01/10/2024    Allen Jacobs, DPM

The Legacy of James Ganley, DPM

Recently, there has been discussion regarding Dr.
James Ganley. Dr. Ganley was a professor avoid
orthopedics at PCPM. Many, such as myself, had the
honor and privilege of learning and studying under
Dr. Ganley. In many ways, he was the William Osler
of podiatry. I thought that I might share some of
his insight and wisdom with PM readers in the hope
that it might improve their daily practice.

Regarding bunion surgery

In the 1970s, distal metaphyseal osteotomy began
to become popular for the correction of bunion
deformities. Dr. Ganley, always receptive to
alternative thoughts and ideas, listened carefully
to the arguments favoring distal metaphyseal
osteotomy. Dr. Ganley favored correction with
either an open up wedge cuneiform osteotomy or
Lapidus procedure. This preceded the current
enthusiasm for the Lapidus procedure, or the
consideration of concepts, such as the CORA. Dr.
Ganley would hold up an x-ray of a foot with a
bunion deformity, and noted there was never a
deformity within the first metatarsal itself but
rather, the deformity was at the metatarsal
cuneiform joint. He would ask the same question
with regard to distal osteotomy. “Why would you
correct a deformity in order to correct a
deformity in otherwise normal metatarsal bone”. He
stated his philosophy “correct that which is
deformed“.

Regarding medical malpractice

Dr. Ganley noted the hindsight bias, often
employed by expert witnesses, blaming a podiatrist
for a poor outcome or less than optimal outcome.
Dr. Ganley told us “the only place they practice
perfect medicine is in the office of plaintiff
attorneys“.

Regarding the management of flatfoot deformity

Dr. Ganley regarded flexible non-neurologic flat
foot deformity, as generally being the result
residual calcaneal valgus of infancy. He pointed
out that in general flatfoot deformity was a
peritalar dislocation, since the talus was locked
between the tibia and fibula, and the foot would
dislocate around a stable talus. During the 1970s,
the concept of flatfoot secondary to compensated
deformities was popularized, following the work of
Root, Weed, Orion and Sgarlato.

One day, the entire school at PCPM was closed in
order to listen to Dr. Merton Root present the
concept of compensated deformities. Dr. Ganley was
present throughout the lectures and considered
what he had heard. With reference to concepts such
as compensated deformities such as forefoot varus
or valgus, or compensated rear foot varus, Dr.
Ganley asked how a child could have a non
neurological/ non vertical talus flat foot
deformity at birth, or prior to walking since
compensation required weight-bearing. When
confronted with the various foot types, Dr. Ganley
stated “morphology does not prove etiology “.

Regarding the role of an educator

Dr. Ganley noted “ a good teacher cannot teach you
the subject you need to learn. A good teacher will
teach you the need to learn about a subject and
motivate you to go about learning about that
subject”. He did this weekly. He would lecture
areas such as rheumatology, showing you why you
needed to master the subject of rheumatology. He
would lecture in pediatrics, again, showing you
the need to go about learning pediatric
orthopedics. He would lecture on vascular disease,
the diabetic foot, and so on. I believe he was
successful in motivating many of us to go about
learning the subjects he told us were important to
master.

Further thoughts on teaching

Dr. Ganley had the mantra “if the student does not
exceed the master, then the master has failed“.
One year at the Connecticut state podiatry meeting
I was lecturing with Dr. Ganley and Dr. Guido
Laporta. Dr. Ganley was on the stage and pulled
out some yellow 3 x 5 cards. He explained that he
kept a 3 x 5 card on every student he taught and
tried to predict what their future professional
careers would be like. He proceeded to read his
description of myself and Dr. Laporta based on his
impressions as students. He was right on the
money.

