Author Archives: Andrew

Diabetes, your feet and the podiatrist

So many foot problems could be prevented if people with diabetes had their feet thoroughly examined by a podiatrist. Worldwide, guidelines for the management of diabetes recommend an annual foot examination at the very least.

Today we celebrate World Diabetes Day. What a pity that so many people with diabetes wont feel like celebrating because they suffer some foot complications. This can be as simple as a painful corn or as complicated as an amputation.

As a podiatrist I would like to be celebrating an improvement in the foot health of South Africans, but unfortunately many people with diabetes have never seen a podiatrist, mistakenly believing that since they have no visible foot problems everything is fine.

Diabetes causes changes to the circulation and nerves to the legs and feet which often develop slowly and almost without notice. Recently I have heard people say that they have the less serious diabetes “the second type”!

Managing diabetes is a team effort and the podiatrist is a member of the team. If you neglect your feet and have no idea if they are showing the effects of diabetes, you are probably going to develop, corns, callus, blisters, ulcers and worse. Do you know the quality of your circulation? Are you sure you can feel everything with your nerves?

Why not commit to better foot health today by making an appointment with a podiatrist for a diabetic foot assessment?

World Diabetes Day 2014 – Act Today to Change Tomorrow

Friday November 14, 2014 is World Diabetes Day. This year’s campaign is the start of a three-year focus on healthy living and diabetes. Look at these facts:

2014 = an estimated 382 million people living with diabetes worldwide. Plus 316 million at high risk of developing type 2 diabetes

2035 = an estimated 592 million people. That’s one person in ten.

This is a pandemic of giant proportions and what makes it more threatening is that throughout much of the world diabetes remains hidden – with up to half of all people with diabetes globally being undiagnosed.

Most cases of type 2 diabetes can be prevented and the serious complications of the disease avoided by following a healthy lifestyle.

The campaign has key messages on possible lifestyle choices and taking informed decisions on healthy choices.

I think that in the developing world we have serious problems with access to appropriate health care, arising from poor governance, the burden of poverty and the dissemination of relevant health information. The is definitely true in South Africa today.

I will be supporting this initiative from the point of view of the role of the podiatrist in developing and implementing appropriate strategies for the prevention of diabetic foot complications, such as foot ulcers and amputations.

Diabetes, Dialysis and the Diabetic Foot: a timely reminder

On July 28 2008, on this website I wrote about Dialysis and the diabetic foot, with a description of a foot ulcer patient.

Last week I was invited to speak to patients of the Cape Town Dialysis Clinics about foot care; during my preparation I came across some startling evidence proving that dialysis is an independent risk factor for foot ulceration if you have diabetes and require dialysis.

We already know that impaired kidney function increases the risk of foot ulcers – also referred to in my 2008 Blog – but this 2010 research proves that:

If you have diabetes and are receiving dialysis, you are 5 times more likely to develop foot ulcers, compared to someone with diabetes who is not on dialysis.

Scary but true clear evidence from a study completed at Manchester UK.

The research showed that patients on dialysis have more nerve damage, circulatory problems and a history of foot ulcers and amputations.

There is a 25% lifetime risk of people with diabetes developing foot ulcers so the key issue whatever your status is prevention.

Diabetic foot ulcers have multiple causes, some are: external trauma from footwear, neuropathy, arterial damage, poor self-care, lack of access to care, poor treatment.

However, as with all research you must ask – “so what?” This patient group did not include any people of colour, so it may not apply totally to South African patients.

So what to do? our objective is always to PREVENT complications.

Every person with diabetes must have an ANNUAL FOOT EXAMINATION so that they understand their level of risk for developing foot complications.

in addition individual education on self management of their diabetes. this is a team effort, paying attention to cardio-vascular health, eyesight, footwear selection and fitting, foot biomechanics (and possibly insoles or orthotics), plus probably the most important factor – can you invest in the care being offered?

Always “take care of your pair”.

New Podiatry Surgery Locations For Andrew Clarke

I'm glad to be able to tell my patients that I am now offering podiatry services from 2 locations in Cape Town and Hout Bay.

You can find the new podiatry surgery locations together with opening times (in Wilderness Road, Claremont and Victoria Avenue, Hout Bay) on my Contact page.

For my patients I have regretfully had to leave behind in Johannesburg, please see my last post here with details of my podiatry colleague, Louise Stirk, who has kindly taken over your continued care.

Where did Andrew go? Help for lost ‘soles’ – introducing Louise Stirk

After months of searching I am very pleased to be able to inform all my Johannesburg patients that their files will be taken over by Louise Stirk, who practises in Woodmead. Louise has a wide range of fields of interest and they dovetail nicely with my own.

Contact Louise on 011 844 0400

Sadly the Wits Donald Gordon Medical Centre has not been able to offer even sessional rooms to any podiatrist, despite attempts by colleagues. Therefore, there is no longer any podiatry service available there.

