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Syndesmosis Procedure for Hallux Valgus & Metatarsus Primus Adductus: My Hong Kong Chronicle

Discussion in 'Foot Surgery' started by Dieter Fellner, Jun 8, 2015.

  1. Dieter Fellner

    Dieter Fellner Well-Known Member

    Members do not see these Ads. Sign Up.
    There is a long line for publication. Around 9 months from submission to print. I was delighted when the Editor of 'Podiatry Management' wrote to thank me for a 'very interesting article'. My work is not a 'scientific' appraisal but a record of a personal journey. Podiatry Management is the premier magazine for the Podiatry profession, reaching 16,780 subscribers. The ideal vehicle to present a 'new' concept.

    Podiatry Management magazine has now published the article I wrote on my return flight from Hong Kong, somewhere over Russia. With most of my fellow passengers napping for the 16 hour flight, I was hunched over my laptop. I wanted to record my thoughts still fresh from the experience. Two thirds of the original article of 3,300 words passed the Editor, to meet publishing guidelines.

    Since then, I have had the pleasure and opportunity to discuss the concept with many surgeons, from an ever more diverse diverse professional background. Infectious Disease, Rheumatology, Pediatric and Adult Orthopedic and Podiatric Surgeons. The great majority express intense interest. A small minority do not.

    Most interesting, is feedback from the general public. There is an intuitive 'understanding' of the concept coupled to a willingness to embrace the surgical philosophy.



    Attached Files:

  2. danielywu

    danielywu Active Member

    It would be a conflict of interest if I make any comments to reinforce many of Dieter’s opinions on syndesmosis procedure but I will at least say, or it actually goes without saying, that I am grateful to his courage of risking a possible disappointing trip from NYC to HK half way around the globe..
    We all agree medicine is an evolving science. Part of our responsibility to patients is keeping an open mind so we may even accidentally make a difference to their results. Soft tissue procedures have long been disfavored and syndesmosis procedure is a rather foreign concept. For it to prevail it has to be able to stand up to the simple test of making common senses, of course so should other hallux valgus procedures. It is mine and I am sure also Dieter’s wish to answer as many questions as constructively as possible on this open forum. Similarly, we should not forget to revisit established procedures either with equally thought-provoking intentions.
    Finally, I would like to again invite anyone interested to Hong Kong which by herself is already a must visit in lifetime but I will also try my best to add more value to it.

    Daniel (a syndesmosis believer)
  3. Admin2

    Admin2 Administrator Staff Member

  4. Dieter Fellner

    Dieter Fellner Well-Known Member


    Thanks for taking the time to comment. We have discussed many of the issues, at length in the related link, kindly appended by Admin. I want to reiterate only briefly, that prior to my visit Daniel and I discussed the concepts for two (or so) years. In many ways the concept flies in the face of those principles I held dear and considered important in the successful surgical management of hallux abducto-valgus. I too had doubts and concerns.

    The literature on the topic is growing, primarily from the excellent peer reviewed published work provided by Dr. Wu. I can only hope that my humble effort can serve as a modest supplement, with an additional perspective.

    I know beyond a shadow of a doubt, the SP is a powerful surgical tool in Daniel's hands and on his patient population. NYC is now on the brink of conducting trials, to provide further evidence of reproducibility of outcomes. The SP has a historical precedent in Italy, Canada, England and China. I fully anticipate that our work will be a formality, and will report back our findings. When this work is completed I will gladly echo Daniel's invitation to invite interested surgeons to contact me.

    There are aspects of the SP that can be appreciated only in the operating room. Surgical pearls best appreciated from observation and direct learning. This acknowledgment prompted my Hong Kong visit. Together with the opportunity to examine patients, before and after surgery to evaluate, for myself, the outcome.
  5. Dieter Fellner

    Dieter Fellner Well-Known Member

    Picking up further on the soft tissue concept. Another interesting article from Dr. Doug Richie, a well known and respected figure in the podiatric world.

    In this work, entitled 'Addressing Myths And Misconceptions About Hallux Rigidus' he re-examines the long held doctrine about the role of metatarsus primus elevatus and the 'hypermobile first ray' (apologies Kevin, if you are reading this).

    In conclusion the article questions the position there is a primarily 'bony' component to hallux rigidus. And that instead, the primary culprit might, perhaps, be found in the soft tissue structures.

    Although a different pathology, there is a trend, one that is directing our efforts away from the traditional surgical remedies, to possibly consider alternatives that might help address the cause of the problem, instead of the effects or the symptoms.


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