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Debate re minimal invasive surgery

Discussion in 'Foot Surgery' started by admin, Sep 29, 2004.

  1. admin

    admin Administrator Staff Member


    Members do not see these Ads. Sign Up.
    Lets get the ball rolling with some old wounds:)

    While this forum is for discusion between foot health professionals, we are asking that those with foot problems wanting help use the Foot Health Forum. Please help out over there with answers to questions if you can.

    While visting there, I noticed some old wounds have been opened re MIS in response to a couple of qustions:
    Bunion Surgery and [font=arial, verdana, helvetica]Post op bunions and [font=arial, verdana, helvetica]Surgery on Both Feet at Same Time[/font][/font]

    What do you think?

    Admin
    Podiatry Arena
     
    Last edited: Oct 1, 2004
  2. admin

    admin Administrator Staff Member

    I see the original person asking questions about her foot surgery is now regretting posting her message. I regret posting here now.
     
    Last edited: Oct 1, 2004
  3. podrick

    podrick Active Member

    mis surgery controversy

    i am a psr trained surgeon,with board certification (abps) and was quite intrigued by all this fuss.the reality is that you can't promote one type of surgery as a cure all.there has been very grave outcomes seen as a result of poor mis surgery.
    however,having said that we can not be blind to the fact that all orthopedic surgery including the foot and ankle,is moving towards minimal incision techniques.if you look at the academy of ambulatory foot surgeons,they may be dismissed by our profession.but they have a huge following world wide (europe,asia,latin america) among orthopedic surgeons,i might add.they have been able to make their case to these orthopods that this is where foot surgery is headed.even the great lowel scot weil,d.p.m. had to admit that may be he had not fully researched into this form of surgery before previously criticizing it(paraphrasing).he said this after ecountering it while on a visit to europe.
    i don't practice it,because i haven't been trained in it.however,i will tell you that i have encountered their patients and they are happy ones,who would never consider conventional surgery.in terms of poor results,i believe their rate of failure is no different than those of bad "open" surgeons.
    if we as a profession don't invest the resources and time to standardize these techniques.i guarantee you orthopods and even plastic surgeons will dominate this type of surgery in the future.
     
  4. steve wexler

    steve wexler Welcome New Poster

    Minimal Incision Surgery

    MIS should only be performed by those surgeons with the training to perform them. Like any procedure performed by an inexperienced doctor the results can be horrendous. The schools have removed the texts on this subject and thus these revolutionary techniques are not taught in the schools. The professors in the colleges don't have the training or experience to teach these techniques and for obvious reasons don't want them introduced. Nobody wants to be retrained to learn anything new. Traditional surgeons should not be threatened by MIS surgeons, but it seems most are. All MIS surgeons were trained in traditional surgery, but very, very few traditional surgeons have any training from qualified MIS surgeons. Patients are now demanding minimally invasive procedures in every field of surgery. Patients do not want any long scars, stitches, wires, pins, screws, staples, casts, or surgical shoes. Patients want foot surgery performed in the doctor's office, just as they prefer dental surgery. Patients don't want to have to obtain medical clearance or undergo unnecessary blood tests, EKG's, Chest x-rays, potentially harmful anesthesia or any prolonged post operative physical therapy sessions. These techniques are now over 40 years old and if they didn't work they would have dissappeared years ago. MIS doctors advise their patients they will not have any "home-depot" hardware in their feet, can bathe or shower the day after surgery, drive in a day or two, and wear their own shoes almost immediately. This is modern podiatry.
     
  5. podrick

    podrick Active Member

    mis surgery

    i agree with dr. wexler with regards to acceptance by patients of mis.whether we admit it or not the types of procedures we offer to our patients are very much market driven.if patients (consumers) reject a certain procedure it will be phased out in time,regardless of results.on the other hand,procedures which offer patients reproducible good results,and painless post operative periods,will always be in demand.it is that simple an issue.
    i would also remind my abps peers,that mis has too evolved.today,many mis surgeons utilize c-arms inorder to aide in the surgical visualization, as well as ultrasound sonography.
    furthermore,many surgeons get pre op clearances from the patient's primary doctor,in cases of patients with remarkable medical histories.there has also been a new program which certifies an ambulatory surgeons office facility,through adherance of standard protocols.these protocols rival those currently used by plastic surgeons,i might add.
    i am taking the time to learn these techniques in order to make me a more complete surgeon.if i don't as a podiatrist,the plastic surgeons will.i am already seeing it in my area.
     
