Vasculitic syndromes in podiatry

[AttackNME]

Obviously a lot of vasculitic syndromes appear in podiatry in the form of foot ulcers, and I imagine that in a multi-disciplinary wound care facility, there would be a vascular physician on the team responsible for the diagnosis and subsequent management of the underlying cause of the foot ulcer while the podiatrist would manage the wound itself with regular debridement.

However, are there situations where the management of the foot ulcer with the associated vasculitic syndrome is left entirely up to the podiatrist? If so, how common would this be?

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[FACN]

Obviously a lot of vasculitic syndromes appear in podiatry in the form of foot ulcers, and I imagine that in a multi-disciplinary wound care facility, there would be a vascular physician on the team responsible for the diagnosis and subsequent management of the underlying cause of the foot ulcer while the podiatrist would manage the wound itself with regular debridement.

However, are there situations where the management of the foot ulcer with the associated vasculitic syndrome is left entirely up to the podiatrist? If so, how common would this be?

I am unsure of what you are asking. I don't think that anyone would attempt a bypass or peripheral angioplasty. Now some vascular conditions I do treat. I will place patients in multi-layer compression therapy Berger's syndrome to stop smoking.

Other options include cardiovascular surgeon or interventional radiologist for management of PAD. But you cannot cure a vascular ulceration without addressing the cause. Remember the VIPs of wound healing. First and foremost is vascularity; without that nothing else matters.

 

[347932]

However, are there situations where the management of the foot ulcer with the associated vasculitic syndrome is left entirely up to the podiatrist? If so, how common would this be?

I was recently consulted on a case like this and I was the one who made the initial diagnosis of Vasculitis. The Hospitalist didn't believe me until I consulted Vasc and they concurred! Once the diagnosis was confirmed, Vascular took over the case. It was very interesting though.

 

[AttackNME]

Severely compromised circulation that warrants bypass would obviously be something that a vascular physician will manage, but what about a moderate vasculitis that manifests symptoms mostly affecting the feet where stronger immunosuppression like cyclophosphamide is required. Would a podiatrist be responsible for administering and managing the side effects? The reason I'm asking is that I have some downtime and I'd like to get an idea of the depth of detail I should prepare for externships.

I am unsure of what you are asking. I don't think that anyone would attempt a bypass or peripheral angioplasty. Now some vascular conditions I do treat. I will place patients in multi-layer compression therapy Berger's syndrome to stop smoking.

Other options include cardiovascular surgeon or interventional radiologist for management of PAD. But you cannot cure a vascular ulceration without addressing the cause. Remember the VIPs of wound healing. First and foremost is vascularity; without that nothing else matters.

 

[347932]

Severely compromised circulation that warrants bypass would obviously be something that a vascular physician will manage, but what about a moderate vasculitis that manifests symptoms mostly affecting the feet where stronger immunosuppression like cyclophosphamide is required. Would a podiatrist be responsible for administering and managing the side effects? The reason I'm asking is that I have some downtime and I'd like to get an idea of the depth of detail I should prepare for externships.

It is a systemic issue manifesting in the feet. I would handle the ulcerations, but not the other manifestations. It's much like handling diabetic ulcerations, but not the diabetes. That's my take on it.

 

[FACN]

Severely compromised circulation that warrants bypass would obviously be something that a vascular physician will manage, but what about a moderate vasculitis that manifests symptoms mostly affecting the feet where stronger immunosuppression like cyclophosphamide is required. Would a podiatrist be responsible for administering and managing the side effects? The reason I'm asking is that I have some downtime and I'd like to get an idea of the depth of detail I should prepare for externships.

You are talking about an unusual situation. The incidence of Wegener's in like 3/100,000. You may see one in your career and I would recommend sending it to a rheumatologist if you didn't have a vascular surgeon.

 

[FACN]

As a resident, you will manage a number of big medical issues. I had a number of transplant patients, severe immunocompromised, really sick trauma patients, etc.

I'm done with that and any attending that wants to medical manage those things is crazy. They are very demanding of your time and attention. If you'd like to make money you find someone else to take care of those items. I mean this with all respect and honesty. PCP make so little because specialist dump these patients on them.