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01/05/2017    David E. Samuel, DPM

The MIS Akin Osteotomy (Joe Boylan, DPM)

I appreciate Dr. Boylan's post and non-
disparaging thoughts regarding treating other
doctors' complications. I can't agree more. We
all see them and do them and understand, that
we usually don't see bad surgery but bad
outcomes, that can happen to all of us.

However, if I saw one of my post-op x-rays with
the capital fragment teetering on a 2-4mm area
on the met shaft with what appears to be a
first met angle easily 18 deg, if not more, I
WOULD BE VERY WORRIED. Dr. Boylan is correct.
My residents are not taught this, will never be
taught this, and I hope when they move on to
their own careers, I will never see a post-op
film like this, with very large IM angle, and
this tiny bone to bone apposition of a capital
fragment, with their names on it.

There may be some limited use of a burr for
foot surgery, but not this. This is why we
teach them Lapidus, base wedge, opening wedge,
etc etc to appropriately correct deformity
within a reasonable standard of care for bunion
surgery. I'm sorry but this is no way standard
of care across the country nor should it ever
be, whether pod, ortho, etc. We have come a
long way. Much better training. Better
didactics, etc.

There are many ways to fix met primus varus,
all dealing with the appropriate management of
the first met angle. Whether someone likes a
Scarf or base type corrections or even decides
to under correct, based on age or bone stock is
certainly surgeons preference and within
reasonable standards. But I cannot see these
post-op films as ever being acceptable as
reasonable standard of care. My personal
feelings is that this can takes us all back if
we as a group accept this as okay. What I hear
is, 'can you believe this is what those
podiatrist do ?'

These forums are great for frank intra-
disciplinary discussion. It makes us all think
and I hope makes us all better. I cannot be the
only one out there who, after seeing these
films did not cringe a little. Otherwise,
meaning no disrespect at all, please let me
know if what I am saying is wrong or needs a
different look. Am I missing anything ? Is this
OK? Do others agree with me or should I be
looking at this whole thing differently?

David E. Samuel, DPM, Springfield, PA

Other messages in this thread:

01/05/2017    Burton J. Katzen, DPM

The MIS Akin Osteotomy (Joe Boylan, DPM)

Regarding Dr. Boylan's response concerning MIS
surgery, First, let me ask Dr. Boylan if he
actually had training and experience in MIS
surgery? Also, does he believe that none of
his patients have ended up in another
physician's office with less than optimal
results? That being said, assuming your limited
experience was 25 to 35 years ago, comparing
MIS surgery at that time to the present would
be the equivalent to comparing bloodletting to
today's modern medical treatment.

MIS is an accepted standard of care in almost
every other medical specialty. The MIS foot and
ankle procedures, instrumentation, and training
(all of us have originally be trained open) are
completely different than your experience. The
real tragedy of his post is not his uninformed
prejudice against MIS, but the fact that he
is closing young practitioners minds to
learning a skill that not only benefits
patients, is being performed throughout the
world, but they will need to survive going
forward given today's medical climate.

With that in mind, The Academy of Ambulatory
Foot and Ankle Surgery has established a
scholarship to bring young graduates to our LSU
Cadaver seminars with the hope that they will
lean a skill that, unfortunately up to now,
that has not been taught in the mainstream
residencies. I would advise you to consider
attending a seminar, and, I assure you, you
will meet the friendliest group in our
profession, along with some of the most
successful. And by the way, I don't know one
member who has ridden off in the sunset. I know
I haven't after 43 years.

Burton J. Katzen, DPM, Temple Hills, MD