Marilyn Engel is back on her feet again and the 71-year-old Barrie woman is mighty glad. As a diabetic she knows amputation is often a slippery slope – once you lose one toe the rest often follow.This was out of the question for Engel and she fought the good foot fight. Her number one weapon for winning this war is Jonathon Clarke, a chiropodist at Royal Victoria Hospital. “I’ve had diabetes since I was a young woman and always controlled it through daily medication and diet. There was nothing I couldn’t do until just the last few years when I began to have problems with my feet,” says Engel. While living in another community her feet got so bad she had to have two toes on her left foot amputated. Soon, the next toe wasn’t looking too healthy either and that’s when Engel said ‘enough is enough.’ “I was mad and angry,” says Engel. “I thought, ‘What do I do now?’ If I keep losing my toes one by one, then soon it will be half my foot and then half my leg and so on,” says Engel. Then she moved to Barrie and was introduced to Clarke who believed that through proper wound care Engel would be able to keep the rest of her toes. He was right. According to Clarke, almost half of all diabetics have their first hospital admission because of a foot ulceration or infection, and 20 per cent of all diabetic hospital admissions are foot related, and even more shocking, every 30 seconds someone loses their leg due to diabetes. “The reason the diabetic foot is potentially at such risk is due to two main reasons – sensation loss and circulation loss,” says Clarke. Now for the good news. Most ulcers can be avoided and prevented with good diabetic health, good footwear, checking the feet daily, seeing a healthcare provider regularly, good diabetic foot care and education, and contacting a provider immediately if complications arise.” As a member of the RVH Chronic Disease Management Clinic team, Clarke works with patients who have high risk foot issues. Last year, RVH logged more than 3,000 foot clinic visits and 3,000 diabetes visits in hospital. At the diabetic foot clinic, Clarke provides wound care, including appropriate reduction of any non-viable tissue, offloading of pressure, dressing management, wound prevention, yearly foot assessments, orthotics and footwear options as well as diabetic foot education. And Engel can’t stop singing his praises. “He’s my favorite chiropodist and I’ll be a patient of his for the rest of my life. He’s keeping me on my feet.” And this is important to Engel, who just a year ago moved to Barrie to live with her daughter and son-in-law and their two small children. She loves to be surrounded by family and enjoys her grandchildren so much more now. Had she not seen a chiropodist, she has no doubt the quality of her life would be drastically altered. “Having a long-lasting chronic health condition can profoundly impact a person’s physical, mental and emotional health,” says Mark Grabner, RVH Manager of the Chronic Disease Management Clinics. “Clinics such as Stroke Prevention, Chronic Obstructive Pulmonary Disease (COPD), Asthma, Heart Function, Internal Medicine, Diabetes and Chiropody, enable people with these serious chronic conditions to receive ongoing specialized care and remain healthier than they would with no intervention.” Referral for these programs, from a health professional, is required. Priority patients are those who have had recent admissions to RVH or the Emergency Department, those without family physicians and patients without access to the above services in the community. “The goal is to keep these patients at home and out of hospital,” says Grabner. “Our expertise will enable patients to enjoy greater quality of life while gaining valuable knowledge in the fight against their chronic diseases.” It is a fight Engel will continue with fervor. “These are my toes and the doctors can’t have any more.” And if Clarke has his way, those toes will stay right where they belong.