Medical device companies that position themselves around limb salvage can grow revenue, protect margins, and strengthen payer and provider relationships while directly reducing total cost of care for high‑risk patients.  With the science of wound care advancing, lets discuss ways to maximize exposure and become a key industry player.

Why limb salvage is a business issue, not just a clinical one

Limb salvage sits at the intersection of three forces that every device manufacturer is already thinking about.  First, the rise of value‑based care, second, increasing scrutiny on device spend, and third the shift toward integrated care pathways. Major device companies consistently generate profit margins in the 20–30% range, but those margins are increasingly tied to demonstrable impact on outcomes and total episode cost. Limb salvage is exactly the kind of high‑acuity, high‑cost domain where meaningful outcome improvements translate into visible financial value for hospitals, Integrated Delivery and specialty Networks, and payers.

At the same time, the global limb salvage systems market is expected to grow from about 2.1 billion USD in 2024 to roughly 3.4 billion USD by 2030.  This marks a projected a steady compound annual growth rate that outpaces many mature device categories. For companies with portfolios in vascular, wound, fixation, orthobiologics, or podiatric surgery, limb salvage is not a just a niche, it is a natural organizing theme that integrates existing technologies into a multifaceted and economically defensible offering.

The economics of limb loss vs limb salvage

From the buyer’s perspective, the business case starts with the cost and trajectory of major amputation versus successful salvage. Major lower‑extremity amputation triggers immediate surgical and inpatient expense, but the true burden sits in downstream.  Expenses for rehab, skilled nursing, prosthetics, readmissions, and loss of independence need to be considered. Limb salvage strategies aim to prevent that cascade by preserving a functional limb, maintaining ambulation, reducing hospitalization days.  The desired result is avoiding amputations.

Evidence from multidisciplinary limb salvage programs, particularly vascular–podiatry alliances, shows that close collaboration can improve clinical outcomes and generate measurable economic value. Literature indicates that a podiatry–vascular limb salvage alliance, not only reduced amputation rates, but also delivered economic benefit through fewer complications, shorter length of stay, and lower readmission rates. For a hospital CFO or payer medical director, that is the core of the ROI narrative a device company needs to be prepared to quantify.

A simple way to frame this is to walk stakeholders through the individual steps, including baseline, intervention, and impact in a single episode of care. Start with the baseline, and calculate the costs of critical limb‑threatening ischemia or severe diabetic foot complications in the covered population.  Look at the historic amputation rate, and the current episode‑of‑care cost. Then describe the intervention as the adoption of a structured limb salvage pathway (supported by your devices), whether endovascular, surgical, wound, fixation, or infection control.  Show that once the care paradigm is implemented within a multidisciplinary team model, outcomes start to become apparent, quickly. Finally, quantify the impact in terms of reduced major amputations, improved limb salvage rates, shorter hospital stays, and fewer readmissions.  This needs to be  translated into per‑patient and per‑population savings over a one‑ to three‑year horizon. The more you can attach concrete numbers, even as well‑sourced ranges, to each of these steps, the stronger and more credible your business case will be.

Market and margin implications for device companies

On the top‑line side, the projected growth of limb salvage systems reflects both rising prevalence of diabetes and peripheral arterial disease, and greater institutional willingness to invest in limb‑preserving technologies. As the market moves from one‑off procedures toward longitudinal programs, companies that can anchor themselves as “limb salvage partners” rather than product vendors will be better positioned to capture share and cross‑sell across service lines.

On the margin side, quality and reliability are not optional. McKinsey’s work on the business case for medical device quality demonstrates that quality events such as product recalls, field actions, and performance failures, carry a much higher financial penalty than most organizations recognize.  These costs including lost sales, remediation, legal costs, and reputational damage. In a limb salvage context, where failures can mean infection, re‑operation, or limb loss, the cost of quality lapses multiplies because it undermines the very economic story you are trying to tell.

