» In the landscape of foot and ankle pathology, few conditions present with greater complexity – or are more overlooked – than the dialysis foot. ...
While often grouped under the broader category of diabetic foot complications, the dialysis foot stands apart as a distinct clinical entity. These patients routinely present with some of the most advanced, multifactorial foot pathologies seen in practice, and yet they remain a minority population in both the nephrology and podiatric care spheres – frequently underserved, often misunderstood.
This issue marks the first time that Foot and Ankle Quarterly has focused exclusively on the dialysis foot, and for me the topic is both timely and deeply personal. From 2013 to 2019, I had the privilege of serving as the podiatrist for the Dialysis Foot Project at Abbotsford Regional Hospital in British Columbia. That initiative brought nephrologists, vascular surgeons, infectious disease specialists, podiatrists and nurses together to improve limb outcomes in dialysis patients – a population with some of the highest rates of amputation and mortality. Though the project ended due to funding constraints, its influence endures in my own practice and in the wider recognition of dialysis-related foot disease as a specialty focus within podiatric medicine.
What also makes this edition of FAQ unique is that every contributor is Canadian. In a specialty where Canadian voices are often under-represented, it is a point of quiet pride to bring together a group of experts who practice in Canada’s healthcare system, and have developed protocols and care strategies attuned to the specific needs of this high-risk group. Their contributions reflect both deep clinical experience and a shared commitment to advancing limb preservation in patients with end-stage renal disease.
Often considered as simply a “more severe” form of the diabetic foot, the dialysis foot is a convergence of ischemia, immune suppression, arterial calcification, autonomic dysfunction and systemic fragility, with or without diabetes. Successful care requires early detection, thoughtful offloading, timely vascular assessment and aggressive infection management. It also requires us, as clinicians, to advocate for a group of patients who often fall between the cracks of specialty care. In these pages, I hope you will find insights that underscore the importance of multidisciplinary collaboration and evidence-based innovation for improving outcomes.
As we look to the future, emerging research continues to highlight the potential for proactive intervention to dramatically reduce complication rates in this population. From advanced wound therapies to predictive vascular screening and surgical offloading, we now have tools that can change trajectories – if we choose to recognize the dialysis foot for what it is: a distinct and urgent clinical priority.
It is my hope that this issue of FAQ will deepen your understanding of the dialysis foot and inspire further innovation, research and advocacy on behalf of these vulnerable patients. Our Canadian colleagues have set a high bar, and I am proud to share their work with you.
Scott A. Schumacher, DPM, FASPS, FACFAS, FACPM
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Article Authors and Lecturers
Howard Green (n.)
James Hill (n.)
Karim A. Manji (n.)
Albert J. Mollica (n.)
Alysha Patel (n.)
Kevin Perry (n.)
Alisha Poonja (n.)
Scott A. Schumacher (1. Data Trace Publishing Co.)
Emily Tran (n.)
Gisele Youth (1. Data Trace Publishing Co.)
Ian Yu (n.)
FAQ Journal Planning Committee
Chrissy Wesolowski (n.)
Lauren Molander (n.)
Stephanie Wu, DPM, MSc (n.)
Guest Editor
Scott A. Schumacher, DPM, FACFAS, FASPS, FACPM Board Certified, American Board of Foot and Ankle Surgery; Board Certified, American Board of Podiatric Medicine; Private Practice, Achilles Foot Health Centre, Surrey, British Columbia; Formerly at Abbotsford Regional Hospital Dialysis Department, Abbotsford, British Columbia
Contributors
Howard Green, DPM, FACFAS President, Canadian Podiatric Medical Association; Director of Continuing Education, Canadian Council on Podiatric Medical Education; Head, Department of Podiatry, Vancouver General Hospital / University of British Columbia, Vancouver, British Columbia; Diplomate, American Board of Foot and Ankle Surgeons; Fellow, American College of Foot and Ankle Surgeons; Master Surgeon, HyProCure Subtalar Arthroreisis; Associate, American Academy of Podiatric Sports Medicine; Private practice, South Surrey, British Columbia
