What American Podiatrists Can Learn From Their Italian Counterparts

In last month’s blog, I wrote about an incredible learning experience in Modena, Italy and how a minimally invasive technique could improve patient care in those suffering from Achilles tendinopathy (see https://www.podiatrytoday.com/blogged/perfect-caper-pulling-minimally-in… ). I have to continue on the Italian theme because there is so much more to share but this month, we will go a bit farther south in Rome.

Afforded with the luxury to have attended many European foot and ankle congresses over the last five years, I have concluded (maybe erroneously) that foot and ankle surgery simply holds a higher status in their orthopedic and surgical spectrum or world than here in the American orthopedic and medical community. In the United States, the hand is just more valued than the foot. If you do not believe me, check reimbursements for a procedure in the foot in comparison to the same procedure in the upper extremity.

My perception is based on a very small learning experience as most of my partners are hand surgeons who seem to be much higher up on the totem pole compared to the foot surgeon — podiatric or orthopedic. This has not been the case in my experience in Europe. There the foot seems to be king and subordinates have the “hand” status. (Again, this has just been my experience.)

Interestingly, I have worked with many American foot and ankle orthopedic and podiatric surgeons as well as many orthopedic foot surgeons in Europe. Are these species of foot surgeons really that different? My answer would be no when you boil it all down and remove the politics from the equation. There are doubtless philosophical differences between each of the folks in these specialties. However, to simply say that there is a big difference, especially one of training, is erroneous. The true difference is razor thin. There may be more similarity between the podiatric surgeon in the United States and the European foot and ankle surgeon (at least what I have seen in Spain, Italy and Southern France) training than between the two orthopedic counterparts. This is especially the case when it comes to biomechanics.

What do you get when you cross an Italian mathematician, an Italian orthopedic surgeon and a person with a passion and interest in foot surgery? Answer: Paolo Ronconi, MD. Dr. Ronconi has started something that I believe is not replicated anywhere else in the world. Along with several of his colleagues, including Francesco Cancilleri, MD, and Vincenzo Denaro, MD, Dr. Ronconi has developed a two-year masters program in foot surgery for orthopedic surgeons who have finished their orthopedic residency. Their students have a very robust syllabus with a very heavy emphasis on biomechanics, which is of particular interest to Dr. Ronconi and very similar to what podiatric surgeons learn.

Several years ago, he asked me to edit his text Il Piede into English, which I did. I learned so much. He has just finished the second edition of this text, which will initially only be published in Italian next month. I am encouraging him to publish it in English so we can begin to get a better grasp and different perspective of the complexity of biomechanical principles that he discusses, which integrates well with the work being done here in the U.S.

When I spent a week with Dr. Ronconi in surgery in 1998, I learned much about the way he applied trigonometry to osteotomies for the correction of hallux limitis/rigidus. I learned that for every 1 mm of proximal displacement, there is a 7-degree increase in range of motion dorsally. This is really cool stuff.

After spending more time with him this summer, I am convinced that there is so much to share between all the folks in this specialty. This sharing will improve patient outcomes so all other considerations are subordinated. There must be a way for both orthopedists and podiatrists in the U.S. to interact with our European counterparts on a more regular and professionally widespread basis. This needs to go beyond just a few of us crossing the pond a couple of times each year to attend each other’s meetings.

The name of their program is: Università Campus Bio Medico di Roma
Master di II livello In Chirurgia del Piede. It is a robust two-year program that includes clinical training and heavy, intense, didactic study in virtually every topic pertinent to today’s foot surgeon. These topics include arthroscopy, endoscopy, diabetic salvage, minimally invasive techniques and biomechanics, to name a few. This is followed by defense of a master’s dissertation. It is interesting that the development of this unique course of study proves that the level and complexity of today’s foot and ankle surgery demand more than just a few rotations, and possibly a six- to 12-month fellowship.

In summation, I would like to thank all of those passionate and generous doctors, especially Dr. Ronconi, for taking the time to develop something like this, and for teaching me something new every time I cross the pond.