A limb is a peninsula and no clinician is an island: Introducing the American Limb Preservation Society (ALPS)

Abstract

According to a well-known proverb: "if you want to go fast, go alone; if you want to go far, go together." When caring for the at-risk lower limb, going it alone may lead to the express lane to an amputation. Unfortunately, once an amputation is performed the next stop on the express lane is often death; the 5-year mortality is 46.2% following a diabetesassociated minor amputation and 56.6% following a diabetes-associated major amputation. 1 In 2014 the Society for Vascular Surgery published the WIfI (Wound, Ischemia, and foot Infection) classification system for staging lower extremities at-risk for amputation 2 and a subsequent metaanalysis of WIfI publications confirmed it to be predictive of one-year amputation risk. 3 The three risk-factors of WIfI inherently suggest the need for interprofessional collaborative efforts if at-risk limbs are to be preserved. In fact, before the publication of the WIfI classification system, several of its authors initiated concerted efforts to promote a podiatric and vascular surgery ('Toe and Flow') team approach to limb preservation. 4 This effort to extend the mileage traversed by at-risk limbs was a nascent recognition of the need to work collaboratively to save such limbs. The following searches, conducted on March 5th, 2021 in PubMed, and yielding only 56 and 54 publication hits, respectively (many duplicative), confirm the historical lack of a team approach to limb preservation.

The quest for wellness: How to optimise self‐care strategies for diabetic foot management?

“…[20][21][22] While these technologies show promise in predicting DFUs, simply detecting a "hot spot" doesn't assure a decrease in DFU incidence. [23][24][25][26][27] For these tools to be effective, patients also need to decrease physical activity upon detecting a "hot spot", thereby significantly reducing the risk of ulcer recurrence. 27 However, rigorous studies investigating practical solutions to enforce patient adherence to post-detection management strategies, including the reduction of weight-bearing activities, are currently lacking.…”

“…Despite encouraging evidence on using technology for detecting local inflammation or “hot spots” to predict DFU and its endorsement using several guidelines, 1,18,19 only a few studies have actually tested its effectiveness, with conflicting results 20–22 . While these technologies show promise in predicting DFUs, simply detecting a “hot spot” doesn't assure a decrease in DFU incidence 23–27 . For these tools to be effective, patients also need to decrease physical activity upon detecting a “hot spot”, thereby significantly reducing the risk of ulcer recurrence 27 .…”

A new declaration for feet's sake: Halving the global diabetic foot disease burden from 2% to 1% with next generation care

“…Many national DFD bodies have recently declared new goals, with most focused on “ending avoidable amputations within a generation” 8–10 . However, we now know DFD is not only the leading cause of amputation, but also a leading cause of global hospitalisations and poor quality of life (QoL) 1,6,11 .…”