Intro: Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward. Here's Melanie Cole.

Melanie Cole, MS (Host): Welcome to UAB MedCast. I'm Melanie Cole. And today, our discussion focuses on the Limb Salvage Program and our Podiatric Surgery Fellowship here at UAB Medicine. Joining me is Dr. Kyle Mauk, he's the Director of the Advanced Podiatric Limb Salvage and Reconstruction Fellowship at UAB Medicine. Dr. Mauk, it's such a pleasure to have you with us.

Before we get into the topic, can you please begin by telling us what training a podiatric surgeon goes through and how are you different than other specialties that deal with foot and ankle? 

Kyle Mauk, DPM: Absolutely. So, thanks first and foremost for having me on. I think this is a great forum to talk about what makes podiatry such a unique and, in my opinion, a great specialty to go into and to utilize. So, to answer your first question, a podiatric surgeon graduates from a four-year podiatry school with a degree of a Doctor in Podiatric Medicine. That's after a completed undergraduate four-year degree, as is standard with most physician providers. They go through various types of medical school. So after the four years and the graduation with a podiatric degree, providers then go into a three-year surgical residency that focuses on surgical training for all foot and ankle pathology. This is consistent with most specialties in that podiatric residents go through various rotations throughout the rest of the body, inclusive of Internal Medicine, Emergency Medicine, Vascular Surgery, orthopedic surgery, and similar rotations throughout these three years. And then once they graduate, we have now some new and exciting fellowship opportunities for our surgeons to gain additional training. And that's what kind of prompted us here at UAB to start our Advanced Provider Fellowship Program here. So, that's Podiatry kind of in a nutshell.

And what I think makes us unique is that from the very first day of Podiatry school, after graduating with an undergraduate degree, we focus almost solely on the lower extremity. So from day one in Podiatry school, podiatrists know what area of the body they're going to specialize in. And the next seven to eight years of our lives are spent exclusively focusing on the lower extremity as a whole. So, I think it really gives us a unique perspective to provide kind of holistic care for the lower extremity in terms of any ailment that can present itself from osseous pathologies to soft tissue pathologies to neurovascular pathologies. We really do it all in the lower extremity.

Melanie Cole, MS: So, that segues really well into my next question about the pathology that you address, both surgically and non-surgically, the conditions, whether it's sports medical injuries, sports medicine injuries, or ankle cases, just kind of give us a little overview.

Kyle Mauk, DPM: Sure. So, another great point, and one that's very salient here in Alabama. So until relatively recently, I think probably about a year and a half or two years now, the scope of practice for podiatric surgeons was significantly limited to where we could only really operate on the forefoot, which is things like bunions and hammertoes, and do soft tissue work inclusive of digital amputations and wound care.

Well, about two years ago, the governor signed into law an expanded scope of practice for podiatric surgeons, which is more in line with the rest of the country. And so, now is a great time to be a podiatrist in Alabama, and certainly a great time to come train here, because our laws are now much more in line with the the rest of the country, inclusive of there's sports medicine injuries, like you said, tendon injuries, Achilles tendon ruptures, traumatic ankle fractures, things along those lines. So, we really can treat almost every condition of the foot and ankle surgically that we haven't always had access to. So, I think that provides a whole lot of expansive options for patients when they're looking to receive foot and ankle care that they might not have had prior. 

Melanie Cole, MS: And we're going to talk more about this later, Dr. Mauk, but diabetes certainly has come to the forefront of your field. And so, it's really certainly something, and we're going to discuss the Limb Salvage Program. But before we do that, you mentioned before the Podiatric Fellowship. That it's a new and innovative concept in your field. Can you highlight this program for us? Because this is really innovative and it's not only the first of its kind in the state, but also one that will be at the forefront of podiatric medical education in general.

Kyle Mauk, DPM: Absolutely. Yeah, and I'm glad that you highlighted that because again, I think it's very important and is what makes us so unique here. Not all podiatric surgical residency programs are created equal. And so, some programs are taking place in small community hospitals. There's not really many across the country that are featured in such a large academic teaching institution like UAB provides. And so, this fellowship not only for being the first of its kind in the state, but also as a whole will give our learners an environment in which they can come and learn and grow and practice that is really unique in the field as a whole. It's not often that our learners are exposed to not only the resources that UAB can provide in terms of support for a fellow, but also the pathology that we see here and the multidisciplinary team approach that we have here is really just second to none. So, I think UAB, in general, is an excellent institution to train in. We've seen that across multiple specialties for years. And now, it's nice that us as pediatric surgeons can be included in that mix and utilize some of the resources that we have here.

