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Multidisciplinary Approach to CLI Treatment: The Role of Podiatrists

Vickie R Driver, DPM, MS, FACFAS, and Richard F Neville, MD, FACS, DFSVS

In this video, Drs Driver and Neville discuss the crucial component of podiatry in the multidisciplinary treatment of CLTI. They urge podiatrists to become more involved with the CLI Global Society and to submit their research to the Journal of Critical Limb Ischemia. (Video and Transcript below)

Multidisciplinary Approach to CLI Treatment: The Role of Podiatrists

Vickie R. Driver, DPM, MS, FACFAS
Medical Director of the Wound Care and Hyperbaric Centers, INOVA Healthcare in the DC Metropolitan Fairfax, Virginia

Richard F. Neville, MD. FACS, DFSVS
Associate Director, Inova Heart and Vascular Institute
Chairman, Department of Surgery, IFH
Director, Inova Vascular Surgery program
Professor, George Washington University
Professor of Medical Education, University of Virginia, Inova campus


(This video has been lightly edited for clarity)

Vickie Driver:
Hi, this is Dr. Vickie Driver, one of the board members of CLI Global Society, honored and pleasured to say that for several years now. And this is my colleague, Dr. Rich Neville. 

Richard Neville:
Hi. Yep, hi, Vickie. it's Dr. Rich Neville, also on the board of the CLI Global Society. Chair of Surgery here at INOVA, also help lead the Heart and Vascular Institute and, also run the vascular practice. And now, running the wound center and the HBO program. (laughs) So, lots of hats.

Vickie Driver:
I think we need to give him more to do.

Richard Neville:
That's right. (laughs)

Vickie Driver:
Now, in addition to what I have been doing my entire career, which is working with patients such as these, I also chair the Wound Care Collaborative Community, which is a collaboration that was at the invitation of the FDA. Who sits on our committee is, not only the FDA, but CMS, the NIH, industry, physicians, industry, and patients. And the idea is to bring this field forward, to develop new medicines, treatments, diagnostics, for patients such as these that really need our help. It's not just about day-to-day practice, it's about actually moving the field forward in a positive, straightforward, evidence-based, scientific, and thoughtful way. And I've been doing this with Rich for a long time, so it's an honor to be with him today.

Richard Neville:
Yeah, and that's a pleasure. Thank you, Vickie. 

Vickie Driver:
I think the idea here with CLI Global is that this is a multidisciplinary team, and we have been for an awfully long time, since the inception, since it was first thought of. We don't always get all the team at the table because we're all busy. And not everyone knows about CLI Global or the Journal of CLI Global, which is fairly new, but robust, and has really quite amazing articles. And that's really what we're here today to talk about:

How do we interest you in participating in the Society and the Journal?

Richard Neville:
Yeah. that's a great point, Vickie. And I, actually, I'm very proud of where we are. You know, we were both on the founding board and Barry Katzen was a prime driver in this as well. We’ve got to acknowledge Barry and all his efforts, all the work he's done to move this society forward. And the idea behind the society is that it's a society dedicated to patients with critical limb ischemia and amputation prevention. 

And it's also dedicated, not necessarily to individual scientific papers, but to more of a programmatic development: healthcare policy, awareness, patient advocacy. Which is really a niche that some of our other societies and journals don't fill. And, you know, the society has grown very nicely. And I'm very proud of the way we've grown. 

The journal has grown enormously. You know we get lots of good contributions now and very good quality papers. I was just finishing two with some of our residents right now that we're going to submit to the journal. And we will submit it preferentially to the CLI Global journal as opposed to the Journal of Vascular Surgery many times because we think the audience is more appropriate with this particular journal. So I'm very excited to participate. 

Vickie Driver:
And Dr. Katzen, you know, was at the helm from the beginning. What today is pulling us all together. And so, we do need each other, we must understand how to work side by side and treat these patients one at a time.

It's not a traditional association. It's a society with patients at heart and mind. And, I think what we were supposed to talk about was, 

“How do we engage other practitioners?

