05/17/2018    Joseph Borreggine, DPM

MIS Returns to Podiatry

With the recent article that appeared in PM News
http://www.podiatrym.com/pdf/2018/4/Peacock418web
.pdf, I began to wonder why this type of foot
surgery has had an unbelievable resurgence in
light of the years that have passed that caused
podiatry to distant itself from this type of
surgery in lieu of the more traditional
techniques taught in the APMA and CPME mandated
three-year, post-graduate DPM surgical residency?

I graduated in 1988 and received my DPM from
Scholl College. One of the reasons that I decided
to become a podiatrist was because I found an
interest in minimal incision surgery or “MIS” as
it was called back then.

As a young college graduate thinking about
entering the podiatric profession those many
years ago, I was ignorant to the fact that the
DPMs who were performing this type surgery were
doing so because they could not get on staff at a
hospital because were either not residency
trained in the field podiatric surgery or a
podiatrist was not allowed to be on staff in the
community that they practiced. I had no idea that
podiatry was not that well accepted or respected
as much as I had assumed they were when I was
making this my career choice.

At the time, I believe this surgical disparity
within podiatry divided the profession into two
separate surgical arms. I opine that this schism
may have gone against the surgical mission
statements of the newly formed American College
of Foot and Ankle Surgeons (ACFAS) and the
American Board of Podiatric Surgery (ABPS). These
organizations were primarily established to
legitimize the podiatric profession as a well-
trained surgical specialty in comparison to the
medical profession.

At the same time, the Ambulatory Academy of Foot
and Ankle Surgery (AAFAS) was established to
answer the needs of the podiatrist who wanted to
be identified with their colleagues who also
performed MIS. This organization still exists
today and continues to educate the podiatric
profession on the many nuances and techniques of
“minimally invasive” foot surgery which has now
replaced the old name to fame for this type of
foot surgery

Most DPMs who performed MIS truly opined this was
a much more lucrative way to practice. There was
less time out of the office and created a benefit
to the patient by lessening the recovery. It was
marketed to the public and heavily in the 70’s
and 80’s as “no stitch” type of foot surgery that
had much less recovery than the traditional
methods and allowed the patient to ambulate right
away.

But, this type of surgery was unofficially taught
either in office preceptorships or in weekend
courses and not residency positions.
Unfortunately, this led a handful of podiatrists
who had over utilized this type of surgery
without prejudice leading to a number of
iatrogenic post-op deformities that caused MIS to
have a bad reputation in the eyes of the
orthopedic surgeons who ultimately saw most of
these complications. In turn and back then, this
did not help the podiatric profession to bolster
its claim that they were “well-trained” foot and
ankle surgeons.

Even though there were a number of pioneers in
the field who tried to improve the reliability of
MIS, it fell out of favor and was frequently
relegated to only using it to resolve “lump and
bump” type issues on the feet. Even with that
said, during that time MIS was a mainstay of
surgical treatment for a number of podiatrists
who were very confident performing these types of
procedures and had favorable outcomes.

So, based on my initial question. Why has MIS
comeback to this profession? Is it answer to the
changes in healthcare? Are the younger DPMs
wanting provide this surgical option to their
patients with great frequency? Are the current
desires of the patient population at large who
are demanding a less invasive alternative to
having foot surgery along with minimal disability
that goes along with their current and busy
lifestyle? Will the MIS resurgence divide or
unify us? Only time will tell.

Joseph Borreggine, DPM, Charleston, IL

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