  6. footmedic

    footmedic Active Member

    MIS in UK

    Please note that there is a new college in the UK for MIS Training.
    The College of Minimally Invasive Foot and Ankle Surgery.
    Soon we will launch it openly in the UK.

    Somuz Miah
     
  7. Dieter Fellner

    Dieter Fellner Well-Known Member

    MIS New College in the UK

    Somuz Miah,

    Can you offer more information about this new College? Under whose patronage is this organized?
     
    Last edited by a moderator: Oct 13, 2004
  8. admin

    admin Administrator Staff Member

    I am bumping this old thread, as the forum and issues that are mentioned in the first message have come up again:
    MIS & Dr Tucker
     
  9. footmedic

    footmedic Active Member

    CMIFAS (UK) seminar 3rd oct 2005. Open to non member. www.cmifas.co.uk :)

    S Miah
     
  10. Ian Reilly

    Ian Reilly Active Member

    Cmifas

    Where will the seminar be? Will SCP Podiatric Surgeons be welcome to attend?

    Ian Reilly
     
  11. footmedic

    footmedic Active Member

    It will be on the website soon, seminar may be held in Nottingham.
    HPC reg podiaitrist or GMC reg practitioner are all welcome.
     
  12. podrick

    podrick Active Member

    mis

    i think that one of the points that is being missed in this whole debate,is an economical one.mis surgery in the right hands not only works well.it pays very well too.patients prefer it and because it is fast and doesn't require trips to the hospital it can be very profitable.quite frankly,a conventional surgical practice can't compete with a well run mis practice.it is not an opinion.it is a fact.there are surveys in medical management journals that bears this out (florida medical business,july,2003).there are very successful mis practices that have opt out of medicare and charge only cash for their procedures.there are two in my area doing very well.
    with this said you have to recognize that the surgical establishment in our profession has labored long to establish an elite surgical class ,while the remainder of our graduates were left to fend for themselves as callous trimmers.the idea being that these glorified chiropodists would then send all the surgeries down their way.this is impractical,since we are considered a surgical specialty.
    luckily,preceptorships and better residency educators equaled the playing field.but practitioners that were a product of this system are left in frustration.they have a psr36 and a bad case of RD itis (real doctor syndrome) and can't handle the fact that they are just d.p.m.'s like the rest of us.this is the reason that they are so vehement about squashing mis,at a time when orthopedic surgeons are lining up to learn it.
    incidentally,my name is rick perez,d.p.m.,i am a buspm graduate with a psr 24 and i went to the academy of ambulatory surgery to learn how to better serve my patients.
     
  13. Ian Reilly

    Ian Reilly Active Member

    Rick

    That’s all just fine, but misses the main concern. Put patient safety before making money and you might construct a better argument.

    From your response it seems you did 4 + 2 years then trained in MIS. US trained DPMs are better trained medically than UK trained Pods (at this moment in time). In the UK we are talking about 3-year trained podiatrists and formerly non-registered chiropodists going straight to MIS. From the CMIFAS website it seems you can apply for full status if you have done 8 cases.

    This is a short cut to surgery when a better system has developed over the last 31 years – 5-6 years post grad at a very high level. I sympathise with the position you found yourself in but the position is very different in the UK to the one you are familiar with. I have studied many times in the US so I can speak with experience.

    I do MIS techniques. They do work, but not for the majority of cases. How many orthopods train in just MIS??? None. They train for years in open surgery – THEN learn MIS techniques.

    Respectfully

    Ian
     
  14. footmedic

    footmedic Active Member

    To embark upon the Fellowship programme the practitioner should have at least three years post-graduate podiatric work experience

    Associate Membership

    There are two routes for Associate members to progress to Full membership.

    1.• Those already doing surgery have up to two years to submit eight cases of ambulatory foot surgery to the membership committee, plus must complete some compulsory training.

