STEP: Save the Extremity Program

The Save the Extremity Program (STEP) at Baylor College of Medicine seamlessly integrates vascular surgery and podiatry for both the outpatient and inpatient population to "salvage" or save their feet.

Diabetic Foot Amputation Prevention

diabetic-foot-amputation-prevention-houston (320x240)
Lack of foot sensation with poor blood flow can increase the risk of a leg or foot amputation.

Every 20 seconds a diabetic-related amputation is performed with over 2,500 limbs being lost per day due to infection and a poorly controlled disease process.

Twenty-five percent of those with diabetes will have a lifetime risk of developing a lower extremity wound with more than 50 percent of those becoming infected requiring hospitalization.

Once an individual has had a lower extremity wound, they carry a 68 percent risk of re-ulceration over five years unless they changes their habits and life styles.

This can all be prevented with a team approach toward care and a focus on prevention.

The "Toe and Flow" Model

Our limb salvage program seamlessly integrates vascular surgery and podiatry for both the outpatient and inpatient.

Often podiatrists are the first to notice signs of peripheral artery disease (PAD) in patients. Here at Baylor College of Medicine’s Division of Vascular Surgery and Endovascular Therapy, our multidisciplinary team includes podiatrists who work closely with our vascular surgeons and radiologists. Our team is uniquely qualified to treat patients with diseases of the foot, ankle and lower extremity. We not only attract patients from Houston, but also from around the globe.

Our limb salvage program seamlessly integrates vascular surgery and podiatry for both the outpatient and inpatient. The "flow" component relates to the importance of good blood flow in order to heal a wound. Our vascular surgeons are the champions of flow. The "toe" component relates to the importance of all procedures required to heal the foot/toe. Our podiatrists are experts in foot surgery and in the management of chronic slow healing wounds.

Symptoms and Risk Factors for Amputation

These factors imply that a person has a high likelihood of having peripheral artery disease:

  • Those who have suffered diabetes or kidney failure for a long period of time
  • Those who are currently heavy smokers or who have had a history of heavy smoking
  • Those with non-healing wounds on their feet
  • Those over the age of 55
  • Those who have progressive pain in their legs, primarily their calves, during exercise, specifically while walking or running (also known as claudication)

Individuals with a history of diabetes or smoking are more likely to have issues with high cholesterol, high blood pressure and an inactive lifestyle, making them at higher risk for the disease. Those who have pain in the calves during walking or running tend to feel better when they stop because their muscles get time to breathe and relax.

Diagnosis and Treatment of the Diabetic Foot

Diabetic Foot Doctor in Houston, Texas
credit: Scott HolmesVascular surgery chief Dr. Joseph L. Mills Sr.

Evaluation involves simple yet highly advanced tools that measure the blood pressure at the level of the feet and toes; low blood pressure here implies obstruction of blood flow. Using ultrasound-guided technology, physicians also can look at the inside of arteries and provide a more in-depth evaluation by finding exactly where there are obstructions along the arteries. If needed, physicians can also use advance imaging, such as CT scans or MRIs, that give more robust information about the degree and location of the disease, which helps plan an intervention if needed.

When it comes to intervention, vascular surgeons have moved away from open vascular surgery to catheter-based procedures, which can be done under local anesthesia, require little to no recovery time, and are more cost-friendly.

New catheter-based interventions have allowed our surgeons to treat those who previously were too sick to have open surgery. These patients now have a less invasive option to treat peripheral artery disease.

Why Choose Baylor Specialists?

The Michael E. DeBakey Division of Vascular Surgery and Endovascular Surgery specializes in the treatment of the most complex foot conditions. Our team is comprised of award-wining, key-opinion leaders in both vascular and podiatric surgery. We are globally recognized as amputation prevention experts and are consistently invited to participate in regional, national and international scientific forums annually.

What separates us from the rest?

Vascular Procedures

  • Advanced endovascular therapies including catheter-based, minimally invasive procedures and retrograde transpedal access – navigating wires and catheters from the foot to restore the blood flow down to the area in need
  • Distal open tibial bypass: A procedure using very distal small incisions in the foot to restore the flow effectively
  • Retrograde transpedal endovascular therapy

Podiatric Procedures

  • State-of-the-art advanced podiatric surgical approaches to preserve and reconstruct lower limbs afflicted by vascular disease
  • Debridement and drainage
  • Advanced wound healing techniques
  • Use of advanced wound care products
  • Offloading devices and support
  • Education