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Toe and Flow

Essential Components and Structure of the Amputation Prevention Team

Lee C. Rogers Amputation Prevention Center, Valley Presbyterian Hospital, Los Angeles, CA.

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George Andros Amputation Prevention Center, Valley Presbyterian Hospital, Los Angeles, CA.

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Joseph Caporusso Private practice, McAllen, TX.

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Lawrence B. Harkless College of Podiatric Medicine, Western University of Health Sciences, Pomona, CA.

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Joseph L. Mills Sr Southern Arizona Limb Salvage Alliance, Department of Surgery, University of Arizona College of Medicine, Tucson, AZ.

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David G. Armstrong Southern Arizona Limb Salvage Alliance, Department of Surgery, University of Arizona College of Medicine, Tucson, AZ.

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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. (J Am Podiatr Med Assoc 100(5): 342–348, 2010)

Corresponding author: Lee C. Rogers, DPM, Amputation Prevention Center, Valley Presbyterian Hospital, 15107 Vanowen St, Los Angeles, CA 91405. (E-mail: Lee.C.Rogers@gmail.com)