Vascular surgeons and interventional radiologists, really, I think, have gotten to understand who CLI Global and the journal is. And interventional cardiology. But I think in terms of, podiatric, the podiatry practice in general, internal medicine, other wound care docs haven't, you know, just it’s new. It’s grown, but we want to reach out to them so that they cannot only contribute in the journal, but contribute in the society in a real way.

And I was asked to speak about, well, “What do podiatrists do with CLI patients?” And I was like, "Oh, wow." There's so many levels.

Most of the time these patients, you know, they've already been in my practice, Rich's practice, with a diabetic foot ulcer, or a venous leg ulcer. Or maybe a traumatic wound of some sort. And so we know them already. And then they go on to develop peripheral arterial disease and then CLI. We're not afraid of treating these patients. That's what I would say about podiatrists. 

We understand the disease. It is a complicated disease. We understand that someone like Rich to tweak that blood flow in whatever way that needs to be done, um, is inherently important. And it needs to be done with some urgency. It's not a, many times, a- a three week consult. It's, uh, calling someone who you know, you- you feel good about, you've- you've- you've had a chance to meet. You call them and say, "I have Mr. Smith or Ms. Jones. And she's got a cold foot."

And, uh, they get it! There's no more conversation. It’s done and things move on. But so many times we don’t understand that a wound healing doctor, podiatrist, a vascular specialist, we are the three people primarily that are gonna help save the limb. We circle around these patients for many years, most of the time, right? I mean Dr. Neville and I, We don't stop once the blood flow is improved and the wound is healed. 

It is, in fact, once the blood flow is improved, the wound is still there. And so something needs to be done. Sometimes that means an intervention. Maybe it’s a procedure that couldn't be done before because the blood flow wasn't good enough. Maybe it's a skin substitute skin, skin graft. And, there are many other types of treatments that podiatrists are aware of now. Both surgical, clinical, and also, let's think about it. We're also involved in the whole area of compression, offloading, wound care, you know, preventative surgery, infection management, those kinds of things. And working side by side with our vascular specialists.

So it’s really, many times we go on after the vascular specialist says, "We'll see you in three or six months." We'll continue to see these patient on a much more regular basis. 

Richard Neville:
Yeah. That's great, Vickie, I agree 100%. You know, you guys are so critical, podiatrists are so critical to what we do. But, in regards to the society and the journal, I think it's a real opportunity for podiatry to get even more involved. 

You know — We are just hungry to have podiatrists be involved, to come to the ISET meeting in Florida, Dr. Katzen’s meeting in Florida is a great place. You know, the- the society was sort of started by interventionally oriented people, you know, vascular surgery and interventional radiology. But now we've gotta build it out and it could really be a really, uh, embracing home. We're hungry for a podiatric involvement. Both at the meeting and in the society and contributing to the journal. 

You know, we want this to be a journal that's not just about bypasses and angioplasty. (laughs) You know, that's written about in other locations. Although, I think we've got some great articles. But, we want, we really are hungry for podiatric input. And- and to contribute to the journal and come to the meetings, and join the society. I think, the podiatric community will find it a welcoming society. 

ISET is a welcoming meeting. You can learn, I always learn something when I go to that meeting. And I always learn something reading the journal. And we're hungry for podiatric contributions to the journal especially. 

Vickie Driver:
ISET is a meeting like no other. I have to say as a podiatrist, the first time I was invited by Dr. Katzen, I thought, where have I been? How did I miss this before?

It's a tremendous opportunity to further your learning about the disease process. And understand what all these other specialists can do to help you with a patient. 

Richard Neville:
Yeah. The thing that I like about it, a lot of interaction. I mean it's a lot of, you get to talk to people. It’s not just sitting in a lecture hall listening to some lectures. I mean there’s that too, but there’s a lot of good interaction, lot of good conversations. Um, so I, yeah, I really enjoy it. And I think that filters over into the society and the journal. 

You know, again, I think it'd be a great place if, any of the podiatric community, or the plastics community, has some papers to contribute. We would welcome them with open arms. 

Vickie Driver:
So, what we're saying is, we need you, and we want you to be part of our society. And it would be a real honor to have you join us. 

Richard Neville:

Vickie Driver:
Thank you.