James Hill, DPM, FACFAS, FASPS Board Member and Past President, Canadian Podiatric Medical Association; Board Member and Past President, Ontario Podiatric Medicine Association; Board Member, Canadian Board of Certification in Podiatric Medicine; Registered Chiropodist, Foot Care Institute, Windsor, Ontario; Podiatric Physician and Surgeon, Department of Surgery, John D. Dingell Veterans Affairs Medical Center, Detroit, MI; Diplomate, American Board of Foot and Ankle Surgery; Certified in Foot Surgery and Reconstructive Rearfoot and Ankle Surgery
Karim Manji, DPM, FACFAS Clinical Assistant Professor, Department of Surgery, Founding Chair, Association of Alberta Podiatric Surgeons; Director, Zivot Limb Preservation Centre, Peter Lougheed Centre, University of Calgary, Cumming School of Medicine, Calgary, Alberta
Albert J. Mollica, DPM, BS Former Fellow, American College of Foot and Ankle Surgeons and Diplomate, American Board of Podiatric Surgery; Former Director, Podiatric Surgical Residency, Vancouver General Hospital; Part-time practice, Achilles Foot Health Centre, Surrey, British Columbia; Recently retired from full-time podiatric practice
Alysha Patel, DPM, FACPM Diplomate, American Board of Podiatric Medicine; Private practice, Vancouver Foot and Ankle Clinic; Former Professor, University of British Columbia; Former Medical Director, Vancouver Foot and Ankle Clinic
Kevin Perry, DPM, FACFAS Rose Zivot Podiatric Surgery Fellow in Limb Salvage and Foot Reconstruction, Department of Surgery, University of Calgary, Alberta, Canada
Alisha Poonja, DPM, FACFAS Director, Rose Zivot Fellowship in Limb Salvage and Foot Reconstruction, Alberta Health Services Department of Surgery
Emily Tran, BSc BS in Kinesiology, Simon Fraser University, Burnaby, British Columbia
Gisele S. Youth, DPM, MS, AACFAS Private practice, Evergreen Foot and Ankle Specialists, British Columbia
Ian Yu, DPM, MSc Medical Education, FACFAS Board-Certified, American Board of Foot and Ankle Surgery, Certificate in AI in Healthcare, Harvard Medical School; Surgical Staff, Providence Hospital; Surgical Staff, Cambie Surgery Centre, Vancouver, British Columbia, Private practice, Vancouver, British Columbia
36-1 In This Issue
FEATURE ARTICLE: The Dialysis Foot: High-Risk Complications and Strategies for Prevention
Scott A. Schumacher, DPM, FACFAS, FASPS, FACPM
CONDENSATIONS and COMMENTARIES
Foot and Ankle Care by Podiatrists and Amputations in Patients with Diabetes and Kidney Failure
Commentary by Alysha Patel, DPM, FACPM
Risk Factors and Frequency of Foot Ulcerations in Patients Receiving Chronic Hemodialysis Treatment
Commentary by Albert J. Mollica, DPM, BS
A Tool to Predict the Risk of Lower Extremity Amputation in Patients Starting Dialysis
Commentary by Howard Green, DPM, FACFAS
Lower Extremity Function and Cardiovascular Disease Risk in Hemodialysis Patients: A Multicenter Cross-Sectional Study
Commentary by Ian Yu, DPM, MSc Medical Education, FACFAS
Prevention and Management of Foot and Lower Limb Health Complications in Adults Undergoing Dialysis: A Scoping Review
Commentary by Scott A. Schumacher, DPM, FACFAS, FASPS, FACPM and Emily Tran, BSc
Evaluation of Risk Factors for Foot Ulceration in Individuals with Chronic Kidney Disease
Commentary by Karim A. Manji, DPM, FACFAS
Renal Function is Highly Associated With Podiatric Risk in Diabetic Patients
Commentary by Alisha Poonja, DPM, FACFAS
Prosthesis Use and the Change in Activities of Daily Living following Below-Knee Amputation in Patients Undergoing Hemodialysis
Commentary by Gisele S. Youth, DPM, MS, AACFAS
The Utility of Advanced Lower-Extremity Duplex Using Pedal Acceleration Time in the Management of the Threatened Diabetic Foot
Commentary by Kevin Perry, DPM, FACFAS
Intradialytic Plantar Electrical Nerve Stimulation to Improve Mobility and Plantar Sensation among Adults with Diabetes Undergoing Hemodialysis: A Randomized Double-Blind Trial
Commentary by James Hill, DPM, FACFAS, FASPS
36-1 AUDIO LECTURE 1: Vascular Assessment of the Lower Extremity in End-Stage Renal Disease (ESRD): A Comprehensive Review
Scott A. Schumacher, DPM, FACFAS, FACPM
36-1 AUDIO LECTURE 2: The Importance of a Multidisciplinary Approach to Limb Salvage in the Dialysis Patient Population
Gisele S. Youth, DPM, MS, AACFAS