Did someone tell you that you needed a leg amputation?

The most difficult conversation I have as a podiatrist is telling patients they may lose their leg. My job and passion is to save every limb I possibly can. That's what podiatrists do, we keep people walking through palliative foot care, routine exams and educating on prevention. I love every part of my job and I've found a great deal of satisfaction helping people stay independent, pain-free and maintaining their "foot fitness."

However, a big part of my subspecialty is in wound care where people suffering from nonhealing wounds below the knee come to see me. I want to share with you this story about (consent obtained) a wonderful patient who found me. Let's call him Mr. Fish. 

Mr. Fish presented as a 70+ year old gentleman with multiple nonhealing wounds for at least 1 year on his leg. He suffered from type 2 diabetes, peripheral arterial disease, heart disease and is a chronic smoker and drinks alcohol regularly. He had seen at least 3 other specialists of a variety (vascular, general surgeon, internal medicine, other podiatrists, etc) who have all recommended a below knee amputation as a treatment plan. When I finally saw him, I have to say, I was in agreement. 

He says to me in sheer desperation, "is there anything you can do to save my leg?" I told him that with his current infection, medical co-morbidities and social history that I don't know for sure, but I can try. However, this will be a longterm treatment plan and he may still end up losing the leg. Think of wound care as a marathon, it will be a long stretch that requires dedication and commitment for success. It will mentally exhaust the patient and their caregivers including family members. There will be ups and downs, some setbacks, needed sacrifices (quit smoking and drinking), some achievements, and it won't be a smooth ride. Plus, we'll have to wrangle with their insurance company to pay for these treatments. He agreed to my treatment plan. 

Of course I wouldn't be writing this if there wasn't a happy ending but I don't want to mislead you to thinking that I can save everyone. Sometimes, patients come far too late for any viable intervention. This patient came at just the right time. Of course, sooner would have been better.

The photos demonstrate the progression from his initial presentation and then one year later where he is finally healed and walking independently. His leg is still attached to his body and he does not have pain. In the process, he developed multiple resistant infections, multiple hospitalizations were required, multiple attempts to establish an IV line because his veins were collapsing but we were able to deal with it right away. I have a wonderful cardiovascuar interventionalist who was able to help improve his circulation and his primary doctor to help with his medical management. I was attentive to any subtle changes and he trusted my expertise every step of the way. 

  Left  - exposed and dead Achilles tendon which had to be removed.  Middle  - first clean up.  Right  - multiple clean ups and eventual skin grafts leaving him completely wound-free and he is walking without complications.

Left - exposed and dead Achilles tendon which had to be removed. Middle - first clean up. Right - multiple clean ups and eventual skin grafts leaving him completely wound-free and he is walking without complications.

What's the lesson here? As a foot, ankle and wound specialist, I care about preventing amputations. If there is a glimmer of hope, physiologically speaking, and the resources are there (family support and medical doctors intimately involved), I feel a deep obligation to try before burning any bridges. Once you remove the leg, you can't go back. 

Could any of this have been prevented? Absolutely. Finding the right specialist who cares about you as a person and not just your disease and what insurance plan you carry is essential in long-term success. Preventive actions such as caring for yourself through diet, exercise and mental wellness is the utmost importance. Being proactive about your health, rather than waiting for something bad to happen to see the doctor, can sure save you a lot of trouble in the long run. 

My advice to you would be to have a podiatrist on your care team early on. If you need help finding a podiatrist in your area, visit the American Podiatric Medical Association. For more Feet Facts visit ACFAS.org.