11/20/2023    Richard M. Cowin, DPM

MD Podiatrist Discusses Advances in MIS

In the article that was posted in the November 17,
2023 edition of PM News, Norman A. Siddiqui, DPM,
MHA is quoted as saying, “In the past, there were
burrs that you could use for MIS; however, the
challenge was they were high-speed, high-torque,
not as accurate and potentially harmful to the
soft tissue and bone if used without strict
control.” Of course, the bur itself does not
control the speed, the power equipment that it
utilized to rotate the bur has that
responsibility.

I have had the pleasure of being a member, fellow,
scientific chairman, and president of the Academy
of Minimally Invasive Foot & Ankle Surgery
(AMIFAS) (formerly The Academy of Ambulatory Foot
& Ankle Surgery for more than 43 years. In fact,
the AMIFAS will be celebrating its 50th
anniversary next year. Of course, “The Academy”
was never mentioned nor given credit in the
article…at least the portion that was published in
PM News. During those more than four decades, I
have had the opportunity to present and to observe
many hundreds of lectures on MIS by some of the
world’s top pioneers and practitioners of MIS.

NOT ONCE in any lecture that I presented nor that
I attended have I EVER heard a speaker or lab
instructor advocate the use of high speed/high
torque instrumentation. Quite the contrary, I
have ALWAYS heard the use of low speed/high torque
advocated. As such, I find it incredibly
disingenuous of Dr. Siddiqui to insinuate that
this is a new technique that has just been
invented. I believe that it would be appropriate
for him to offer a public apology to those of us
that have come before him and who have invented
and refined these wonderful MIS techniques.
Respectfully, how about giving credit where credit
is due?

In addition, Dr. Siddiqui further stated that,
“Low-speed, high-torque allows you to make an
osteotomy and not disrupt the soft tissue.” I
disagree with that statement, as well. The #1
advantage of using low-speed/high-torque technique
with burrs is to reduce the possibility of thermal
necrosis that can lead to delayed healing,
infection, and a myriad of other complications.
If one inserts a rotating burr into soft tissue at
ANY speed, soft tissue can be disrupted. This, in
my opinion, is NOT a function of the speed of the
bur, but the quality of the technique utilized by
the surgeon.

Richard M. Cowin, DPM, Orlando, FL

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