Institutional toe & flow programs: How and why the teams work

Abstract

Diabetic foot ulcers with or without concomitant chronic limb-threatening ischemia put patients at exceedingly high risk of limb loss and death. The toe & flow model is a multidisciplinary team-based model captained by a podiatrist or orthopedic foot and ankle specialist and a vascular specialist, which streamlines treatment for patients with diabetic foot ulcer and chronic limb-threatening ischemia. This model creates a functional ecosystem around it by integrating other medical professionals and community partners. It provides a high standard of care first via community education and engagement. It eliminates barriers to access between it and the community by establishing clear referral pathways. This model uses the best available evidence to create treatment pathways governing the patient trajectory through different stage of disease. Once acute treatment is provided, it aims to consolidate success and disease remission through aggressive surveillance and collaboration with the community. An important aspect of this model is that it collects and reports its outcomes and serves as an educational hub within its region. It ultimately aims to develop national policies and allocate resources to continue to improve. This review sheds light on successes associated with institutional toe & flow programs.

Keywords: Chronic limb threatening; Diabetic foot ulcers; Ischemia; Limb preservation; Multidisciplinary; Toe & flow.