    2.• Those Associate members who do not have formal training will have to undergo Parts 1,2 and 3 of the College’s training programme to perform MIS
    The course may be completed within four years.


    Full Membership
    For practitioners who have the skill and proficiency in the surgery
    Practitioners with advanced study may apply for exemptions and attendance at seminars with appropriate courses may be included in this. (Please send copies of your course certificates).




    Please read carefully visit www.cmifas.co.uk
     
  15. C Bain

    C Bain Active Member

    M.i.s.

    Hi Podrick,

    Speaking as a lowly Chiropodist, (Working in England!). I to like Ian above, but coming from the other end of the profession, stand aghast at the thought of an ordinary Podiatrist (Degree or otherwise?) entering into M.I.S. surgery without the training describe by Ian!

    I would have thought in England an M.I.S. Surgeon (Other than from, the traditional sources of medical training!), would be swatted at birth by the Royal College of Surgeons or the B.M.A.!!!

    Isn't the term 'DOCTOR OF MEDICINE' protected in English Law? Also the practice of the same defined in law. Are they not CRIMINAL OFFENCES if not practiced by medically trained doctors and surgeons??? Certainly not two or three years courses of ordinary podiatry???

    Regards,

    Colin.
     
  16. podrick

    podrick Active Member

    mis

    ian,

    i was not familiar with the differences in education between britain and te states.i can tell you that with regards to the states there is greater parity in education between guys performing mis today and conventional surgery.percutaneous podiatric surgeons in the states have the training and priviledges to do whatever surgical procedure they choose,at least forefoot that is.our residency programs are standardized,with the exception of advanced rearfoot programs.
    here is the ugly truth about all this.the only complex rearfoot procedures these guys are getting are low income,indigent,managed care insurance the orthopods don't take.that is what has spawned this deep frustration.then they go out on the open market and have to compete with us glorified chiropodist and they can't take it.i know what i am telling you i used to be one of them.
    as for your comment about the low qualification standards for diplomate status.let me let you in on another dirty little secret.a good portion of the old timers were all grandfathered into the abps and acfs.the oral aspect of the board certification (abps) is very politically subjective.i know i benefited greatly from it.
    in the u.s.a. we podiatrist eat our young.this has nothing to do with quality patient care trust me.
    i am curious about one thing tell me more about this mis school in britain.how does this work?
     
  17. Ian Reilly

    Ian Reilly Active Member

    Hi Rick

    I get over to the States every year so I know some of your history. You have my sympathies.

    The MIS group can be found at the CMIFAS website detailed above. We all know MIS procedures work – for me it is not about that. Compare that to the training scheme the Society of Ch and Pods has developed over the last few years.

    If you go to the Podiatry Mailbase and search for MIS under:

    http://www.jiscmail.ac.uk/cgi-bin/webadmin?A1=ind0502&L=podiatry


    … you will find some interesting threads…

    Ian
     
  18. Ian Reilly

    Ian Reilly Active Member

    Sorry

    search "Amin Sain" and you will find Amin's threads with Pod Surgeons about the development of MIS...

    (MIS will get you misaligned, etc...!)

    Ian
     
  19. podrick

    podrick Active Member

    mis

    ian,
    thank you for the infor.incidentally,how exactly does the scope of practice with surgery work in britain.i don't understand what the difference between a traditionally trained pod and practitioners from a chiropody means.where do british pods perform surgery and how are they reimbursed (private insurance,cash,national health plan,etc).
    what is this purpose of this mis college to act as a sort of postgraduate training or as an entirely new school?
    by the way i perform both conventional and mis surgery.it depends on what the patient needs.
     
