Foot And Ankle Surgery: We’ve Come A Long Way Since 1969

I recently had the pleasure of observing an ankle replacement while staying in Seoul, South Korea. Bom Soo Kim, MD, arranged for me to spend a day with his professor, Jin Woo Lee, MD, the Chief of the foot and ankle program at Yonsei University, a prestigious Korean medical school.

   Dr. Lee skillfully executed the procedure with the Hintegra implant (Integra Life Sciences). He had the assistance of a chief orthopedic resident and a first-year foot and ankle fellow. Dr. Lee explained each step as he went along and encouraged me to take photos. The procedure ordinarily takes one hour but this case was particularly difficult and went three hours.

   After a couple of hours, the professor was concerned that I needed a lunch break and summoned another orthopedic resident to take me to the doctor’s cafeteria. I had a great Korean lunch, the type that was spicy enough to burn twice.

   I returned to the OR to watch the professor complete the operation. The fellow and chief resident held the retractors throughout the procedure and were allowed to close the wound. They are not allowed to perform operations.

   The atmosphere in the Korean OR was tranquil with soft classical music playing and no conversation other than the professor explaining the procedure to me.

   Though I no longer perform foot and ankle surgery, I was honored to be invited to observe. I also reflected on the differences in our surgical training in comparison to other cultures. During my residency, I remember the attending turning the case over to the externs and me, and leaving the OR. I am not sure which system is best. American surgical residents get plenty of experience and the Koreans gain a lot of knowledge.

   I also reflected on my first opportunity to observe foot surgery. I had just applied to podiatry school and was visiting a DPM’s office. He invited me to watch a surgical procedure. I worried about becoming ill and vomiting on his patient.

   His office was state-of-the-art for 1969. The walls were fake dark wood paneling. There was a green shag carpet and a noisy aquarium full of bored looking fish. The doctor and his receptionist/nurse/X-ray tech were both chain smokers. The doctor wore a lime green barber’s jacket. The office had a strong odor that I later recognized as phenol.

   I was to observe removal of a Morton’s neuroma. I was scared to death. I feared that after I vomited on the patient I might pass out and wet myself. I was calmer at my wedding a few months earlier.

   I followed the doctor into the small exam room. He rendered a local anesthetic and then went out to a lab with a scrub sink. He took a last drag on his cigarette, flipped the butt into the sink and scrubbed his hands for a few minutes. The doctor put a mask on his face and handed one to me. Tying the strings on a facemask should have been easy but I screwed it up. The doctor smirked and fixed it. Then I followed him back into the exam room.

   The nurse/receptionist had just finished applying a layer of iodine to the foot and rinsed it with alcohol. The combination of cigarette smoke, iodine, alcohol and my own sweat was overwhelming. The patient seemed to be enjoying my obvious terror.

   The doctor picked up a scalpel with a gleaming #10 blade and rendered a gaping hole on the top of the foot between the third and fourth metatarsals. He dove between the bones with a hemostat and clamped a piece of white tissue. The patient let out a yelp. The doctor muttered, “Got it!” Then he dispatched the offending neuroma with a pair of curved scissors.

   The room got darker and began to spin. I took momentary solace in the realization that the mask would prevent me from upchucking on the patient. I hurried out of the room and leaned against the wall. Everything went black.

   I awoke suddenly with the nurse placing a cold washcloth on my forehead. The doctor chuckled as he walked past me. The patient yelled, “How’s your other patient, doc?”

   Despite this eventful initiation to my surgical experience, I made it through podiatry school, a surgical residency and 34 years of podiatric surgery.

   Fortunately, I was able to observe the Hintegra procedure in Korea without disgracing my profession on an international level. I found a Dunkin’ Donuts on my way to the subway and neutralized my flaming intestines.

   Foot and ankle surgery has come a long way since 1969.

   Dr. McCord recently retired from practice at the Centralia Medical Center in Centralia, Wash.