Healing Feet, Avoiding Amputation

As an academic vascular surgeon, I work to develop cost-effective, resilient, and equitable strategies to prevent leg amputations. This contains a portfolio of resources I am sharing to help others interested in reducing the rate of leg amputations.

Tenets of Treatment for Health Care Providers

Pages providing practical guidance with rationale/evidence/support. Included here both to make this easily available amongst our teams and colleagues, but also with the hope that increasingly consistent approaches to diagnosis and treatment might help decrease the racial and ethnic disparities in leg amputation rates in Texas and elsewhere.

Deep infections get drained/incised.
Ensure or establish adequate arterial inflow.
Reconstruct, reestablishing intact epithelium over the entire extremity.
Maintain mobility – even if amputation is performed.

Health professionals interested in getting a more comprehensive summary of the nature of the disease and the spectrum of care that may help prevent leg amputations can read our 2013 “System of Care” review paper or our 2011 “framework” review paper. This 2019 “Advances in PAD” paper describes state-of-the-art developments in management.

Information for People with Diabetes

These videos discuss strategies to lower the risk of developing diabetes- and circulation-related foot problems. They also summarize how foot ulcers are often treated.

Guard your Feet is a ~500 word brochure written to help persons at risk for foot ulcers and amputation with understanding how diabetes can lead to foot ulcers and infections and quantifying amputation risk. It helps people reduce their amputation risk, recognize a foot infection, and develop a contingency plan if infection does develop.

This brochure is written with plain language and no undefined technical terms. We have incorporated feedback from patients who have graciously reviewed it. Fantastic colleagues here in Houston have helped translate it from English into 16 additional languages that represent the languages spoken by 96.8% of the United States population. Please feel free to download and distribute these brochures. Use them to start a conversation with your patients or to learn about your condition.

A Selection of Our Manuscripts Relevant to Clinical Care

Foot ulcer prevention clearly represents to best opportunity for cost savings: reduced amputation rates + lower cost than current care.
All patients with large or infected foot ulcers merit objective testing (toe pressures, skin perfusion pressures, or angiogram) to identify peripheral artery disease. This diagram demonstrates the optimal diagnostic strategies for peripheral artery disease identification.
Leg bypass operations have lower perioperative mortality than leg amputation in patients with advanced comorbidities.
Providing revascularization and limb salvage efforts appears to be cost-effective for all patients and may even provide cost-savings in elderly, functionally-marginal patients.
Foot infections in bone (osteomyelitis) with E. coli or Pseudomonas are associated with worse outcomes; infections with methicillin-sensitive Staphylococcus aureus.

For Texans Interested in Addressing the Disparities in Leg Amputation Rates

This two-page health policy brief, written with the University of Texas Medical Branch’s Center to Eliminate Health Disparities, summarizes the problems caused by leg amputations and suggests some steps forward.
Significant racial and ethnic disparities persist in Texas, as people categorized as Black and people categorized as Hispanic undergo higher risk-adjusted rates of leg amputations than people categorized as White.
Geography and lack of nearby specialist care at high-volume centers may contribute to leg amputation rates in many areas of Texas in these areas of Texas.
See maps demonstrating population-adjusted rates of peripheral artery disease-associated leg amputations within the largest four metropolitan areas in Texas. You can also peruse the interactive Texas state maps showing the annual incidence rate of leg amputations by county, the frequency of leg amputations among persons categorized as Hispanic by county, and the proportion of lower extremity revascularizations done as surgical bypasses (rather than endovascular interventions) by zip code.