APMA News - March/April 2019 - 29

APMA News: These new products
are undeniably incredible developments. It seems as though podiatrists are having some of the greatest success using them.
Dr. Davis: Yes. In our hands, if
someone has a medial or lateral
gangrenous toe down to the bone,
we can regenerate that tissue. Some
other specialists might say, "It's just
a toe, take it off." Don't ever say that
within 50 miles of me. Obviously if
the entire toe is completely gangrenous, you can't save the whole toe,
but you can regenerate areas of the
toe that are partially gangrenous.
The hallux is a big part of balance.
If you can keep the hallux, the patient
maintains their balance and ambulates better, and their biomechanics
are far better. If the patient sustains
a partial ray resection, the gait will
typically become unstable, and new
pressure points develop. The literature clearly shows those patients who
have an amputation have a 20-percent chance of a second amputation
within the first year, and a 50-percent
chance of a second amputation by
year three. Diabetic patients who
suffer a below-knee amputation have
a 68-percent five-year mortality rate.
That's higher than the five-year mortality rate for breast cancer, prostate
cancer, and Non-Hodgkin's lymphoma
all put together.
We have the technology to prevent
amputations and save more of the toe
and the foot than in the past. In podiatric medicine, we do it. We recognize
the biomechanics at play, and we take
the time to do what no one else will
do. Our job is limb salvage. If you save
the toes, you save the foot; if you
save the foot, you save the leg; if you
save the leg, you save the life.
APMA News: Has anything
changed about the patients in the
years you have been practicing
wound care?

Dr. Davis: Diabetes is the fastest growing disease in the United
States. The Centers for Disease
Control and Prevention predicts that
by 2050, one out of three Americans
will be diabetic. Anywhere from one
in four to one in six will get an ulcer.
And it's an international epidemic,
as well. The number of diabetics in
China outnumbers the entire population of the United States. Diabetes
is not going away in our lifetime. Our
job right now is to save limbs.
We can prevent amputation. The
Thomson Reuters study and the
Duke study* back us up. Up to 85
percent of amputations can be prevented by good lower extremity care,
and nobody knows offloading the
way we do.
APMA News: It's obvious that you
have tremendous enthusiasm for
wound care as a subspecialty of
podiatric medicine and surgery.
Dr. Davis: It's exciting! Wound care
includes so many facets of our practice-surgery, radiology, infectious
disease, dermatology, conservative
care, biochemistry. It is especially
dependent on biomechanics, a field
of study that no one understands as
well as podiatrists.
It's an enormous investment of time,
but I go home with a big smile on my
face. In my hospital and wound care
centers, our profession is valued. My
partner and I were recently called
into a meeting with the head of the
Surgery department, the CEO, the
CFO, and I thought, "Uh-oh, what did
we do?" The head of the department
said, "Do you have any idea how well
you're doing in limb salvage?" The
average amputation rate was down
from 14 below-knee amputations per
month for the past 27 years to two
every six months during our tenure in
the wound care center.
I thought, "Holy smokes, someone
else knows we're making a differ-

ence!" The wound care centers that
don't have podiatrists suffer.
APMA News: What's on the horizon
for wound care?
Dr. Davis: Fresh placental tissue,
lyophilized placental tissue, and
Prestige™ lyophilized placental
tissue, which is live cell placental
tissue that is in suspended animation
and can be brought back to active
life after being on a shelf for more
than six months. Then there is
cryopreserved umbilical tissue.
Umbilical tissue brings the same
technology (stem cells, epidermal
growth factor, fibroblasts, site
specific regeneration), and umbilical
tissue is 10 times stronger than
placental tissue. We're using it
for patients with ulcerations from
Charcot foot, and we can use it to
regenerate the thick plantar skin
and the fat pad underneath it. We're
also using umbilical tissue in several
aspects of podiatric surgery and
reconstructive surgery.
We bring hope and success to our
patients, and we've done it time and
time again. We're using the technology and our training to make a
difference.
Carls, Ginger, et al, "The Economic
Value of Specialized Lower Extremity
Medical Care by Podiatric Physicians in
the Treatment of Diabetic Foot Ulcers."
Journal of the American Podiatric Medical
Association 101, no. 2 (2011): 93-115.
Sloan, Frank, et al, "Receipt of Care and
Reduction of Lower Extremity Amputations
in a Nationally Representative Sample of
U.S. Elderly." Health Services Research 45,
no. 6 (2010): 1740-62.
Disclosures:
Dr. Davis is a speaker for
Smith & Nephew and
Osiris Therapeutics, Inc.

APMA News March/April 2019

APMA News - March/April 2019

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