For portfolio strategy and pricing, limb salvage gives you a clear rationale for premium pricing when you can credibly link product features to reduced complications, shorter OR time, or fewer revisions. It also creates an opportunity for bundled or pathway pricing across devices used by vascular surgery, podiatry, orthopedics, and wound care, aligned with DRGs or other value‑based arrangements. In addition, a strong limb salvage value proposition opens the door to risk‑sharing pilots.  For example, supporting a limb salvage program in exchange for volume commitments tied to clinical metrics, can underwrite that risk with consistently strong quality performance.

What medical device companies specifically need to do

For a device organization, “knowing” the business case for limb salvage means operationalizing it across strategy, R&D, evidence, and commercial execution.

1. Define your limb salvage thesis

Start by mapping where your current products touch the limb salvage journey.   Look at the processes of screening and diagnostics, revascularization, infection control, skeletal stabilization, wound closure, offloading, and follow‑up. From there, decide whether you will position the business as a focused technology leader in a specific slice of that pathway (for example, below‑the‑knee endovascular) or as a broader systems partner that works across multiple specialties.

2. Build a clinical–economic evidence platform

You can strengthen your evidence platform by creating, supporting or joining multidisciplinary limb salvage programs across a system, health group, or hospital.  Bringing vascular, podiatry, and wound care together, allows you to prospectively collect outcomes and resource‑utilization data tied directly to your technologies. As you do that, design studies that capture not only limb salvage rates but also length of stay, readmissions, OR time, and post‑acute utilization.  These are the variables that hospital and payer executives ultimately use to judge value.

3. Align quality and product development with real‑world risk

Apply what we already know from broader analyses of device quality to tighten design controls, create protocols for post‑market surveillance, and field‑issue response.  This must be done with particular rigor in high‑stakes limb salvage indications. From there, prioritize design features that reduce the failure modes most likely to cause infection, re‑operation, or delayed healing, and make sure you explicitly connect those features to economic outcomes in your clinical and commercial materials.

4. Reframe commercial messaging and engagement

Equip your teams to lead with a limb preservation, and a total‑cost‑of‑care narrative.  This should be anchored in your own data, referencing credible third‑party literature, rather than defaulting to commodity product comparisons. In parallel, develop practical tools that help hospital partners model the financial impact of a limb salvage program for their own system, incorporating market growth projections and their internal benchmarks, so the value story becomes specific, local, and actionable.

5. Think in terms of programs, not products

Help customers design a true limb salvage service line.  Create clear referral criteria, standardized protocols, multidisciplinary clinics, and rigorous data tracking, but make sure your devices are embedded as the enabling tool, rather than one‑off products. Then back that up with implementation support in the form of education, pathway templates, and outcomes dashboards that make it easier for a health system to launch, operationalize, and ultimately strengthen a limb salvage program using your portfolio.

Strategic advantages beyond immediate revenue

Companies that lead in limb salvage gain more than incremental device sales. They become central to how providers and payers think about a complex, chronic, high‑cost problem. That strategic positioning tends to yield early invitations into pilots for value‑based care, preferred‑partner contracts, and co‑branded centers of excellence. It also creates meaningful differentiation in a device industry where many product categories are increasingly commoditized and where quality, outcomes, and service are becoming the real basis of competition.

There is also a reputational component. Limb salvage is a domain where the human impact is highly visible, and judged by outcomes.  Promoting preserving mobility, independence, and, in many cases, life expectancy are key drivers for natural interest. For boards, investors, and employees, it is often easier to rally around a strategy that can clearly articulate both economic return and human value.  Limb salvage offers that combination in a way that few other device categories do.

Don’t know where to start?  Let’s talk.  Contact me directly to discuss your project and thoughts.

Most companies say they want strong board members with opinions, but what they actually need are people whose opinions are grounded in real, on the ground experience. That’s where I live.

I’ve spent more than two decades building and running a multi-location medical practice, treating complex clinical problems, and navigating the messy realities of healthcare economics and business operations. That combination shapes how I look at governance, strategy, and the kind of people who belong in a boardroom.  When considering this matter, it has to be the right fit for both the company (or organization) and the potential board member.

Why experience matters on a board

A board seat is not just an honorary title.  It is a job with real world influences and consequences.

