Saving feet

It’s one of the most dreaded complications of diabetes and vascular disease: foot sores. If left untreated, these sores, also known as diabetes foot ulcers, can lead to foot and lower leg amputations. According to Diabetes Canada, amputations of a lower limb occur once every four hours in Ontario alone. Over 85 per cent of these amputations could have been avoided. 

UHN Chiropodist Titilola “Titi” Manning-Atwell is determined to save as many limbs as she can. A veteran in the field of chiropody for more than 44 years, she has handled the most difficult chiropody cases at UHN. 

Chiropody is a regulated healthcare profession that focuses on the assessment and management of the foot and foot related conditions. Treatment is achieved through a medical, surgical or palliative approach. Source: The Michener Institute of Education at UHN.

“I was worried about what would happen to all of Titi’s knowledge and experience if she ever decided to retire,” Leo Goldhar recalls. So he and his wife Sala decided make a major investment in chiropody training in memory of a dear friend.  

Launched in 2019, the J. Douglas and Tennys Hanson Foot and Wound Care Clinic is a partnership between the Michener Institute of Education and the Vascular Clinic in the Peter Munk Cardiac Centre. This goal of this partnership is to expand the capacity for specialized foot and wound care through to a new fellowship training program at the Michener Institute, allowing Titi to pass along her expertise and experience to a new generation of advanced practice chiropodists. 

The first fellow, Maryam Dadgar, has already had an interesting career journey. Originally from Iran, Maryam practiced as a family physician for over 15 years. “At the time, I didn’t have a full appreciation of just how important the foot is to overall health.” 

When she came to Canada almost 10 years ago, she was determined to put her medical background to good use. After extensive research, she decided to become a chiropodist and completed a three-year program at the Michener Institute in 2018. She had been working in private clinics and at Women’s College Hospital when she found out about the fellowship. 

Maryam Dadgar is the inaugural Advanced Foot and Wound Care Fellow in the J. Douglas and Tennys Hanson Foot and Wound Clinic..

Maryam started the clinical part of her study in February 2020 at the J. Douglas and Tennys Hanson Foot and Wound Clinic at Toronto General Hospital.  Under Titi’s guidance, Maryam learned how to form and apply a special pressure relief padding to the bottom of the foot – an offloading technique designed and perfected by Titi. Unlike traditional plaster casts, this padding, made of felt, is more comfortable and well-tolerated by their patients, and reduces pressure on the foot by over 50 per cent. Maryam recalls treating a man who had one foot amputated and was in danger of losing his remaining foot. She saw him weekly and noted a marked improvement in his condition thanks to the padding and Titi’s special touch.  

Now that Maryam has completed her fellowship, she is hoping to work in a hospital setting and apply the knowledge she gained from Titi to help save the limbs of people who are living with serious foot wounds. 

 “I would not have been able to learn from Titi if I did not have this fellowship opportunity. I hope to share this knowledge and help other patients so they can keep their mobility and quality of life.” 

Fast facts about diabetes and amputations:

  • Over 1.6 million Ontarians have diabetes.
  • 16,600 – 27,600 people are expected to have a Diabetic Foot Ulcer (DFU) in one year alone.
  • Diabetes foot ulcers are the leading cause of limb amputations.
  • 2,000 people are expected to need to have a lower limb amputated in a single year.
  • 85% of amputations are related to non-healing wounds.
  • 85% of amputations are preventable.

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