With the aging of Japanese society, the number of people facing problems with their feet has grown rapidly. Many of these people have comorbidities that affect their blood vessels, such as arteriosclerosis obliterans and diabetes. However, the major cause of such problems is a reduction in walking function or its loss altogether. Medical facilities use a range of equipment to assess patients’ walking abilities from the standpoint of biomechanics. However, no further assessments are conducted after patients have returned home. With advances in the“internet of things”and information and communication technologies, it has become possible to conduct analyses of patients’ walking function and ability to perform activities of daily living. The use of such equipment means that information can be obtained not only after individuals become ill, but throughout their daily lives, which allows medical care to be tailored to the patient. Deploying technology to the domestic setting through partnerships between medical practitioners and biomedical engineers has resulted in clear improvements in patients’ way of life and walking abilities.

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Annual medical expenditure in Japan reached 41,000 billion yen in 2015 and is expected to increase. In the field of foot care, it is important to evaluate the efficiency of health care. Health economics evaluations are used to evaluate the efficiency of health care and explain how people make decisions regarding their use of health care. In this review, I comment on the use of economic evaluation methods and their interpretation in the health care.

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The Japanese Society of Limb Salvage And Podiatric Medicine（JLSPM）established a certified masters system. The first certified masters were appointed by the society in 2015. The JLSPM-certified masters will be responsible for limb salvage treatment centers; i.e., they will act as gatekeepers. Furthermore, they will replace the horizontal segmentation approach to limb salvage with the vertical segmentation method. It is important for them to meet patients with conditions other than foot ulcers, such as those with foot diseases. Physicians who are certified masters are conscious of the need to act in a responsible manner. It seems that the JLSPM-certified masters will play a leading role in limb salvage and the treatment of foot diseases. In addition, they will provide educational activities for gatekeepers, civilians, and medical workers. In the future, it is expected that the JLSPM-certified masters will engage in a broader range of activities.

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In Japan, nearly 7 million people aged ≥60 years suffer from foot lesions. Due to the rapid aging of Japanese society and the rising prevalence of diabetes, the number of patients that are at high risk of developing such lesions is also increasing. Consequently, preventive foot care, which is mainly provided by nurses in outpatient departments, is becoming more important. However, some patients present with foot lesions due to disorders such as advanced neuropathy or vascular insufficiency, and it is necessary to understand the pathology of such conditions. In addition, it is important to employ preventive measures against such lesions, assess the factors associated with their early identification, and provide care that will facilitate early healing and prevent recurrence. Accordingly, the Japanese Society of Limb Salvage and Podiatric Medicine（JLSPM）has begun to train and certify foot care specialists. This paper describes the role played by JLSPM-certified nurses at our hospital.

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Peripheral arterial disease and diabetic foot disease affect walking, so the role of physical therapists is important. But there are no studies on this issue. I will report the efforts of rehabilitation at Kasukabe Central General Hospital and educational activities.

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Although it is widely acknowledged that multidisciplinary interventions are of great importance for limb salvage, the unfortunate reality is that little recognition is given to the role that medical technologists can play in such interventions. Even at my hospital, nursing staff used to play a key role in patient assessments and care, with the result that medical technologists were only passively involved in the process; i.e., they performed evaluations of the ankle-brachial index as directed by doctors and then submitted the results. However, one cannot overstate the importance of conducting various tests on the lower limbs and the vital role that such tests play in determining the optimal treatment plan for each patient. The role of medical technologists who are certified in limb salvage is to first draw on their expertise to promptly submit test results that are both precise and accurate and then proactively offer advice based on these results, which can facilitate patient diagnosis and improve the care provided by doctors and nurses. Thereby, medical technologists can act as so-called “gatekeepers” and are capable of detecting serious conditions within appropriate timeframes.

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The author works as a prosthetist and an orthotist at a hospital and was certified by the Japanese Society of Limb Salvage and Podiatric Medicine in 2015. Our hospital has been producing and repairing prostheses and orthoses for more than 60 years. Therefore, we receive many requests from users of prostheses and orthoses. As the local community is aging, the number of elderly users of such devices is increasing. During the management of individual cases, cooperation with other professionals both within and outside of our hospital is important. In addition, holding workshops in facilities for the elderly in the local community and other residents was found to be an effective way of disseminating information regarding the necessity of prostheses and orthoses in integrated community care. A number of prosthetists and orthotists work in the hospitals in our local area（approximately 50）, but we would like to contribute more to limb salvage and integrated community care. Moreover, we hope that the number of prosthetists and orthotists will increase and that professionals in other fields will contribute to the provision of comprehensive care in the local community.

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A group focusing on the prevention and rehabilitation of chronic lower limb wounds was launched with the aim of 1) providing and disseminating information about the rehabilitation of patients with chronic leg wounds, a condition for which multi-disciplinary collaboration is essential, and 2) promoting clinical studies in this area. In terms of teaching and disseminating information, so far three study meetings for physiotherapists, occupational therapists, prosthetists, and other professionals associated with rehabilitation have been held as satellite meetings of the Annual Meeting of the Japanese Society of Limb Salvage and Podiatric Medicine, and symposia, lectures, and workshops for related medical associations and groups have also been conducted. These educational and information-disseminating activities have provided information not only for therapists who are already involved in limb salvage treatment, but also for those who will engage in such treatment in future. Research activities associated with the group have received Health and Labor Sciences Research Grants, and the results were shared in study meetings, in which the topics concerned were explored further. The group continues to encourage the spread of information about the rehabilitation of patients with chronic leg wounds and to promote research activities on the basis of multi-disciplinary collaboration.

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Peripheral artery disease（PAD）is associated with increased risks of cardiovascular and cerebrovascular events. In patients with PAD, it is important to screen for cardiovascular disease（CVD）and coronary artery disease（CAD）in order to detect these conditions at an early stage. As for PAD screening, it should be conducted in a convenient and non-invasive manner. We previously reported that PAD screening using the perfusion index（PI）is useful in dialysis patients. We carried out PAD screening using the PI in 94 inpatients. The cut-off PI value used to identify suspected low perfusion was <1.0. In total, 18.1% of the patients had suspected PAD. PAD screening based on the PI led to the early detection of PAD. This approach has now been adopted by our whole hospital.

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Total contact casting（TCC）is an offloading modality used in the treatment of foot ulcers to reduce plantar pressure and the shear forces generated during walking. It can be performed in the outpatient setting. We conducted a multicenter prospective registry study to examine the effects, complications, and costs of using TCC as a treatment for refractory foot ulcers among maintenance dialysis patients and patients with diabetes and lower-extremity peripheral arterial disease. Among 55 patients（36 males and 19 females; mean age, 58.2±11.7 years）who were treated with TCC for foot ulcers that were refractory to 4 weeks of standard treatment, favorable outcomes were observed in 42（76.4%）, with 26（47.3%）, 33（60%）, 42 （74.5%）, and 43（76.4%）achieving a cure or sufficient improvement at 4, 8, 12, and 16 weeks, respectively. Only four（7.3%）patients discontinued treatment due to adverse events. These results show that TCC is a highly effective and safe treatment for refractory foot ulcers in Japan.

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