So, again, I think this is going to be a great program that will change the way that we practice in the state and will hopefully be able to help us recruit and keep our surgeons in the state once they're done graduating.  

Melanie Cole, MS: Well, thank you for that. So now, tell us about the Limb Salvage Program and higher level expertise that you provide at UAB. Tell us about the program, the multidisciplinary approach to limb salvage that you focus on at UAB and how being integrated into the vascular department is a huge benefit.

Kyle Mauk, DPM: The diabetic work that we do is usually the first thing that people think about when they hear the term Podiatry or podiatric surgeon. It's usually in the context of a diabetic foot complaint or an ulcer or the need for an amputation, unfortunately. And so, of course, that's a large portion of the work that we do here at UAB and in Alabama. In particular, diabetes, it makes up a large portion of the population, so we certainly see all of those complications here. And at UAB, we're lucky to be fully integrated into the Vascular Surgery program here, which is really is a benefit for the patients and our providers because most diabetic foot complications involve some component of peripheral arterial disease. And so, having those colleagues right in our department again provides us with resources that aren't always present elsewhere in the world of podiatric surgery. So, I think that gives us a really unique head up above the rest of the training programs that exist certainly in the southeast with having access to those resources readily available for us.

I also think that having these docs right down the hallway is certainly something I know I've come to rely on as a provider. And hopefully, we'll be able to instill in our trainees the value of working closely with our Vascular colleagues in addition to others such as Infectious Disease and our Wound Care Nursing teams.

And so, again, I know I keep harping on all of benefits of having this training program at UAB, but it really is something that doesn't exist a lot of places in our field. And so, again, I think, it just speaks volumes to the potential that we have here and the ability to train really, competent and excellent surgeons for our state.  

Melanie Cole, MS: Dr. Mauk, some of these patients can be quite complex, and you've mentioned the multidisciplinary approach. But there's so many more when we think of all the comorbid conditions that go along with these conditions that might be vascular or diabetes in nature. I'd like you to summarize for us the key takeaways, why these complex patients receive such great care at UAB Medicine and what you would like the takeaway to be about the fellowship program in Podiatric Surgery.

Kyle Mauk, DPM: Great question. And this is one that I have already been been kind of discussing with potential candidates as they've reached out, inquiring about what the shtick is, so to speak, of our program. And I just can't highlight enough the benefit of having everyone in the same hospital system and even under the same roof.

When these patients come in with these comorbid conditions, they're diabetic, they've got peripheral arterial disease, they have peripheral neuropathy, they have blood glucose that's completely uncontrolled, being able to send a referral to a doctor in the same clinic or across the street under the same umbrella of the same health system is just so easy for patients and providers alike. Everything is in the same EMR. Everybody is working towards the same goal. Everyone is able to see what the other providers have written in their chart. And so, the team approach is really of value for these patients that are extremely complex. I've worked in other systems where that wasn't always the case.

And so, a patient would come in with this complex Charcot foot deformity or something that was really high level in terms of the need for acute management, and we would send them to an outside endocrinologist and an outside neurologist and an outside vascular surgeon and a wound care doctor. And so, when they would come to me for surgical planning, I would have to pull together charts and faxes and documents from multiple providers from the multiple offices in different health systems. And it just really is challenging from a provider standpoint to be able to do that.

And so, here in our system, if patients are referred in, that doesn't happen because everything is here in a nicely bundled package that everyone has access to. And we can all kind of keep an eye on our individual portions while maintaining the team goal of whether it's saving a limb or something else. So, again, I think that just is really a unique aspect for these higher acuity problems that ultimately these patients always end up at a center like UAB. And so, that's what makes it so rewarding for me as a practitioner to work here because we're seeing high level complex pathology that we don't get elsewhere, but also we're doing so in a way that is very colloquial with other teams and patients just receive holistic care that is really second to none.

So, anyone who comes here for training purposes or as a patient is going to be handled under that umbrella. And I just think it's such a unique place for podiatric education and treatment that just doesn't exist elsewhere in our field. And so, I'm excited about the potential for us to not only grow the pathology that hasn't always been associated with Podiatry in Alabama, that we've talked about before, the acute injuries, the sports injuries, the trauma, but also to really expand upon the excellence that we have here in terms of our limb salvage program. And I just am really excited about what the future holds for us here.  

Melanie Cole, MS: Thank you so much, Dr. Mauk. It's really a comprehensive program and such a forward-thinking program with that comprehensive approach. Thank you again for joining us. And for more information, please visit our website at uabmedicine.org/physician. That concludes this episode of the UAB Medcast. I'm Melanie Cole. Thanks so much for joining us today.