  20. simonf

    simonf Active Member

    Hi Rick,
    In the uk a podiatry degree is a 3 year university course, the scope of practice with this qualification extends to use of local aneasthetic, nail surgery(phenolisation mainly) palliative care, orthoses, biomechanics diabetic wound care etc. Surgical training is a post grad undertaking, after 2 years working at basic level, you can undertake surgical training, this is initially acedemically based, leading to a masters degree equivalent, practical surgical training follows successful acedemic progress, this is usually for 2-3 years (maybe 1-2 days per week in a surgical department). Following success in a practical surgery examination a candidate would be expected to spend the next 3 years working under the auspices of an established consultant podiatric surgeon, undertaking a body of work before being issued with a certificate of completion of training. At this point one would be able to head a surgical team in your own right.

    there are around 60 surgical units active in the national health service currently, staff in these departments are salaried employees, in addition many consultants work privately, some pateints will be able to fund surgery from health insurance, the rest are self funding (cash)

    the concern about a new player in surgical training in the uk is that such splinter groups may undo some of the hard work of the last 30 odd years. For the last 7 or 8 years we have enjoyed a united approach in surgical training and have been able to accomplish many positive things, in contrast to some of the problems our profession faced in the years before the amalgamation of the previous 2 routes to surgical practice.

    hope this helps

    simon
     
  21. Ian Reilly

    Ian Reilly Active Member

    Nice summary Simon

    ... and the point that Rick does open surgery too is key - UK MIS "surgeons" will only be able to do MIS. The Podiatry Mailbase archives explanins how the situation came about...

    Ian
     
  22. Al Kline DPM

    Al Kline DPM Banned

    Interesting threads, I think MIS has its place, but not really in bunion surgery where the actual ideal is realignment. We have come to far to take this step backward. I think the postings linked above to the other forum shows how our profession still lacks in unified training and podiatry ideals. Hopefully , the new residency protocol of 3 year programs in hospital settings will help to unify our profession.
     
  23. footmedic

    footmedic Active Member

    Minimal Invasive Foot Surgery Upcoming Events

    Learn how MIS can help in your practice and how you can develop your skill for Minimal Invasive Foot Surgery.

    Date for seminar see www.cmifas.co.uk
     
  24. Al Kline DPM

    Al Kline DPM Banned

    MIS Surgery

    I just painfully read through all the responses (MIS & Dr. Tucker ) in the Foot Health Forum. It seems that there is a great divide concerning accredidited foot surgeons and MIS surgeons. I also believe that in the States, many foot doctors left out of residency and 'formal training' resort to MIS surgery in their office. Unfortunately, I too, have seen many disasterous results concerning this type of surgery. But this is mainly out of the lack of training by the surgeon and these particular surgeons misleading the public (ie painless surgery, no scars, etc. etc.)

    I am not board certified and don't really believe in its merit anyway. I think it is best that 'patients beware' when it comes to MIS in the States. I applaud the CMIFAS to take MIS a step further. I think it has its place, but from my experience, I will never perform surgery with a burr and blind ambition.
     
  25. Dieter Fellner

    Dieter Fellner Well-Known Member

    Cmifas

    OMG :eek: :eek: :eek: - Oh I am repeating myself....ah well !

    Minimal Invasive Foot Surgery Upcoming Events

    --------------------------------------------------------------------------------

    Learn how MIS can help in your practice and how you can develop your skill for Minimal Invasive Foot Surgery.

    Date for seminar see www.cmifas.co.uk
     
  26. HPC and MIS

    I note from the list of nominees standing for election to the Health Professions Council, a Somuz Miah as an alternate from the podiatry profession. Out of interest, are the courses proposed by CMIFAS recognised by the regulator?

    Mark Russell
     
  27. Ian Reilly

    Ian Reilly Active Member

    Mark

    Can you just clarify who the regulator is (and their role)?

    Thanks

    Ian
     
  28. Hi Ian

    None other than the HPC. As to their role......!

    Regards

    Mark
     
  29. Ian Reilly

    Ian Reilly Active Member

    Of course! “Doh!” as Homer Simpson would say!!!

    Perhaps members of CMIFAS would be able to answer your question about recognition though…

    Ian
     
  30. David

    David Member

  31. David

    David Member

  32. MIS with out drill

    The MIS technic is a very limited procedure and have a lot of post-op complications, specially when using a drill after a 20 year practicing podiatry, it is better to see what we are going to do for better results. also no fixation is use in almost every case.
     
  33. MIS with out a drill

    Dear Dr. You are perfectly correct about your coments, ther is a part for each procedure MIS is been abused and even in the hands of the podologist (nurses specialized in foot primary care) NO podiatrist or ortopedist ther should be limit to sertain specific indications, and with out the use of power equipment. fernando vazquez,d.p.m.,m.d.
     
