Healthcare: Cardiovascular Medicine

Diabetic Foot Limb Salvage


What Is the Connection Between Diabetes and Limb Loss?


One of the most serious complications of diabetes is loss of circulation, and ultimately, loss of sensation to the feet. These issues put patients with diabetes at greater risk for foot ulcers, non-healing wounds, and infections that, left untreated, often result in loss of a limb.

Individuals at risk include:

  • Those who have suffered diabetes or kidney failure for a long period of time
  • Those who are currently heavy smokers or who have had a history of heavy smoking
  • Those with non-healing wounds on their feet
  • Those over the age of 55
  • Those who have progressive pain in their legs, primarily their calves, during exercise, specifically while walking or running (also known as claudication)

Can Amputation Be Prevented?


STEP: Save the Extremity Program

STEP, Save the Extremity Program, part of the Division of Vascular Surgery and Endovascular Therapy, is a clinical and research collaboration dedicated to recognizing diabetic foot-related conditions and providing interventional treatments to prevent amputations and save limbs. A exceptional STEP team includes vascular surgeons, podiatrists, wound care specialists, and researchers, who give you access to the latest, state-of-the-art wearable technology available. Our STEP professionals work to keep you complication free, mobile and independent. Call for more information today at (713) 798-5700.

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What Is the "Toe and Flow" Model?

Our limb salvage program seamlessly integrates vascular surgery and podiatry for both the outpatient and inpatient.


Often podiatrists are the first to notice signs of peripheral artery disease (PAD) in patients. Our podiatrists work closely with our vascular surgeons and radiologists to identify and treat patients with diseases of the foot, ankle and lower extremity using a "Toe and Flow" model.

The "flow" component relates to the importance of good blood flow in order to heal a wound. Our vascular surgeons are the champions of flow. The "toe" component relates to the importance of all procedures required to heal the foot/toe. Our podiatrists are experts in foot surgery and wound healing.


How Is Diabetic Foot Diagnosed and Treated?

Media Component
Scott Holmes
Vascular surgery chief Dr. Joseph L. Mills Sr.

Using ultrasound-guided technology, physicians also can look at the inside of arteries and provide a more in-depth evaluation by finding exactly where there are obstructions along the arteries. If needed, physicians can also use advance imaging, such as CT scans or MRIs, that give more robust information about the degree and location of the disease, which helps plan an intervention if needed.

When it comes to intervention, vascular surgeons have moved away from open vascular surgery to catheter-based procedures, which can be done under local anesthesia, require little to no recovery time, and are more cost-friendly.

New catheter-based interventions have allowed our surgeons to treat those who previously were too sick to have open surgery. These patients now have a less invasive option to treat peripheral artery disease.


Vascular Procedures


Our highly trained group of surgeons have mastered the following procedures that lead to increase in the blood flow to the foot, which then allows better healing rates.


What to Expect From Your Visit


The primary goal in ulcer management is healing the wound as soon as possible. Immediate intervention significantly reduces the risk for infection and need for hospitalization and possible amputation.

When seeing a wound specialist there are several key factors for the management of a foot wound which may occur at your first visit:

  • Assessment of blood flow
  • “Debridement of the wound” - Removing dead skin and tissue
  • Applying medications and/or dressings to the wound
  • Prevention of infection by the use of antibiotics
  • “Offloading” - Removing the pressure from the area of concern. This may include being prescribed a special shoe or boot.

Will I Require Surgery?


A majority of non-infected foot wounds are treated without surgery; however, if treatment fails, surgical management may be appropriate. Surgical options may include:

  • Shaving or the removal of the bone(s)
  • Surgical debridement (cleaning) of the wound
  • Surgical care to correct various deformities such as hammertoes, bunions or bony prominences



Saving a leg is a complex process and there is no guarantee it is a permanent fix without a commitment to a healthier lifestyle. But the team of professionals in the Division of Vascular Surgery and Endovascular Therapy will work with you, your family, and primary care provider throughout the process. For many patients, our limb salvage techniques mean the difference between a minimally invasive procedure or an entire leg.


Clinical Trials


Our team of vascular surgeons, podiatry experts, biomechanical engineers and researchers are currently testing new and innovative podiatric techniques for the treatment of PAD. 

Learn More

A second chance at life: Discovering an alternative to diabetic foot amputation


The Save the Extremity Program (STEP) at Baylor College of Medicine, founded by Drs. Joseph Mills and Miguel Montero uses the latest technology to save the limbs of diabetic patients.