The Obligation and the Opportunity of the Chiropodist in the Treatment of Diabetes

Five years ago, Lee Sanders, DPM, wrote to me insisting that I consider bidding at an online auction for a little-known book titled Diabetic Surgery by the legendary McKittrick and Root [1]. I knew nothing of the book, but I certainly knew of these two great men, often referred to as “Joslin’s diabetes surgeons.” I made my bid (I think I was the only bidder) and received the volume shortly thereafter.

The book, which was published in 1928, just a few years after Toronto’s Banting, Best, Collip, and Macleod were credited with the discovery of insulin, was astonishingly modern. It was a response to the logarithmic rise in complications that came along with the gift of life that insulin provided. In many ways, it could serve as an instructional text for the aspiring surgeon today (in fact, it is required reading for the fellows in our program). What I have come to realize is that this wonderful article by Joslin, written 3 years before McKittrick and Root’s book, serves as a kind of prologue to that volume, and I am grateful to the Journal staff for rediscovering this work and sharing it with the podiatric medical community.

Joslin was a podiatric pioneer. Although obviously not a podiatrist, he was one of the profession’s earliest champions. His vision of a team approach was 60 years ahead of its time. It can be argued that his efforts led to the current culture of amputation prevention in the United States and abroad. Joslin begat McKittrick, who begat LoGerfo, Andros, Gibbons, Pomposelli, and others. At the same time, podiatric pioneers touched by Joslin created opportunities for giants like Giurini, Habershaw, Frykberg, Rosenblum, Chrzan, Basile, and others. These clinicians have touched countless others and have made a measurable contribution to the reduction in high-level amputations and Joslin’s “menace of diabetic gangrene” around the world.

A single person with passion and vision can make a difference. This is true even in a profession as obstinate, parochial, and resistant to change as medicine. I invite you to read, reread, and enjoy this brief essay as a seminal case in point.

Center for Lower Extremity Ambulatory Research

Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science

North Chicago, Illinois