When someone has spent years managing a practice or a business, they’ve already made the hard calls.  Decisions like hiring and firing, opening new locations, investing in technology, negotiating with payors, and owning the downside should already be tools in the toolbox.  However, it is prior issues with this examples that allow someone to standout when things don’t go as planned. Those experiences create pattern recognition you cannot get from theory alone.

In my world, that has meant leading a podiatry group that’s treated tens of thousands of patients, scaled to multiple providers and locations, and maintained quality while still keeping an eye on margins and growth. That’s not abstract, these are lived decisions that either help a company stay healthy or quietly bleed out.

What I actually look for in a board member

When I think about board composition for any position, whether for a medical group, a healthcare startup, or any organization that sits at the intersection of clinical care and business, I believe you need to look for a few non-negotiables.

I’m looking for someone who has actually owned P&L responsibility, not just advised from the sidelines, and who has truly led people rather than simply managed projects. They need to understand how strategy shows up in real operations.  This includes things like scheduling, staffing, cash flow, capacity, quality, and outcomes.  It must be more than just a slide deck. Just as important, they should be able to read a balance sheet with ease and then walk out into the clinic or office and have a grounded, respectful conversation with a frontline staff member without a hint of condescension.

My own path has blended clinical medicine, surgical practice, diabetic wound care, and practice economics, reinforced by formal training in healthcare management. I’ve been responsible for both what happens in the operating room and what shows up in the monthly financials, which means my perspective on “advice” is always tied to implementation and risk.

When I talk with founders or leadership teams about their boards, I push them to think past résumés and ask, very directly several important questions. I’m asking where this person has personally carried risk and when they’ve been truly accountable for outcomes, not just deliverables. I want to know if they can point to specific situations where they changed the trajectory of a business, not just attended meetings and nodded along. That kind of lens quickly filters out a lot of impressive titles and leaves you with the people who are actually useful when things get difficult.

The advantage of a clinician-operator in the boardroom

Healthcare is full of people who understand medicine and people who understand business. However, there are fewer who truly live at both ends of that spectrum.

Running a podiatry group that delivers advanced wound care, limb preservation, and surgical services across a broad community requires much more than clinical expertise. You have to understand how margins behave when payer mixes shift, how access, scheduling, and day-to-day operations affect both outcomes and revenue, and how staffing, culture, and the patient experience ultimately drive retention and long-term growth.

That’s the lens I bring to board discussions: I’m not looking at a company only as a spreadsheet or only as a mission statement. I’m constantly asking what this strategy looks like on a Tuesday, and how a decision will affect the people actually doing the work. I want to know whether it improves patient outcomes, operational efficiency, and long-term financial health at the same time. When you’ve built systems that see thousands of patients a year across multiple locations, with a team of specialists and staff depending on sound leadership.  This means stop thinking in slogans and start thinking in throughput, quality metrics, real-world constraints, and how to align all of that with a sustainable business model. Boards need more of that.

How organizations should think about board composition

If you are building or reshaping a board (whether in healthcare or another field) here’s how I’d approach it based on what has actually worked in my own world:

1. Start with your reality, not your aspiration.
   Look honestly at what stage your organization is: early growth, restructuring, scaling, or stabilizing. Then recruit people who have actually lived through that specific phase, in real operations, not just as outside advisors.
2. Balance specialists with operators.
   You may need legal, financial, or technical expertise, but you also need at least one person who has built something from scratch and kept it alive through good and bad cycles. That’s where practical, grounded opinions come from.
3. Prioritize people who understand your ecosystem.
   In healthcare, that means someone who knows how payors think, how clinicians think, and how patients actually behave. Translate that principle to your industry and you’ll quickly see which board candidates will be useful and which will be decorative.
4. Look for people who ask operational questions.
   The best board members I’ve worked with want to know how strategy shows up in the day-to-day: what changes at the front desk, in the exam room, in scheduling, in billing, in staffing. They’re not satisfied with surface-level answers.
5. Choose people who are willing to disagree.
   Opinions are only valuable if they’re honest. If my experience tells me something is unsustainable (like a growth target, a staffing model, or a marketing strategy), I’m going to say that. That’s what you want from a board member: someone whose experience gives them the confidence to challenge the room when needed.  Avoid “YES” men

Why my perspective is opinionated on purpose

Over the years, I’ve seen what happens when organizations stack their boards with name recognition instead of real operators. The meetings are pleasant, the minutes look clean, and the execution quietly suffers.

