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October 2009 Issue

UC Health vascular specialists have partnered with a group of 10 community foot specialists to bring inpatient podiatric care to UC Health University Hospital. UC’s George Meier, MD (left), is the chief of vascular surgery and podiatry, and Cary Copeland, DPM, is the podiatry program director.
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UC Health Adds Inpatient Podiatry Services

By Amanda Harper
Published October 2009

UC Health has launched a new service designed to help patients with complex vascular diseases avoid preventable amputations as the result of delayed or mismanaged treatment.

UC vascular specialists have partnered with a group of 10 community foot specialists to bring inpatient podiatric care to UC Health.

Led by George Meier, MD, the team says the initiative will give patients the type of coordinated, timely care necessary to effectively manage and treat chronic vascular health and circulation problems.
The care team—made up of surgeons, physicians, podiatric medicine specialists, nurses and dieticians—has seen approximately 150 patients since launching the service in early 2009.

Meier serves as chief of vascular surgery and podiatry, with podiatrist Cary Copeland, DPM, serving as the podiatry program director. 

By combining the two specialties, Meier says UC Health is able to offer a caliber of comprehensive vascular and podiatric care that doesn’t exist elsewhere in the Greater Cincinnati region.

“This brings a new level of podiatric care to residents in our community because—for the first time in this region—a top-notch academic health center-based vascular team is working with a community podiatry practice to deliver high-quality, coordinated care to patients in a single place,” explains Meier, who is also a professor at the UC College of Medicine.

“These patients need the benefit of vascular expertise to ensure that blood circulation is good as well as podiatric expertise to reshape the foot to encourage chronic wound healing. Both are critical to limb salvage.”

According to the American Podiatric Medicine Association, more than 23.6 million Americans have diabetes and an additional 8 to 12 million have peripheral arterial disease. Both conditions can result in severely compromised blood flow and vascular health impairments that lead to lower-limb problems, including amputation.

The organization estimates that proper foot care would reduce amputations by 45 to 85 percent.
“We need to educate both patients and primary care physicians to recognize the early warning signs of vascular disease. Unfortunately, right now many patients only seek our help once their limb is virtually unsalvageable,” says Meier.

“I can fix a patient’s circulation if it’s not normal, but I need a podiatric specialist who can fix the foot to ensure the patient is getting the best care—and best outcomes.”

As part of the new podiatry service, patients are first seen by the UC Health vascular team to triage issues related to compromised blood flow, underlying medical conditions and whether surgical correction is necessary. If podiatric care is necessary, a specialist is called in to consult with the vascular team to devise a plan for additional treatment, which may include anatomical modifications of the foot designed to relieve high-pressure areas contributing to poor blood flow and poor wound healing.

“The key is to intervene with podiatric care early. If these issues are caught early and good circulation is established, wounds are able to heal properly without more invasive treatment,” explains Copeland. “However, if the ulcer fails to heal with conservative care, surgery is another option.”

The goal then, says Copeland, is to minimize or better distribute peak pressure areas which will increase chances for healing. Sur-gery may involve shortening or elevating a bone, lengthening a tendon to decrease forefoot pressure or shaving a knobby bone that is interfering with healing of the foot.

“In doing any of these surgeries, one of the goals is to biomechanically rebalance the foot in an attempt to eliminate or lessen peak pressure areas,” adds Copeland. “The podiatric surgeon must have a keen sense of the biomechanics of the lower extremity/foot so as to hopefully lessen or eliminate return visits to the operating room.”

Vascular surgeons provide medical and surgical management to treat an array of problems with the human vascular system. This includes patients with peripheral, arterial, venous and lymphatic diseases. It is the only medical specialty where physicians are trained to treat all aspects of peripheral vascular disease, a common disease that is often associated with pain in the lower extremities during walking.

Podiatrists specialize in the medical and surgical treatment for conditions of the feet, ankles and related structures of the leg. In addition to treating foot complaints associated with diabetes and vascular diseases, they treat corns, calluses, ingrown toenails, bunions, heel spurs, and arch problems; ankle and foot injuries, deformities and infections.

“Timing is everything with vascular disease. The best advice to maximize the patient’s treatment options and chances for recovery is to seek treatment early,” adds Meier. “Our ultimate goal is to preserve mobility and minimize vascular complications (strokes, heart attacks, amputations) for patients with compromised vascular health.”

For more information, call (513) 558-3700 or visit Inpatient care takes place at University Hospital. Out-patient care is available in Clifton (Medical Arts Building) and West Chester (University Pointe Medical Office Building).

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