Toe and Flow

Abstract

At the end of an anatomical peninsula, the foot in diabetes is prone to short- and long-term complications involving neuropathy, vasculopathy, and infection. Effective management requires an interdisciplinary effort focusing on this triad. Herein, we describe the key factors leading to foot complications and the critical skill sets required to assemble a team to care for them. Although specific attention is given to a conjoined model involving podiatric medicine and vascular surgery, the so-called toe and flow model, we further outline three separate programmatic models of care--basic, intermediate, and center of excellence--that can be implemented in the developed and developing world.

Building a scalable diabetic limb preservation program: four steps to success

“…It is preferable to have both specialists available concurrently for the evaluation of complex cases where the expertise of both specialties is needed for planning and intervention. If this is not feasible, then a close-knit working relationship is required of the two specialists to synergistically improve patient outcomes [8]. Physical therapy-centric wound-healing clinics nested within this model can also be very useful as they provide highly skilled services that may allow for active day-to-day operations [15,16].…”

“…Limb preservation programs consists of interdisciplinary teams that work synergistically to exchange information, discuss assessment, and create joint plans to achieve the goal of limb salvage in an integrated model. This model often incorporates podiatric and vascular surgeons (‘Toe and Flow’ model) as the core of an interdisciplinary team but which may include a diverse group of health professionals [5–8]. We have previously identified seven essential skills, first described by Fitzgerald and co-workers and later refined to eight skills by Wukich and colleagues, to define the key skill sets associated with care across a limb preservation program (Table 1) [9,10].…”

Tandem Specialty Management of Complex Lower Extremity Wounds: A Report of Three Cases

“…Lower extremity wounds are exceedingly common in patients with comorbidities such as diabetes mellitus and Charcot-Marie-Tooth disease, with some prevalence estimates approaching nearly 25% [6]. The effective management of these wounds can ultimately be the difference between saving or losing a limb [7]. The literature contains multiple examples of the interdisciplinary management of foot and ankle wounds [7-11], however, we were unable to find any examples in PubMed of wound cases being managed exclusively between wound specialists, such as a podiatric surgeon with advanced wound training, and orthopedic surgeons.…”

Pandemia global, COVID-19 y podología

“…Este tipo de pacientes, especialmente cuando se acompañan de complicaciones como enfermedad vascular periférica y/o neuropatía periférica, representan una población especialmente frágil con un riesgo muy elevado de pérdida de la extremidad, o incluso muerte, si no se lleva una monitorización cercana de sus pies por parte del podólogo 2,3 . Los pacientes más complejos con grados más avanzados de isquemia, que presentan ulceraciones activas, o sin ellas pero sin posibilidades de recibir un cuidado rutinario periódico, también aumentan drásticamente el riesgo de infectarse, lo que también incrementa la tasa de amputaciones y muertes en este colectivo 4 . Muchas unidades de úlceras y unidades de pie diabético se han visto cerradas en este tiempo, ya que todos los recursos del hospital (incluido su espacio físico) han sido ocupados para tratar pacientes con COVID-19, y estos pacientes han podido ser seguidos o monitorizados en nuestras clínicas.…”