podiatry is medical school

[AttackNME]

AnkleBreaker, I don't know how much MD/DO knows about what podiatrists do, but regardless, what we do includes hammertoe and bunion surgery, and I know the the complication rates for those procedures are pretty high, which to me is disappointing. To me that means that although we have a good idea, we still don't understand the etiology of foot deformity well enough to be improving at HT/HAV surgery.

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[AttackNME]

AnkleBreaker, that is true and probably explains most of the complications but not all. From what I've learned so far being a 2nd year student, a lot of what is measured in clinic is subjective, for example manual muscle testing, and even the amount of shortening in an osteotomy. Although you can say that those are skills to be learned as a clinician and surgeon, it does thwart research efforts when there are no measured numbers to bring up. I don't know, I still got a long road ahead of me but from what I know, but I feel dissatisfied with what I've been taught so far and will be doing my best to contribute to the profession by starting on my own research project.

 

[dtrack22]

I know the the complication rates for those procedures are pretty high, which to me is disappointing. To me that means that although we have a good idea, we still don't understand the etiology of foot deformity well enough to be improving at HT/HAV surgery.

The foot and ankle are essentially a perfect storm of everything that makes healing difficult. If we walked on our hands complications would drop...but we also wouldn't exist as a profession...you win some you lose some

It's like saying orthopedics don't understand ortho pathologies of the shoulder because failure/complication rates are so much higher than ACL recons...it has little to do with understanding and a lot to do with the anatomical structures/function that make up each joint.

 

[347932]

AnkleBreaker, I don't know how much MD/DO knows about what podiatrists do, but regardless, what we do includes hammertoe and bunion surgery, and I know the the complication rates for those procedures are pretty high, which to me is disappointing. To me that means that although we have a good idea, we still don't understand the etiology of foot deformity well enough to be improving at HT/HAV surgery.

What do you rate as a high complication rate? And what type of complications are you talking about? I would say that of all the procedures I perform, my bunion and hammertoe correction patients are the happiest with their outcomes based on decreased pain and increased function, and smooth return to normal activity. If the appropriate procedure is selected with bunion deformity correction, the recurrence rate is more than acceptable so I'm a little mystified by your comments.

 

[347932]

It's like saying orthopedics don't understand ortho pathologies of the shoulder because failure/complication rates are so much higher than ACL recons...it has little to do with understanding and a lot to do with the anatomical structures/function that make up each joint.

You hit the nail on the head there dtrack. Surgical outcomes are multifactorial and even if one of the factors is over looked, disaster can strike in post operative complications and outcome assessment.

 

[347932]

AnkleBreaker, that is true and probably explains most of the complications but not all. From what I've learned so far being a 2nd year student, a lot of what is measured in clinic is subjective, for example manual muscle testing, and even the amount of shortening in an osteotomy. Although you can say that those are skills to be learned as a clinician and surgeon, it does thwart research efforts when there are no measured numbers to bring up. I don't know, I still got a long road ahead of me but from what I know, but I feel dissatisfied with what I've been taught so far and will be doing my best to contribute to the profession by starting on my own research project.

In order for our profession to truly (versus theoretically) understand the interaction between the structure and the function of the foot, thousands of feet need to be measured with full motion capture MRI devices to measure angles that joints make with one another, the position of the bones and the length of muscles and tendons during gait to accurately assess when in the gait cycle these muscles function, for how long, and to what center of moment. THAT will be a revolution. Then to relate that with motion capture of gait with all the same feet with Hollywood motion capture devices and then integrating that with gait plate information.

Integrate all that info with Rootian theory and PRESTO!

How cool would that be??

 

[347932]

...and even the amount of shortening in an osteotomy.

This has been measured in many empiric studies. When I lecture about using callus distraction for the Evans procedure rather than the classic bone graft, one of the studies I quote talks about the fact that with a one centimeter graft, once bone is resorbed throughout the healing process, you only really get 4 mm of length to the lateral column. The studies are out there, you just have to find them and read them.

 

[AttackNME]

What do you rate as a high complication rate? And what type of complications are you talking about? I would say that of all the procedures I perform, my bunion and hammertoe correction patients are the happiest with their outcomes based on decreased pain and increased function, and smooth return to normal activity. If the appropriate procedure is selected with bunion deformity correction, the recurrence rate is more than acceptable so I'm a little mystified by your comments.

I admit I haven't done my pubmed search on these complication rates but it was reported by my clinician professor in one of my surgery class lectures that hammertoe correction complication rates are 42%.

In order for our profession to truly (versus theoretically) understand the interaction between the structure and the function of the foot, thousands of feet need to be measured with full motion capture MRI devices to measure angles that joints make with one another, the position of the bones and the length of muscles and tendons during gait to accurately assess when in the gait cycle these muscles function, for how long, and to what center of moment. THAT will be a revolution. Then to relate that with motion capture of gait with all the same feet with Hollywood motion capture devices and then integrating that with gait plate information.

Integrate all that info with Rootian theory and PRESTO!

How cool would that be??

I think that would be cool indeed, but it's still not enough, its still only a snapshot of how the foot is moving at that instance. I think prospective studies still need to be done to determine for example how many repetitive steps with whatever amount of force and whatever severity of ankle equinus and any other variables and how it all influences the soft tissues and bones of the foot. Maybe you're aware of some paper that did this already or that theres a trial of such a prospective study being done right now?

This has been measured in many empiric studies. When I lecture about using callus distraction for the Evans procedure rather than the classic bone graft, one of the studies I quote talks about the fact that with a one centimeter graft, once bone is resorbed throughout the healing process, you only really get 4 mm of length to the lateral column. The studies are out there, you just have to find them and read them.

Well callus distraction is lengthening, but from what I learned in class it seems that for example a methead resection with a Weil osteotomy is kindof eyeballed? Or do you actually just line it up with the adjacent met heads and that is good enough? Thank you for correcting me, I haven't read anything about surgical procedures and some of their associated statistics yet and I admit I was just frustrated that I haven't been taught enough about these things and yet I'm about to start rotations soon, but when I find the time to read those articles, I will!

 

[347932]

A couple of things to consider.

Surgery is an art, not a science. There are just too many variables for ANY study to take them all into account.

Every surgeon approaches their corrections and surgeries in a different way regardless of published research.

Weil Osteotomies are currently the flavor of the month procedure and there is A LOT of research needed to truly quantify this procedure and it's efficacy imho. Yes, most will eyeball where they want the met to sit and use a Mini C-Arm in the OR to guesstimate. Just because you put a bone where you want it doesn't mean it will heal there either. Again, way too many variables.

 

[Sabin]

Stop trying to justify yourself and just do what you are trained to do. If you do it well and humbly so, everything will fall into place.

My New Favorite Quote!