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In 1989, Robert Anderson, MD, had recently returned to Carolinas HealthCare System after a fellowship in foot and ankle orthopaedics when he was approached by Edward Hanley, MD. Dr. Hanley, the chairman of Orthopaedic Surgery, asked him to consider starting a new rotation that would allow residents to immerse themselves further in orthopaedic surgery, a burgeoning field of medicine that had seen recent growth.
Nearly 25 years later, it’s clear the initiative provided one of the cornerstones of the System’s leading role in training young doctors, while offering a highly regarded fellowship in foot and ankle care.
“For a long time, we were one of only a few residency programs in the country that offered a rotation or residency experience in foot and ankle,” said Dr. Anderson, a founding physician of The Foot & Ankle Institute, based at Carolinas Medical Center-Mercy. “We’re very proud of what’s been created here, and we’re considered one of the leading foot and ankle centers in the country. It’s been a team effort.”
Foot and ankle subspecialty training is a growing interest for new medical school graduates pursuing orthopaedic surgery. This shift in interest has fueled the orthopaedic surgery fellowship program, which selects three fellows each year from a field of about 45 applicants.
“Our fellowship and residency program is an organized and formalized learning experience because it includes experience seeing a wide variety of foot and ankle problems – not only experience in the OR, but also in an office setting,” said Dr. Anderson, who is also a past president of the American Orthopaedic Foot & Ankle Society. “It’s a very highly sought-after position around the country.”
Research Research and Patient Education Prioritized
In 2013, the foot and ankle team co-authored three published studies. One concluded that a minimally invasive tarsi approach was a valuable method for treating intraarticular calcaneal fractures, having comparable rates as an extensile approach, yet a significantly lower incidence of wound complications and secondary surgeries when compared to those treated with an extensile approach.
Another study investigating whether stereotypical patterns of gait initiation are altered in those with posttraumatic ankle osteoarthritis resulted in the suggestion that supraspinal motor control mechanisms may have changed in those with posttraumatic ankle osteoarthritis.
The final study concluded that temporary invasive distraction with use of intra-operative external fixation can be safely performed with minimal risk of increased morbidity and offers potential technical advantages during open osteochondral graft transfer procedures for treatment of lateral osteochondral lesions of the talus.
The foot and ankle program is actively working on 17 research studies this year, and will focus on two studies tracking surgical outcomes – in foot and ankle joint replacement and Achilles heel repair.
In addition to research, the program will focus on advances in patient education. “We’d like to continue adding more Internet-based options,” said Dr. Anderson. “Rather than dictating specific treatment options to the patient, we try to educate them enough that they can make an educated choice. Providing information to patients about their individual diagnosis, treatment and prognosis is critical in order for them to make an educated choice.”