Diabetics may
walk last mile
in slippas

A Big Isle surgeon says
rubber slippers might
be a factor in
foot amputations

---

By Rod Thompson
Star-Bulletin

WAIMEA, HAWAII >> Rubber slippers are part of Hawaii's culture. They're close to Hawaii's sole.

But for diabetics here, cheap slippers are not something to joke about, says a Big Island foot surgeon who has to perform amputations because of damaged feet.

Dr. Douglas Hiller says people in Hawaii have some of the most unhealthy feet in the nation, and wearing rubber slippers in combination with diabetes may be a cause.

"I'm one of the guys who cuts legs off. We're talking about whether you keep your feet and save your legs," he said.

"I was just appalled at how advanced the disease is at an early age (in Hawaii). I was seeing a lot of amputations," said Hiller's colleague Dr. Susan Sanderson, who arrived in Waimea about a year ago.

Diabetes is a much bigger problem in Hawaii than on the mainland. The ongoing Native Hawaiian Health Research Project being conducted in North Kohala has found that people of Hawaiian, Filipino, and Japanese ancestry are three to four times more likely to have diabetes than Caucasians.

As diabetes advances, circulation in the foot slows down and nerves in the foot go dead.

Hiller tells horror stories, like the one of the man walking around with shoes, not realizing he had a soda bottle cap crushed into the bottom of his foot. He noticed a problem only when he found blood in his shoe.

Dennis Yamada, a physician's assistant who works with Hiller, points out that the same problem can come from kiawe thorns or other foreign bodies stuck in the foot while a person wear slippers.

Even the normal foot absorbs three to six times a person's body weight with every step, Hiller says. That's a tremendous force with a 300-pound person whose feet are already damaged by diabetes.

The solution is relatively simple. The best footwear is running shoes, Hiller says.

High quality slippers, such as those sold in surf shops, are good too, although they can cost $20.

If $20 sounds like a lot, Hiller said that's cheaper than a $300 pair of custom diabetic slippers, and a lot cheaper than $30,000 for surgery.

Still, there's no actual data on those $20 slippers. So Hiller is seeking a $25,000 grant to study how footwear affects diabetics, using a machine that reads pressure patterns on special inserts that can be placed between the wearer's feet and slippers.