You can drastically slash that progress. You can slow the disease process down. And we can even put type two diabetes into remission.”
Radd explained that type 2 diabetes does not have to be an inevitable, progressive sentence, noting that removing excess visceral fat from organs like the liver and pancreas through early lifestyle changes, eating whole and unprocessed plant foods, avoiding ultra-processed foods, and timing meals to protect circadian rhythms can help patients reclaim their health.
The Limb Shift will premiere during Amputee Awareness Week in Australia on October. You will find episodes here, as well as Spotify, Apple podcasts and YouTube podcasts.
