36-1: The Dialysis Foot

EDITORIAL

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