Between 2004 and 2006, amputations in hospitals under the National Healthcare Group (NHG) fell by 26 per cent. Those performed under Singapore Health Services (SingHealth) dropped by 9 per cent. Over all, the hospitals performed about 950 leg and foot amputations in 2006.

Some amputations are necessary following accidents or infections, but most here are carried out on diabetics. The disease can reduce blood flow and damage nerves, especially in patients' legs and feet.

Patients lose feeling in their limbs and may not be aware they have developed wounds. When these become infected, a part or all of the affected limbs sometimes have to be removed.

Better foot care and control of diabetes - which includes keeping close tabs on a patient's blood sugar, cholesterol and blood pressure - are probably behind the fall in amputations, said Dr Tay Jam Chin, who is with Tan Tock Seng Hospital's department of general medicine.

Dr Tay, who also heads an NHG working group on diabetes-related foot problems, said: 'The results are encouraging. We hope to continue reducing the number of amputations, especially since the number of people with diabetes is expected to go up as the population ages.'

PROBLEM TRACKED 'I didn't follow (the foot-care tips). Now, I do because they keep reminding me.' MR JAYAPRAKASAM KUPPUSAMY KALIMUTHU, 60, who lost a toe, but now sees a podiatrist and a foot-screening nurse regularly

The number of foot screenings at NHG and SingHealth polyclinics has gone up.

Staff at NHG polyclinics, for example, screened the feet of more diabetic patients between January and September last year than in the whole of 2006.

Both NHG and SingHealth hospitals also do foot screening, and refer high-risk patients to podiatrists so their problems can be tracked.

Of the 5,812 diabetic patients whose feet were screened at the NHG hospitals between last June and last month, more than 350 were found to be 'at high risk' of amputation.

These patients are referred to podiatrists for monitoring and given early treatment if ulcers or other problems arise.

One such patient, Mr Jayaprakasam Kuppusamy Kalimuthu, 60, lost a toe after letting an ulcer fester.

Now, he sees a podiatrist every two months and a foot-screening nurse twice a year.

The retiree said: 'I already knew most of the foot-care tips, but sometimes, I didn't follow them. Now, I do because they keep reminding me.'

Getting patients to follow the advice can be tough, said his nurse, Ms Parimala Devi Govindasamy, 48. 'But so far, none of my patients has needed amputation,' she said.

Diabetes, which can also lead to heart disease, stroke, kidney failure and blindness, affects 8 per cent of adults here, a 2004 national survey found.

huichieh@sph.com.sg

Vigilance pays

National Healthcare Group (NHG)