VA - Veterans Affairs and Pedors Shoes

The Prevention of Amputation in Veterans Everywhere (PAVE) Program

The PAVE program was established in 1993 and  is a comprehensive initiative designed to address and reduce the incidence of amputations among veterans. With a focus on enhancing the quality of life and overall health of veterans, PAVE incorporates multifaceted strategies to achieve its goals.

The program's primary goal is to decrease the prevalence of amputations among veterans, particularly those at higher risk due to conditions such as diabetes, vascular diseases, and traumatic injuries. Currently the prevalence of diabetes in VHA is about 24% making this a priority clinical issue for Veteran care. PAVE aims to achieve this through a combination of education, screening, early intervention, rehabilitation services, and ongoing research and development.

PAVE begins with extensive educational outreach efforts, including workshops and seminars for both veterans and healthcare professionals. This serves to raise awareness about preventive measures and the importance of regular check-ups. The program also includes mobile clinics for on-site screenings, making preventive services more accessible to veterans.

In terms of intervention, PAVE emphasizes timely access to rehabilitation services and collaborates with prosthetic services to ensure that veterans receive necessary support and interventions. Continuous research and development efforts are a core component of the program, with a focus on staying at the forefront of innovative technologies for prosthetics and amputation prevention.

Collaboration and partnerships are crucial to the success of PAVE. The program integrates with existing VA healthcare facilities, partners with nonprofit organizations specializing in amputation prevention, and collaborates with private healthcare providers to expand its reach and impact.

The program's effectiveness is continuously assessed through regular evaluations, monitoring the reduction in amputation rates among participating veterans, and gathering feedback from both veterans and healthcare professionals. The funding and sustainability of PAVE are ensured through budget allocations, grants, donations, and long-term partnerships.

In summary, the Prevention of Amputation in Veterans Everywhere Program is a proactive and collaborative effort to safeguard the well-being of veterans by preventing unnecessary amputations. Through education, screening, intervention, and research, PAVE strives to make a lasting impact on the lives of those who have served in the military.

The PAVE program provides a model of care for:

(1) Those veterans at risk for primary amputation for example Veterans with diabetes, peripheral arterial disease, chronic kidney disease or any disease which causes sensory neuropathy who are considered highly susceptible to developing foot ulcers.

(2) Those veterans who have already suffered an amputation ( whether traumatic or as a complication of a disease process. 

A VA medical facility PAVE coordinator incorporates interdisciplinary management of care utilizing available amputation prevention and rehabilitation resources which could include but are not limited to primary care providers, infectious disease providers, diabetic educators, nurses, podiatrists vascular surgeons, rehabilitation providers, therapists (physical, occupational, recreational), social workers, mental health care providers, and prosthetic and orthotic providers. 

The VA and Footwear 

For veterans considered to be at Level 2 or Moderate Risk with sensory loss, and may have diminished circulation, a foot deformity or minor foot infection and a diagnosis of diabetes, a referral to Podiatry or foot care specialist for regular scheduled preventative foot care and careful observation is recommended. There is provision for Depth Shoes Inlay footwear and orthosis to accommodate foot deformities to compensate for soft tissue atrophy and to evenly distribute plantar foot pressures. Depth Shoes Inlay Footwear are prefabricated shoes with a higher toe box to accommodate hammer toes and other foot deformities and has enough room to accommodate diabetic inserts.