On the technological imperative

Dr. Ganley was well aware of the technological
comparative even in the 1970s. He warned us back
then about the influence that industry and recency
bias could have on evaluation and treatment of
patients. He was lecturing at the Milton Hershey
annual scientific seminar and was on the stage
with five individuals who that time, were the
major thought leaders in our profession. The topic
was bunion surgery. Each of the speakers presented
a new bunion procedure. Dr. Ganley was the final
speaker. Each of the prior speakers had
multicolored spectacular slides, and were using
two carousels simultaneously. Dr. Ganley presented
his first slide which was photographed off of a
typewriter and was black and white. The slide
stated simply “how many bad results can you afford
to have limping about your town“. He was correct.
When was the last time interview performed a DRATO
bunionectomy, or performed a Valenti bunionectomy,
or performed a hat graft procedure to correct a
bunion?

Humility

One day, it seemed as though many of the students
were not paying particular attention to Dr. Ganley
in class. One of the students, Fran Lynch, was
upset at the lack of respect for Dr. Ganley. After
the class he went up and apologized to Dr. Ganley
for the inattention of the students in the class.
He told Dr. Ganley “they have missed a wonderful
opportunity to have learned what you just
discussed“. Dr. Ganley looked Fran Lynch and said
“that’s OK. In the future they will be paying to
attend a seminar to get the same advice and
information“.

He was indeed a humble individual. I was speaking
at the North Carolina state podiatry seminar one
year, and Dr. Ganley was also speaking at the
meeting. Dr. Ganley and his wife Ann were sitting
in the audience as I was speaking. I don’t recall
the topic, but I mentioned that “ontogeny does not
prove etiology “. As I continued my talk, I saw
Dr. Ganley reach into his jacket pocket and remove
a pencil and pad and start writing something down.
I was wondering to myself what I had said
incorrectly. After the lecture during a break, Dr.
Ganley came up to me and told me how much he liked
the quote that ontogeny does not prove etiology.
He wanted permission to use that in a future
paper. I reminded Dr. Ganley that it was his
statement which was found in his classic paper on
calcaneal valgus of infancy. He thought about it
for a second and looked at his wife Ann and said
“no wonder I liked it so much”.

I have had the privilege and honor of presenting
scientific material at many of our seminars
throughout the years. I frequently quote Dr.
Ganley. To this day I continue to meet individuals
who thank me for reminding them of Dr. Ganley, and
the great role that he played in motivating them
to become better doctors than they would have
been. Although deceased, his thoughts and insight
continue to live on in our profession.

Allen Jacobs, DPM, St. Louis, MO

Other messages in this thread:

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01/12/2024    Steven Kravitz, DPM

The Legacy of James Ganley, DPM (Allen Jacobs, DPM)

Dr. Jacobs’ post to pay tribute to Dr. James
Ganley is an absolute pleasure to read. Thank you
Dr. Jacobs for taking the time to articulate this
and to Dr. Block for publishing and helping it
gain some traction and attention, so that many
have the ability to read it. There's a lot of
lesson in it and Dr. Jacob's beautifully touches,
the surface describing attributes, nuances, and
the ability to get to feel who Dr. Ganley was, and
why he is recognized as an icon. Humble with
humility, brilliant, without exception,
compassionate for others, a sense of balance in
life and ability to enjoy other aspects outside of
his profession, sailing being just one of them.

One important point that comes out as you read the
tribute is how much Dr. Ganley appreciated and
enjoyed being a podiatrist. There's too much
negativity today about our profession and some of
the inadequacies or problems that we face. But as
I grow older, I realize how lucky I am and in a
similar way to Ganley, have a good fortune of
being a podiatrist and would recommend considering
our field to anybody seeking a career in medicine.
The opportunity to practice many different aspects
from surgery to biomechanics, orthopedics,
pediatrics to sports medicine on and on. Dr.
Ganley reflected a base of knowledge in so many
different areas and through his teaching
encouraged all of those who had the privilege to
learn from him to also appreciate how great our
field can be and develop interests and expertise
to help patients through knowledge in these
various areas of medicine.

Dr. Jacobs and those who have commented on the
stream including Dr. Caringi my good friend, Dr.
Joe Agostinelli have added to the stream as well.
There's not much more than I can say except I'm
glad this was written.