For details of my current practice locations in Cape Town and Hout Bay please click here for my Contact page.

Holiday Foot Health

Foot health care needs to be checked if you are going away for Easter.Wherever you go, you are probably going to spend more time on your feet! Most of you will be OK and recover quickly from the aches & pains of that long walk on the beach,in the Bush or mountains.It might even be running some extra kilometres because you have time off!Often it is that extra round of golf!
To prevent foot problems, make sure you have the right footwear for what you are doing. That romantic barefoot walk on the beach can be ruined if you develop pains in the soles of your feet( plantar fasciitis), so use your takkies for some of the time.
Watch out for blisters caused because your shoes were rubbing. Don’t open or burst them, rather put a plaster firmly over the area to bind it down for a few days until it dries up. If you really have to open them use a clean instrument and immediately put on an antiseptic dressing with gauze.
Don’t forget it is easy to get sunburn on the tops of your feet if they are usually covered up at work!

Just a few thoughts to help you to enjoy your break.

South African Podiatry Association Biennial Congress 2011

The South African Podiatry Association (SAPA) will be holding their Biennial Congress from 29-31 July 2011, at Khaya Ibhubesi, Parys, in the Free State. The theme of the congress is Developing You – Promoting Podiatry. An interesting mix of lectures, expert panel discussions and papers has been planned. For more information, contact the Congress organiser Ken Richards at Excel Solutions. Tel: 083 753 2937. Fax: 086 671 4444. Email:

Kameeldoring tree:A rare Bush injury?

Walking in the Bush can be one of the joys of living in Africa. However, it does have its drawbacks apart from the animals you may encounter!

Last week a young man came in as an emergency, telling me that whilst walking in the bush, a thorn had gone into the inside of his left ankle. The thorn was removed completely and initially there was no pain, but about 4 hours later it was excruciating. The thorn was from a tree called in Afrikaans Kameeldoring, one of the Acacia species, certain of which are poisonous.

A local Doctor prescribed antibiotics for 10 days, but now, the foot was still very painful and only relieved by taking an anti-inflammatory every 8 hours.

Examining the site of entry(parallel to the ground and straight into the medial malleolus – that’s the lump on the inside of your ankle), – there was no inflammation, but lower down towards the arch there was some swelling and inflammation.

Standing on tip-toe was painful so initially thought of damage to the Tibialis Posterior Tendon. However, the pain was described as …”burning and running over the bridge(arch) of my foot.” As I palpated down the foot towards the sole, it was possible to create the pain, which also went “into the foot”.

A Sonar scan was ordered which showed some fluid collection around the tendon when compared to the right foot. No other pathologies were detected, such as a foreign body, thrombus, tendon tear etc.

So what is the provisional diagnosis? Possible trauma to the Tibial nerve. The diagnosis is based on the nature and site of the pain described, plus the fact that the Tibial nerve runs in the area where the thorn penetrated the foot. For the time being the treatment is local ice and continue with the anti-inflammatory.

Free Diabetic Foot Screening

Free foot screenings for people with diabetes are still available from certain podiatrists nationwide this week. Due to the demand, in our practice we will still offer them during next week too.

Protecting your feet from the complications of diabetes is a serious responsibility.

Managing your diabetes is the foundation of protection against complications that affect your eyes (Retinopathy), kidneys (Nephropathy) and feet (Neuropathy).

Feet can be severely damaged by diabetes and yet they are painless. This allows injuries to occur undetected and often leads to ulceration and amputation.

The purpose of the FREE FOOT SCREENING is to establish your risk level for developing foot complications, because many foot injuries can be prevented by being informed about the status of your feet.

Even people with severe loss of sensation can and do avoid problems by a combination of good blood sugar control and regular foot  inspections by a podiatrist.


World Diabetes Day – November 14 2010 – Foot Screening

World Diabetes Day takes place every November 14th. Diabetes is a serious chronic disease. It is estimated that 250 million people worldwide have diabetes (about 6% of the adult population between 20 -79 years). This number is expected to reach 380 million by 2025, (7.1% of the adult population)

Every 30 seconds a leg is lost to diabetes somewhere in the world!

Many diabetic foot ulcers and amputations can be prevented

Starting this week podiatrists nationwide will be promoting foot health awareness in various ways as their contribution to preventing the complications of Diabetes.

Check your local press for details of free screenings, talks, fun walks etc., often with Diabetes SA.

In our practice free screenings can be booked via Lauretta. 011 726 6363.

Nationwide contact the South African Podiatry Association; 011 7943297

Screening is a short observation of key signs to identify the risk level of your feet.

Not every person with diabetes is at risk, but some are and have no idea that they are.

If you know that you are at risk, the podiatrist will become a key person in your life.

Act now – your life might depend on it! 

Take this opportunity to finf out your risk status.

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