LONDON, Ont. - Ontario will pay more than $100 million this year to amputate the feet of diabetics, but won't pay $100 each for boots and casts that could save their limbs.

Only two small groups of diabetics in Ontario get public coverage -- the RCMP and federal inmates.

"It's crazy. Every other developed country pays for it," said Doris Grinspun, chief executive of the Registered Nurses' Association of Ontario.

The lack of coverage hits hardest where diabetes and poverty are widespread: Amputations are nearly twice as prevalent in northwestern Ontario, where the disease afflicts up to half the people in some First Nations communities.

"Diabetics have to wait until things go drastically wrong. It's cruel. It's discriminatory," NDP health critics France Gelinas said.

A broad coalition of those who advocate for diabetics wrote to Ontario Health Minister Eric Hoskins in December and met twice with his staff, most recently last week.

But his staff wouldn't commit to spend $2.5 million to prevent amputations with devices that take pressure of the foot -- they only promised to review the request.

That promise was repeated in an e-mail the ministry sent to Postmedia Network after a request to interview Hoskins wasn't met.

"The ministry would like to thank the (Registered Nurses' Association of Ontario) for raising this important issue ... Ontario is committed to preventing diabetes and its related complications. This includes examining the best evidence-based approach for preventing and treating diabetic foot ulcers in order to stop the devastating effects of preventable amputations."

Hoskins' ministry expanded on his statement with another e-mail: "The ministry acknowledges that diabetic foot ulcers are a devastating complication of this disease and can lead to preventable amputations... The ministry is committed to examining the evidence that supports the most effective treatments."

Asked if the ministry disputes that amputations cost Ontario more than $100 million a year, officials didn't respond.

Diabetics risk amputation because the disease can cut off sensation from the foot -- sufferers don't notice when it's cut or pierced and don't seek treatment. The wound is made worse because diabetics have poor circulation and less resistance to infection.

But devices that take pressure off the wound can save the foot, research has shown, from those that are permanent and cast-like to those that are removable like boots.

Mariam Botros knows what it's like to tell a patient he needs to lose a foot -- she's a foot specialist (a chiropodist) and executive director of the Canadian Association of Wound Care.

"It is highly devastating. It's the loss of mobility," Botros said.

While Ontario does spend a lot of money medicating diabetics, when it comes to preventing amputation, something else is needed.

"It's a matter of mechanics, not medicine," Botros said.

Ontario is not alone in Canada in turning its back on casts and boots that protect diabetic feet. Most provinces don't cover those costs either, with Alberta and British Columbia providing partial coverage.

DIABETES AND AMPUTATION

-- From 2008 to 2012, surgeons amputated 6,729 feet, lower legs and toes from diabetics at a cost of $70,000 to $80,000 each. There were also 130,000 hospitalizations to treat infections.

-- In a single year (2011/12) in Southwestern Ontario alone, there were 157 amputations.

-- Amputation rates in northwestern Ontario were nearly double that of the rest of the province.

-- About 345,000 of 2.7 million diabetic Canadians will develop a foot ulcer

-- 85% of leg amputations are the result of foot ulcers that don't heal

-- Between 49% and 85% of leg amputations can be avoided with education, monitoring and early treatment.

-- Diabetic foot ulcers cost the Canadian health-care system more than $150 million a year

-- Diabetics are 23 more times likely than non-diabetics to be hospitalized for a limb amputation

Sources: The Canadian Diabetes Association, the Canadian Association of Wound Care, Ontario Health Ministry

THE POLITICAL PUSH

-- In 2012, Canadian premiers backed a push by the Registered Nurses' Association of Ontario to educate diabetics at risk of foot ulcers, provide them with proper footwear, refer them to specialists early if problems occur and treat them aggressively to prevent amputations

-- Provinces and territories have failed to act, the association says.