My experience running a high-volume, multi-physician podiatry group, working in complex diabetic limb preservation, and navigating the business side of healthcare has taught me that the cost of a passive board is always paid by someone: the staff, the patients, or the future of the company.

Spending time in the business trenches,  I have opinions about business matters, board structure, and who should have a seat at the table. They’re not theoretical. They come from years of balancing clinical quality, patient experience, growth, and financial sustainability in real time.

I’ve spent a lot of time thinking about the “last mile.” In logistics, that phrase means the final leg of a delivery.  It is the point where a package leaves the distribution hub and actually lands on the customer’s doorstep (all those Amazon trucks you see every day).  It’s the most expensive, unpredictable, and failure-prone part of the supply chain. Oddly enough, after years in podiatry, I’ve realized it’s not that different from what we do with diabetic foot care. Healing the wound is one thing. Keeping it healed, now that’s the last mile.

When I studied logistics in business school, I learned that the last mile could make or break the entire operation. You could have perfect inventory management, efficient routing software, polished warehouse systems, but if the driver can’t find the address, or the customer isn’t home, none of that matters. The product doesn’t reach the person it’s meant for. The last mile is where the sole meets the surface. In diabetic wound care, it’s the same.  Everything we do leading up to wound closure (the offloading, debridement, infection control, etc.) means little if the patient doesn’t make it that final step to staying healed at home. That’s the last mile in medicine.

At WeTreatFeet, I see this play out often. A patient comes in with a chronic wound, usually a crazy history) something like my dog licked my right foot and now I have a wound on the left).  We build a plan, execute it carefully, maybe even perform a minor surgical procedure when necessary. Then the wound granulates, the margins contract, the skin re-epithelializes, success!  The wound is closed. But a month later, sometimes they’re back (it was the cat this time). Same area, same problem. That’s when I know we didn’t fully manage the “last mile.”

In logistics, the weak points are always the handoffs.  Points where there is machine to human transfer, truck to porch, etc. In healthcare, it’s clinician to patient. The transition from clinic to home is our critical handoff.   I’ll admit, it’s where many care plans falter. Once the patient leaves the controlled environment of our office, the variables explode: offloading compliance, blood sugar fluctuations, poorly fitting shoes, even how their floors are at home (I didn’t realize there was a tack strip holding down my carpet). These small, easily overlooked details can derail weeks of progress. I’ve had patients heal beautifully only to develop a new callus in the same spot because they went back to an old pair of sneakers. That was their version of the driver missing the turn.

One thing logistics taught me is to never assume the process ends when the truck leaves the warehouse. You track, confirm, and follow up. We should take that same mindset to diabetic wound care. I’ve started thinking about discharge from wound care the same way I used to think about delivery confirmation. There’s a protocol, a checklist, a final verification that the care plan is being executed where it matters, the patient’s day-to-day environment.  

This is where education and accountability come in. Patients who stay healed typically have one thing in common, they understand the “why” behind every instruction. I can tell someone to wear their diabetic shoes 100 times, but unless they connect that to real consequences (This relieves pressure where the tissue broke down), it doesn’t stick. In logistics, technology helps track that endpoint, barcode scanning, delivery photos, GPS markers. In medicine, we rely on something less tangible, trust and repetition. Sometimes it’s a phone call. Sometimes it’s a follow-up visit sooner than we would like. Whatever it takes to make sure that “package” (healing), arrives safely and stays there.

Of course, the analogy isn’t perfect. Healing human tissue involves biology and behavior, not just route optimization. But the systems-thinking part of me loves the comparison because it forces us to consider efficiency, reliability, and sustainability as clinical goals. Healing a wound is an achievement. Keeping it healed is a system.

