Toe and flow: essential components and structure of the amputation prevention team

J Am Podiatr Med Assoc. 2010 Sep-Oct;100(5):342-8. doi: 10.7547/1000342.


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.

MeSH terms

  • Amputation, Surgical*
  • Diabetic Foot / surgery*
  • Humans
  • Models, Organizational
  • Patient Care Team / organization & administration*