Indian J Thorac Cardiovasc Surg. 2026 Apr;42(4):506-514. doi: 10.1007/s12055-025-02109-0. Epub 2025 Dec 16.
ABSTRACT
Peripheral arterial disease (PAD) is a chronic vascular condition characterized by narrowing or obstruction of arteries to the extremities, leading to symptoms such as intermittent claudication, rest pain, foot ulcers, and gangrene. Its severe form is known as critical limb ischaemia (CLI), which is characterized by rest pain, tissue loss, and reduced perfusion pressures. Most CLI patients have multiple medical comorbidities ranging from diabetes, hypertension, hypercholesterolemia, to ischaemic heart disease, chronic lung disease, and previous strokes. The most effective management of CLI requires a multidisciplinary approach that integrates expertise from vascular surgeons, endocrinologists, podiatrists, interventional radiologists, microbiologists, plastic surgeons, primary care physicians, and specialist nurses. This article explores the pivotal role of multidisciplinary team foot clinics (MDT foot clinics) in the holistic management of CLI, emphasizing their benefits in providing patient-centric care and better clinical outcomes with cost-effectiveness. The MDT foot clinics are the best approach to CLI management, as they provide diagnostic evaluations, wound care, infection control, long-term medical therapy, and referrals for any revascularization procedure, all in a single coordinated setup. These clinics also address barriers such as transportation challenges, high-frequency visits made by patients, distrust of healthcare systems, and expensive treatment options hence, providing a more patient-centered approach. Multiple studies have demonstrated that the introduction of these clinics has significantly reduced the rates of amputation and inpatient admissions and has improved treatment outcomes and limb salvage rates. In conclusion, the multidisciplinary approach is indeed the gold standard approach that paves a path to better outcomes in patients with CLI by delivering superior outcomes through comprehensive, integrated, and patient-centric care. This approach focusses on most, if not all, aspects of management, starting from treating the active disease symptoms, preventing the disease progression, and also enhancing the quality of life with regular follow-ups and continuous monitoring of patients, all in a community setup.
PMID:41835835 | PMC:PMC12982717 | DOI:10.1007/s12055-025-02109-0