Steven Kravitz, DPM Winston-Salem NC area.

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01/11/2024    Joe Agostinelli, DPM

The Legacy of James Ganley, DPM (Allen Jacobs, DPM)

I am writing this after reading three times Dr,
Allen Jacobs’ thoughts on Dr. James Ganley. That
brought back memories from 1977-1981 during my
time at PCPM. Although during that time, Dr. Ganley lectured
mostly on pediatrics to our class. Dr. Jacobs’
comments are “spot on” as to the influence Dr.
Ganley had on his students! Personally during my 23 years in the USAF, we had Dr. Ganley speak to our armed forces DPMs several times. We had one particular seminar where Drs.
Ganley and E. Dalton McGlamry lectured a full day
each back to back.

I still remember the “pearls of knowledge from
both of these giants of our profession. Dr. Ganley
would sit in a chair on stage, reflecting back on
his few slides - but was talking to us “rather
than lecturing about various topics. He always
mentioned the medicine/surgery education and
training he received as a corpsman in the U.S.
Navy, and like all of our armed forces DPMs, his
experiences in the military mirrored ours as far
as our training with and working with orthopedic
surgeons. Dr. Jacobs mentioned the concept that
Dr. Ganley taught us about the “talus locked in
the tibia/ fibula and the foot basically
dislocating from the talus!”

He made complex things so simple by his humble
presentations. Dr. Ganley held court with us at
lunch time and after the days lectures - we could
not obtain enough knowledge during the day
lectures and he was more than happy to spend extra
hours with us. I have to thank Dr. Jacobs for
writing his comments about Dr. Ganley and “making
my day”!

I am sure countless other DPMs as students at
PCPM, and doctors at military and civilian CME
seminars have similar memories of how Dr. Ganley
influenced their careers.

Joe Agostinelli, DPM, Colonel, USAF (Retired),
Niceville, FL

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01/11/2024    Greg Caringi, DPM

The Legacy of James Ganley, DPM (Allen Jacobs, DPM)

I had an unusual relationship with Dr. Ganley.
Since I was an OCPM graduate, I did not know him
as a professor. He was a personal friend of Dr.
Chauncey Roelofs, my first employer in Lansdale.
Like myself, Dr. Ganley's first job out of the
Navy was in Dr. Roelofs' original office in
Phoenixville. He was introduced as a friend. We
worked together training residents at our
respective hospitals in Norristown.

His "residency" was the best fellowship a student
could have at that time and his former residents
have all had great success in our profession by
following his lessons in podiatry and in life. As
CPME requirements for residencies became stricter,
we were able to help him out with the required
rotations at our program. A small price for the
remarkable education I personally received from
Dr. Ganley. In practice, I don't believe a day
went by where I didn't use something he taught me.

As Dr. Jacobs' recently provided some insight into
this great man, here are some of my recollections.

Dr. Ganley would say, always do what is best for
the patient instead of what gratifies your ego or
bank account.

He was always a proponent of the interpositional
arthroplasty (modified Keller) procedure for a
wide range of pathologies. Dr. Ganley taught me
his technique. He could reliably demonstrate a
reduction in IM angle using the procedure because
of the reduction in soft tissue retrograde force.
It still works.

As complex as his surgeries could be, like another
mentor Dr. Ray Suppan, Dr. Ganley would always try
to avoid fusions and instead use osteotomies
(often opening wedges) to realign the abnormal
structure at the exact point of the deformity. He
often lectured on the opening cuneiform osteotomy
for correction of metatarsus primus adductus. He
also brought the Evans procedure to Podiatry.
Again, an opening calcaneal wedge osteotomy
instead of a fusion.

Dr. Ganley would say, if you do enough surgery,
you will have complications. He would say you
cannot guarantee your patients anything other than
doing your very best work. If a complication
occurs, give them all of your attention. If you
cannot solve the problem, find someone who can.
No ego. Always in the service of his patients.
Gone much too soon. A once-in-a-generation
physician and friend.

Greg Caringi, DPM, North Wales, PA