Cheering On The Champions Of Limb Salvage

Podiatry Today’s recent poll showed that not all of our colleagues are happy with their career choice (see http://www.podiatrytoday.com/if-you-had-do-it-all-over-again-would-you-s...). Among those are several podiatrists, who are now nearing retirement and were not fortunate enough to have gotten residency programs years ago. They have not been able to practice to the fullest extent of their potential and they feel that they were cheated out of what they could have done.

However, I take exception with one thing that some of them say, namely that there is no such thing as “limb salvage” in podiatry. Sorry, gentlemen, but you are just flat out wrong.

At the American Podiatric Medical Association National Scientific Meeting in Seattle last month, Lee C. Rogers, DPM, gave an inspiring update on the subject. There is no doubt that at the leading centers for limb salvage and many community practices and hospitals around the country, doctors of podiatric medicine are doing just that – saving limbs and saving lives.

I had the opportunity to ask Dr. Rogers to clarify exactly what “limb salvage” means so there is no question for the naysayers in the profession. He said limb salvage means “limb sparing.”

Dr. Rogers went on to explain that the podiatric clinicians at advanced centers work in concert with the medical team, especially with the vascular surgeon, to address all of the needs of the patient in a quick and efficient manner. In addition to resolving possible infection, patient needs may include vascular, nutrition, medical, biomechanical, social and any other issues that preclude the patient from ambulating successfully on the residual limb. After eradicating infection and ensuring adequate vascularity in consultation with vascular surgeon colleagues, podiatrists perform appropriate debridement to allow for reconstruction of the remaining foot.

At centers run by Dr. Rogers in Southern California, John Steinberg, DPM, in Washington, D.C. and David Armstrong, DPM, MD, PhD in Arizona, success rates of limb salvage in patients with diabetes are running in the 94 to 96 percent range. This is remarkable given the rates of several decades ago that featured ranges with mortality rates instead of ambulation rates.

I might be one of those people voting “unsatisfied” with my career had I not chosen to go into academia because frankly I am not entrepreneurial. I would have failed in business and thus been unhappy there. I think it takes a combination of business sense and scientific knowledge to make a go of it as a private practitioner these days.

Let us cheer on our colleagues who are forging a new road ahead for podiatry. It is good for the patients and the profession. It is indeed saving limbs and lives.



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