I’ll give you an example that still sticks in my mind. A retired bus driver with long-standing diabetes came to us after two failed wound treatments elsewhere. Big plantar ulcer. Debrided, infected, and unhealthy.  I started the treatment (the order) and worked to reduce weight and improve glucose control (the delivery). After eight weeks, he was healed (package in hand). We celebrated this achievement. Then, three months later, he returned with another ulcer, same location. Turns out his daughter had bought him a pair of shoes she thought would help (extra wide, they have a different definition of this than I did) without an offloading insert. That one small deviation reopened everything. That’s the “missed delivery.” Everything before that had gone according to plan, right up to the final handoff. I learned that day to never assume the last mile is in place until I see it myself.

In logistics, you map routes meticulously, but the street-level variables still get you: weather, traffic, construction, misplaced addresses. Same idea goes for wound healing. The vascular flow can look great, the A1C numbers can be acceptable, but one pressure point under a metatarsal head can undo everything. So, like a logistics manager anticipating delays, I’ve learned to plan redundancies.  I allow for extra follow-up appointments, shoe evaluations, nursing check-ins. If there’s one thing that I’ve learned in 25 years of treating diabetic feet, it is that healing is a process, but staying healed is a promise we make together.

There’s another parallel to also consider.  It is the data. In logistics, you track every metric: cost per mile, on-time rate, failed deliveries. In diabetic wound management, we also have data, items like wound size, duration, ABI, infection markers. What we rarely measure is post-healing durability. How long does the wound stay closed? This is the metric I want to optimize. A “healing durability index,” if you will. Because once we start measuring it, we can improve it. That’s how logistics transformed from guesswork into precision science, and in medicine, we should do the same.

Something else I’ve taken from my business training, lean courses, (school of hard knocks ) is to take pride in the small victories. A perfectly delivered package. A healed wound that stays closed for a year. Neither happens by luck, they both happen because of dozens of tiny decisions lined up just right. The driver took the time to triple-check the address. The patient decided not to walk barefoot, even once. These micro-choices define whether success holds.

Honestly, that’s where the human side of medicine still amazes me. You can design the best offloading device, optimize the antibiotic regimen, digitize every wound photo, and it is still about relationships. Logistics systems depend on drivers showing up and customers being home. My clinical outcomes depend on patients showing up, both mentally as much as physically. When they understand that “last mile” belongs to them, healing shifts from something I do for them to something we do together.

So if there’s one thing these  very different, yet exactly the same concepts have taught me, it’s this,  systems fail where communication ends. In logistics, that means an undelivered box. In diabetic wound care, it means a patient who heals but doesn’t stay healed. Every time I see a wound close now, I think about the delivery truck pulling up to the house. The job isn’t done until it’s safely inside (and the amazon drivers stop blocking each other in).

That’s the last mile. And for anyone living with diabetes, that mile is where everything counts.  It is the difference between healing and hospital, between independence and another round of treatment. So as a doctor, my job isn’t just to close wounds. It’s to make sure the healing gets delivered, and stays delivered.

In 2026, medical progress means outperforming yesterday’s care on outcomes, cost, and access. This means things need to be better, cheaper, faster. Make today’s treatment better than yesterday’s. Costs are paramount, and speed of the essence. Is this really the future of medicine? I spend a good amount of time thinking about this.  What will medical care look like when I am no longer a spook on a cog, but a patient in a bed?

Medicine only progresses when it delivers care that is better for the patient, more affordable for the system, and faster to access in the real world. That is the framework I use every day as a clinician at WeTreatFeet Podiatry  and as a consultant and educator through The Podiatry Voice. After more than two decades of doing this work, I have learned that if an idea does not improve at least two of those three areas, better, cheaper, or faster, it usually looks good in a presentation but fails when it meets real patients and real clinics dealing with real insurance providers.

When I talk about making medicine better, I am not referring to marketing language. I am talking about actual outcomes. That means fewer amputations, fewer deep infections, and fewer people losing their independence because of wounds that never heal.

