Our Project - shoes and footcare education for diabetic and leprosy patients

For the IHOP program Annie and I both have to do a preventative public health project. We were quite stressed over the last couple weeks trying to figure out what we were going to end up doing. At first we wanted to do something with HIV/AIDS or malaria, but these turned out to be much bigger diseases/problems than we could have managed in the period of a few weeks. However, now we have selected our project and are working towards our goal so we feel much better.

While working in Kumi hospital we have met a lot of patients who have had to get their leg or foot amputated because of (type II) diabetes or leprosy.

Some of you have asked how diabetes or leprosy leads to foot problems. Here is a basic explanation of what happens (I am sure I have mad a few mistakes, but it is the general idea anyway):

Diabetes (mostly type II, adult onset, in this area):
1) Trouble with, or insensitivity of, the insulin receptors makes it difficult for glucose (sugar molecules) to get inside fat and muscle cells in the body (some of the main tissues that use glucose). Type I diabetes is a little different because the body doesn't make insulin.
2) This results in higher than normal levels of blood glucose because it can't get into fat/muscle.
3) The high levels of blood glucose cause some of the initial symptoms: excessive thirst (body is trying to dilute the extra sugar), excessive urination, weight loss (the fat cells can't get glucose), and fatigue (muscle isn't working probably).
4) Prolonged uncontrolled diabetes leads to constant high blood sugar. These damages many parts of the body, but primarily the nerves and blood vessels.
5) Damage to the nerves and blood vessels predisposes people to get sores on their feet. This is because they can step on something sharp and injure their foot without knowing it. Then the sore can get infected and there is poor circulation to help repair the injury.
6) If the infection gets out of control the person has to get their foot amputated.

Therefore people with diabetes should control their blood sugar, wear good shoes, and clean/examine their feet everyday to look for injuries, etc.


Leprosy leads to foot problems because the leprosy mycobateria damage the nerves in the cooler parts of the body such as the ears and extremities and patients can't feel injury to their feet.

It turns out that many patients with diabetes and some with leprosy in Kumi don't have shoes and therefore it leads to the very bad foot problems. (see following pictures).

My part of the project is to try to make good shoes affordable for patients with diabetes and leprosy. Annie is going to do educational foot care posters and information about diabetes.


People with diabetes and leprosy should wash their feet and examine for injury every day. This can be hard in rural areas of Uganda where water can be hard to come by.

Here is a pair of shoes that can be purchased for 1,500 shilling (a little less than $1 US). They are made from old tires and last for about 20 years. I am trying to get the shoes modified so they will have a leather strap which should be more comfortable.

A craftsman making the tire shoes.

Splitting the rubber tires.

A view of the tire shoe guy and his work area. Guess what? There are lots of tires in his work area. Go figure.


Below are some pictures of wounds from the hospital. I got every patient's permission before taking each picture.

A patient with leprosy and a wound on her foot. She has already had all of her toes amputated.

A person with diabetes who had dead tissue removed through surgery after allowing the foot to get infected.

A person with leprosy who needs an amputation.

Anyway, you get the idea. A had a picture of some one with diabetes who had their foot amputated, but it showed his face, so I couldn't put it up on the website.