New surgical approach lowers amputation by 23 per cent

A new surgical approach has been developed to address the threat of arterial disease which now equals diabetes as a leading cause of foot and leg amputations.

Podiatric surgeons and vascular surgeons from the Manchester Royal Infirmary have formed the Lower Limb Preservation Team, which has reduced major amputation rates by about 23 per cent in the city over three years.

They now work together in the operating theatres bringing their specialist knowledge together, significantly altering the health outcomes for hundreds of people with peripheral artery disease, diabetes or both.

The podiatric surgeons working within the Manchester Lower Limb Preservation team are a unique group of surgical practitioners. They specialise in foot medicine from the start, qualifying as podiatrists, and then later as podiatric surgeons making them the authority in the surgical management of the bones, joints and soft tissues of the foot and lower limb.

The specialist expertise they bring to the operating table includes the technical ability to carry out rare foot surgeries, and their inclusion in Manchester’s Lower Limb Preservation team has revolutionised the service it offers, according to a paper published in Podiatry Now and the Diabetic Foot Journal.

Professor Paul Chadwick, clinical director at the College of Podiatry and co-author of the paper said: “We are now seeing a situation where the number amputations resulting from diabetic and non-diabetic foot ulcers is about the same.

“An increasing number of specialist foot procedures have to be performed on patients with a compromised vascular supply to the foot or leg, so having both kinds of surgeons making the clinical decisions together gives the patient best chance of a good outcome.

“The close collaboration between podiatric surgeons and vascular surgeons has brought significant benefits to patients and has, to a large extent, been responsible for a reduction in the major amputation rate of about 23 per cent in Manchester over three years.

“Furthermore, podiatric surgery is now providing important training for the next generation of vascular surgeons, arming them with new reconstructive techniques that they too can pass on.”