At WeTreatFeet Podiatry, across our locations in Maryland, Washington DC, and Pennsylvania, we have built our model around advanced lower extremity care. We focus on foot and ankle surgery, diabetic limb preservation, and complex wound care. We do this with a practical focus on what truly changes a patient’s trajectory. That often means using advanced technologies such as bioengineered tissue grafts and negative pressure wound therapy. It also means pairing those technologies with the basics that are not glamorous but are absolutely essential. Those basics include offloading, blood sugar control, vascular evaluation, proper shoegear, and consistent follow up.

Many times, the real turning point for a patient is not the “high tech” solution. It is getting them into the right shoe with the right offloading device and giving them a clear plan that fits their actual life.

Better care also requires honesty about surgery. My clinical background includes advanced reconstructive procedures and minimally invasive surgery. I have worked extensively with implant and fixation systems and have helped teach and refine several of these techniques over the years. I have lectured on bunion correction with specific plate systems and on subtalar implants. I have consulted with biomedical companies to improve the tools we use in the operating room.

In my own practice, however, surgery is a tool, not a default answer. The decision to operate must be grounded in biomechanics, long term durability, and realistic recovery. The question is simple, will this procedure give this person a more stable and more functional foot?  That same mindset, careful and practical, is what I try to share with colleagues and through my content on LinkedIn and X.com

The second pillar, making care cheaper, is where my clinical experience and business background intersect. In private practice, you quickly see how expensive avoidable complications really are. A major diabetic foot infection that ends in amputation can cost tens of thousands of dollars when you add hospitalization, operating room time, intravenous antibiotics, rehabilitation, and lost productivity.

The human cost, which includes loss of independence, depression, and caregiver burnout, does not even show up on a financial statement. If I can keep that same patient in my office (instead of the hospital) with aggressive wound care, intelligent offloading, appropriate diabetic shoes, and close monitoring, I have reduced cost for the payer, the patient, and the family. That is what I mean by cheaper.  It is care that improves outcomes without cutting corners on quality.

We have adopted tools and workflows that support this approach. Structured follow up, remote monitoring, and properly used telehealth visits are not temporary ideas left over from the pandemic. They are now permanent parts to keep high risk patients on our radar.  This is done without forcing them to miss a full day of work for a brief wound check. Newer research into remote and technology assisted monitoring of wounds and diabetic feet is pointing in the same direction. These tools use images, temperature data, and pattern recognition to identify trouble earlier. 

The result is intervention before the situation becomes critical. From a consulting standpoint, this is where I push practices and health technology teams to focus. If your solution can truly reduce hospitalizations, major amputations, or unnecessary in person visits, you have more than an interesting tool. You have something directly tied to outcomes and cost. That is where payers, health systems, and group practices start paying attention.

The third pillar is speed. Faster care is often misunderstood. It does not mean rushed visits or assembly line medicine. It means reducing friction so patients receive the right care at the right time without needless delays. At WeTreatFeet, we have worked deliberately to build a multi location, multi provider model that allows patients to be seen quickly for most foot and ankle problems.

From Owings Mills to Rosedale to Towson at University of Maryland St. Joseph Medical Center, the idea is straightforward. Get the person in, make an accurate diagnosis, and start a clear plan. Having imaging, wound supplies, and diabetic shoe and orthotic services available on site lets us compress the care timeline even more. Instead of stretching diagnosis, treatment, and prevention over several separate visits and weeks, we can often address all three in a much shorter time frame.

Telehealth plays a role in speed as well, but only in appropriate situations. A fresh postoperative complication, such as a wound that has opened, needs an in person exam. A stable chronic wound that is slowly improving, a diabetic shoe follow up, or a minor flare up with a known history can often be safely managed with good quality photographs or even a focused video visit.

I think of the construction worker who cannot easily afford to lose a day’s pay to come in for every single follow up. By alternating in person visits with telehealth check ins, and by having him send wound photos on a schedule, we can make his care more realistic and efficient without sacrificing safety. That is not just convenience. It is adherence and continuity.