  34. admin

    admin Administrator Staff Member

    The fuss is the formation of a new group in the UK offering MIS as an alternative to the normal and acepted surgical qualification:
    http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=338
     
  35. Ian Reilly

    Ian Reilly Active Member

    From the Podiatry Management newsgroup.

    Any comments from the UK MIS proponets …


    "Famous" WA DPM Surrenders License, Disputes Boards Findings

    To foot-surgery students in half a dozen countries, he's Professor
    STEPHEN ISHAM, with five surgical procedures named after him. He's
    past president of the Academy of Ambulatory Foot and Ankle Surgery,
    and – in the words of a Spanish physician he taught – "the
    foot surgeon of the world." But there's one thing that Stephen Isham
    can no longer be, at least in Washington state: a foot doctor.

    Isham, a Spokane-area podiatrist for nearly three decades, has
    promised state regulators to "not ever resume his practice" in
    Washington after a complaint over foot surgery he'd done – in Idaho – four years ago. Isham, the Washington's Podiatric Medical Board ruled, "performed unnecessary surgery" on a patient's
    toes. The initial charges had blamed him for a post-surgical
    infection that landed the woman in the hospital and deformed her
    right foot. In an agreed-to order, Isham disputed the board's
    finding, but agreed to not work as a foot doctor in Washington, even
    as a volunteer or in an emergency, for the rest of his life.

    Isham has repeatedly had to defend his techniques. Court records
    show that he's faced five malpractice-related lawsuits in Washington
    since 1994 and been disciplined by state medical regulators four
    times since 1989. Isham maintains that time will vindicate his
    techniques. "All pioneers have to go through it," he said. "Anybody
    that comes out with a new procedure or philosophy gets nailed.
    Internationally, I'm famous. But right here, through a group of
    podiatrists, I'm a target."

    Source: Richard Roesler, Spokesman-Review [6/23/05]
     
  36. MIS opinion dr.villadot from spain

    MIS, is a technic to dificult to correctlly perform because is a blaind form of treatment, done with power equipment is even worse because the bone if you scrash it it bleeds, if you breack it can be fix, but if you burn it it dies. In one book a copy of Dr. Blair ByCura old MIS autor or the one from Dr. Jack Gorman 1983 also MIS autor very nicelly presented with lots of pictures and disections nothin new the book from dr.mariano¿ an ortopod from murcia spain dr.villadot an old well known foot ortopeadic surgeon from spain coments that MIS is very dangerus and can produse a lot of damage to the patient. i am agry with him and it can be worse in the hands of no DPM or Ortopod, it seams like we are goin back where barbers use to do surgery now pedicurist whant´s to do surgery. ther are in mexico few m.d.´s who goes to a weekend mis seminars and they call them self podiatrist, like if MIS where all what podiary is. Let´s get podiatric medicine and surgery where it belongs. I know about the restrictions of Isham to work in Washington he had several problems with patients with bad t.v. and newspaper publicity in mexico but the group of general medical practitioners who idolaize Isham after his weekend seminar they pretend to do bunions, hamertoes, etc. etc. etc.
     
    Last edited: Jun 24, 2005
  37. Ian Reilly

    Ian Reilly Active Member

    Fernando

    Do you do open techniqes as well or are you just MIS?

    Ian
     
  38. Felicity Prentice

    Felicity Prentice Active Member

    Just had another look at the site (it is a bit like being a rabbit blinded by headlights - you know you are in danger, but damn it all the misspellings alone are hypnotising...)

    The recognition page states

    The college is honoured and proud to be affiliated to the Academy of Foot and Ankle Surgery in the USA

    but the crest/logo beside this statement is that of the Academy of Ambulatory Foot and Ankle Surgery

    I am truly ignorant - I confess - but are these the same creatures? If not, surely there is a wee deception as work.
    cheers,

    Felicity

    (Yes Craig, I know, I should be marking those exams, but this is FAR more interesting).
     
  39. Hi Ian, i do mainly open surgery, i like to see what i am doing, I am a Dr.McGlamry, Kelish, Mercado Student 20 yrs. on practice now. regards. fernando vazquez,d.p.m.,m.d.
     
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