Nashville, Tennessee — August 6, 2026
There are few better ways to start a national meeting than looking out at a packed room of mission driven folks at 7:30 in the morning.
I had the privilege of chairing and lecturing in the opening session of the 2026 American Podiatric Medical Association Annual Scientific Meeting—The National, focused on a subject that increasingly sits at the center of limb preservation: using advocacy to prevent amputations.
The question underlying the session was deceptively simple:
How do we turn what we already know about preventing limb loss into what patients actually receive?
I was joined by an extraordinary group: Lawrence E. Burns, DPM of Maharry Medical College; Shanika L. Hill, MS, DPM of Barry; and Joseph L. Mills, MD, the 78th President of the Society for Vascular Surgery and my longtime friend and limb-preservation partner (flowmigo prime in our toe and flow parlance).
Our discussion moved well beyond the operating room or wound clinic. We talked about multidisciplinary limb-preservation systems, underserved communities, referral pathways, access to specialists, health policy, and the barriers that can allow a manageable foot problem to evolve into hospitalization—or amputation.
And that gets to the central point.
Amputation Is Often a Systems Failure
Preventable amputation is not simply a clinical problem.
It is a systems problem.
We absolutely need superb clinical care. We need the familiar “toe and flow” partnership between podiatry and vascular surgery. We need revascularization, infection control, debridement, reconstruction, offloading, surveillance, and prevention.
But those tools only work when a patient can reach them.
The machinery surrounding clinical medicine matters enormously: access, referral pathways, reimbursement, policy, incentives, education, and advocacy.
A perfectly functioning instrument does very little good if the patient never reaches the surgeon.
That is why advocacy belongs in the limb-preservation toolbox alongside every diagnostic test, device, drug, and procedure we use.
From Individual Rescue to System Design
For decades, limb preservation has understandably focused on the individual patient in front of us: heal this wound, restore this blood flow, control this infection, save this foot.
That work remains essential.
But the next step is larger.
Instead of asking only, “How do we save this limb?” we should increasingly ask:
“How do we build a healthcare system in which this limb was never placed in jeopardy in the first place?”
That means identifying risk earlier. Connecting patients to care faster. Building reliable multidisciplinary pathways. Moving surveillance into the home. Addressing disparities in access. And ensuring that policy supports prevention rather than rewarding rescue after catastrophe.
In other words, we need to move from saving limbs by heroics to saving limbs by design.
The packed house at APMA National suggested that this idea resonates. There is tremendous energy within podiatric medicine—and across vascular surgery, rehabilitation, wound care, primary care, technology, and public health—to move upstream.
After the session, Patrick A. DeHeer, DPM, APMA’s 100th President, joined us for the photograph above.
There is something wonderfully symbolic about that image: leaders from podiatric medicine and vascular surgery standing together after a discussion devoted to preventing amputation.
The future of limb preservation will not belong to one specialty.
It will belong to the systems we build together.
Here’s to moving from saving limbs one patient at a time to building systems that save limbs by design.
Photo: Following the opening session of APMA’s 2026 Annual Scientific Meeting in Nashville. From left: Patrick A. DeHeer, DPM, APMA’s 100th President, who joined the group after the session; Lawrence E. Burns, DPM; David G. Armstrong, DPM, MD, PhD, session chair and faculty speaker; Shanika L. Hill, MS, DPM; and Joseph L. Mills, MD, 78th President of the Society for Vascular Surgery.
Special thanks to APMA’s CMO, Dyane Tower, DPM, MPH, MS, CAE for organize this symposium!
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