When you combine better, cheaper, and faster, you start to see the real opportunities for innovation. This is the conversation I have with clinicians, practice owners, and entrepreneurs through The Podiatry Voice, and my consulting work. The overlap of those three goals is where the real value lives. A remote monitoring platform that lets a podiatrist review photos quickly, automatically flag any concerning changes, and integrates directly into the existing clinical workflow will improve healing, prevent expensive hospital admissions, and reduce unnecessary office visits.

By integrating a remote monitoring platform directly into the clinical workflow, podiatrists can quickly review photos and receive automatic flags for concerning changes. This approach will lead to improved healing outcomes, a reduction in unnecessary office visits, and the prevention of costly hospital admissions. A networked and protocol driven practice, with standardized pathways for diabetic foot care, wound management, and surgical decision making, can spread best practices across multiple locations. That means patients in different offices benefit from the same well designed playbook, instead of relying on chance or individual habit.

From the practice management side,  I spend a lot of time considering these issues. Where does practice spending effort that does not improve any of the three pillars? What practice activities are being done that do not contribute to improving the three main pillars? If a process does not make care better, cheaper, or faster, it is a candidate for streamlining, automation, or removal?  That may include repeated paperwork, poorly designed scheduling templates, inefficient referral patterns, or technology that adds clicks and complexity without adding meaningful value. I focus on that intersection of clinical excellence and business reality.  If a practice fails financially, patients eventually lose access to care, no matter how good the medicine might be.

As a medical writer, speaker, and consultant, I see one more layer that often gets overlooked. Communication must be a part of this equation. If patients do not understand the plan, they will not follow it (they might understand and not follow it anyway!).  If staff doesn’tt understand why a new protocol or device matters, adoption will be weak. If leadership does not clearly see how an innovation improves outcomes, reduces total cost, or speeds up access, it will not receive long term support. That is one of the reasons I created The Podiatry Voice. It gives our profession a place to discuss clinical reality, business strategy, and innovation in the same conversation and in plain language.

Right now, there are enormous opportunities in medicine, especially in podiatry and limb preservation. We are facing aging populations, rising diabetes rates, payer pressure to control cost, and a growing list of new tools, from implants to remote devices, that are ready to be used intelligently.The challenges we face include an aging populace, increasing rates of diabetes, and pressure from payers to curb expenses. Simultaneously, a growing range of new tools, from implants to remote devices, are available and ready for intelligent application. On WeTreatFeetPodiatry.com, you can see our commitment to advanced care, appropriate technology, and patient centered service across many locations.

On PodiatryVoice.com, you can see the thinking behind those choices and how we help other practices navigate the same questions. In both settings, I use the same test. Does this make care better, cheaper, and faster for real patients in real clinics with real conditions? If the answer is yes to at least two of those, and ideally all three, then we are not just changing our workflows or buying another device. We are moving medicine in the direction that actually matters.

In podiatry, we all see the same pattern: two patients with essentially the same diagnosis, the same procedure, the same follow‑up plan.  Then they have very different outcomes. One heals smoothly and gets back to walking the dog, working, and playing golf. The other drifts in and out of care, “forgets” the boot, misses dressing changes, and eventually ends up with complications we were trying to prevent. It’s easy to blame noncompliance or “difficult patients,” but that doesn’t actually help us change anything. Over time in practice, I’ve found it’s more useful to ask a different question: what’s really driving their behavior?

That’s where the Motivation–Opportunity–Ability (MOA) model becomes useful. The MOA model has its roots in work on employee performance and human behavior.  This emerged in organizational psychology in the late twentieth century.  Blumberg and Pringle wrote about this in their 1982 article appeared the Academy of Management Review.  The article stressed discussed a three‑factor model consisting of “capacity, willingness, opportunity”.  This later evolved into the AMO/MOA family of frameworks. (AMO is Ability–Motivation–Opportunity model)

It’s a simple way to think about why people do—or don’t do—the things we ask them to do. In my world as a podiatrist, it applies just as much to patients as it does to staff, and even to my own. The model says that for someone to take meaningful action, three pieces have to line up: motivation, opportunity, and ability. When all three are present, things tend to move in the right direction. When one is missing, we get the familiar mix of apathy, frustration, and stalled progress that one would see in any business.

