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Does ignorance still pervade foot surgery?

For many years I have attended international meetings of foot and ankle surgeons, in many parts of the world.  Each time I leave perplexed.

 

Recently I attended two meetings, each addressed by persons of international standing, made famous by their publications.

 

In the first, a professor and head of department (in America) was asked whether lengthening the calf muscles had a place in foot surgery.  The response was “well some people do it in America but it is not our policy”.

 

A few weeks later a similar conference was addressed by a person of similar standing who said that calf lengthening was his treatment of choice for a wide number of foot pathologies, which he listed.

 

Yet another head of department attributed clawing of the toes to “ischaemic fibrosis of the intrinsic muscles”.  I pointed out that fibrous shortening of the intrinsics would have the reverse effect and straighten the toes.  He then conceded error, and later in his lecture forthrightly acknowledged that “he did not know the cause of clawed toes”.

 

There are surgical procedures, frequently used, which defy all logic.  One is the concept of the “metatarsal arc” and the belief that a long (or short) metatarsal is the foundation cause of some foot pain.  As a result many tens of thousands of osteotomies on the metatarsals are performed, to lengthen or shorten, “pathological” metatarsals or the adjacent (non symptomatic) metatarsal.

 

This is all nonsense of course.  These metatarsals have served their owners well for 50 or more years.  When they become symptomatic in the last quarter of life it cannot be that they are a development error.  Some other factor must have intervened to cause the symptoms.  What is important is to know what is that additional factor and to isolate and treat that factor, without damaging a perfectly normal metatarsal by surgical insult.

 

Should I not be perplexed that these precepts of foot surgery, which have no rational support, drive a massive orthopaedic and podiatric industry?  Should I be surprised when these procedures fail and the victims appear in my consulting rooms day after day?

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