Motivation is the “why.” It’s the internal drive or external pressure that makes a patient actually want to follow instructions (despite when they just nod politely in the exam room). A motivated patient isn’t just trying to “heal the wound”; they want to walk at their granddaughter’s graduation, or keep their job, and even avoid the hospital. Sometimes it’s positive, when it provides more freedom, less pain. Sometimes it’s negative, avoiding surgery or amputation. Both can work if they’re specific and personal. When motivation is missing, you can feel it in the room. The dressing change instructions land, but there’s no spark behind the eyes. The patient hears you, but they don’t really see the point, and nothing changes when they walk out the door.

Opportunity is the piece we, as physicians, tend to underestimate. We assume that if people know better, they’ll do better. But I’ve had plenty of patients who desperately wanted to heal and still couldn’t follow the plan (I often say, if I only took care of people who listened to me, I would be very lonely). Opportunity is all the external conditions that either support or sabotage what we’re asking from the patient.  Things like their time, transportation, money, having home support, changing work demands or the physical environment. Think of the patient who wants to offload but stands all day at work, the person who can’t get a ride to follow‑ups and walks a mile to the office, or the patient whose dressing supplies are too expensive or not covered.

It is important to understand that they’re not ignoring you, they’re boxed in. On the practice side, opportunity shows up as staff levels, scheduling realities, EHR workflows, and whether we give our team the space and tools to do what we’re asking them to do. When motivation is there, but opportunity is missing, everyone ends up frustrated. The patient feels like they’re failing. The team feels like they’re spinning their wheels.

Ability is the third leg of the stool. This is where skills, understanding, and experience live. Patients need to know not just what to do, but how to do it.  How will they behave when care is in their own hands, or in their own home, even with their own limitations. Problems arise like issues with  dexterity, balance, memory, and health literacy. If you’ve ever had a patient who “keeps doing it wrong” despite seeming engaged, you’ve probably run into an ability problem. They nod in the office, but when they’re back in their bathroom at 10 p.m., nothing you said translates into action. Our staff face the same issue when we throw new workflows, documentation demands, and clinical expectations at them. They may want to do a good job, and have the time to do it, but they simply haven’t built the skills yet.

What makes the MOA model actually practical is how these three factors combine. When motivation, opportunity, and ability are all present, you see what we call success.  The wound that steadily improves, the post‑op patient who follows restrictions, the team that runs clinic smoothly. When motivation and ability are present but opportunity is missing, you see frustration.  It is the patients who wanted to do the right thing, but can’t because of work, finances, transport, or home realities. When opportunity and ability are present but motivation is absent, you see apathy.  People have plenty of capacity, just no real interest in performing the task. When motivation and opportunity are there but ability is missing, you see a skills gap.  This is the patient or staff member who cares, has time and tools, but still can’t execute consistently.

In day‑to‑day practice, I’ve found that this model works best as a quiet mental checklist. When a case isn’t going the way it should, I ask myself, is this primarily a motivation problem, an opportunity problem, or an ability problem? For the non‑healing diabetic ulcer patient who keeps loading the foot, maybe we haven’t connected the plan to something they actually care about, so motivation is weak. Maybe they can’t realistically stay off work and don’t have access to a scooter or boot that fits their reality, which means opportunity is lacking. Maybe they literally don’t know how to get from bed to bathroom without loading the wound, which is an ability issue. Once you see which leg of the stool is wobbly, the intervention changes. Instead of repeating the same instructions louder, you adjust the plan: reframe the “why,” remove a barrier, or teach the skill in a more hands‑on way.

At the end of the day, we’re not just treating skin, bone, and biomechanics, we’re treating human behavior.  This is in real life, often with messy circumstances. The MOA framework doesn’t fix that complexity, but it gives you a cleaner way to navigate it. If you build it into how you think about patients, staff, and even your own habits, you’ll find it easier to understand why good plans fail and what you can tweak to get people moving in the direction you both want.