Guest: Dr. Christopher DiGiovanni, MD
Presenter: Neal Howard
Guest Bio: Dr. DiGiovanni is an internationally recognized foot and ankle surgeon. He earned his BA from Dartmouth College and MD from the Brown University-Dartmouth Medical School Program. Dr. DiGiovanni currently serves as Chief, Foot & Ankle Service, and Vice-Chair for Academic Affairs for Massachusetts General Hospital. He is the consultant for the U.S. Ski Team and team physician for Boston College Athletics. He also serves as associate professor of orthopaedic surgery at the Harvard Medical School. Dr. DiGiovanni has been honored numerous times as one of America’s Best Doctors and Top Surgeons. He was given the Excellence in Teaching Award by his residents and the Patient’s Choice Award by his patients. Dr. DiGiovanni is a fellow of the American Academy of Orthopaedic Surgeons and remains an active member of the American Orthopaedic Foot and Ankle Society.
Segment Overview: Dr. Christopher DiGiovanni, MD, Chief, Foot & Ankle Service, Massachusetts General Hospital discusses research presented at the American Academy of Orthopaedic Surgeons (March 2018) on the management of the most common foot and ankle pathologies.
Neal Howard: Welcome to Health Professional Radio. I’m your host, Neal Howard. Thank you for joining us. Our guest is Dr. Christopher DiGiovanni, here on the program to have a conversation about some research that was presented at the American Academy of Orthopedic Surgeons on the management of some of the most common foot and ankle pathologies. Welcome to the program Dr. Di Giovanni. How are you?
Dr. Christopher DiGiovanni: I’m doing well. Thank you for having me.
N: Great. What is your role there at Mass General?
D: At Mass General, I’m one of the associate professors and vice chairs of academic affairs in the Department of Orthopedic Surgery but I also serve as the Chief of the Foot and Ankle Service at the hospital as well as the Fellowship Director here.
N: Talk about some of the most common problems that you treat in your practice.
D: In our practice, we do exclusively foot and ankle which we define as essentially any musculoskeletal problem below the knee and those types of issues range from injuries, trauma to the foot and ankle that cause fractures, or sprains, or instability or dislocation to things like diabetes that can cause problems with neuropathy, and poor sensation, the foot that can cause skin breakdown and destruction in the foot. We also take care of complex deformities such as patients with various musculoskeletal imbalances, so for example very flat feet, or extremely high arches, or congenital deformities. We do a lot of sports medicine and taking care of both day-to-day athletes and elite athletes, even Olympic and professional athletes who experience a lot of wear and tear in their feet and their ankles. So really, what we do runs the gamut of musculoskeletal pathology in the foot and ankle.
N: So we ask our feet to do so demanding. I mean everything from lower back pain, upper shoulders stress, all of that is related to how healthy our feet are. You were recently presenting at the American Academy of Orthopedic Surgeons. You spoke a bit on the management as some of the most common foot and ankle pathologies as you just described to our listeners. What are some of the trends that you talked about?
D: We talked about a number of different foot and ankle issues. For example, we talked about peroneal tendon pathology which are tendons that cross the ankle into the foot to help stabilize the ankle and the arch. They are fairly common injuries. People know those as “Tendinitis” but they also can result in tendon tears or even tendon ruptures. We talked about midfoot disease and how to fix midfoot arthritis. The arch of your foot, that’s quite a bit of work. So if it gets injured or progressively arthritic, it can actually be fairly debilitating. And so we presented some data on how best we might be able to manage that type of problem for patients going forward. We also talked about how to enhance the ability of bone to grow when we don’t have foot replacements. It’s not like the shoulder, or the hip, or the knee or many other big joints in the body where you can replace those joints in healthcare today, you can’t do that in the foot. And the foot is a very evolved structure which needs to be a stable platform on which we can walk so we haven’t yet reached technology that can effectively replace it. So we’re stuck when these joints, and tendons and ligaments wear out. We’re stuck with having to realign, and reconstruct and fuse these areas to stabilize them and maintain good structure and good function over time. So we also talked about how to get the bone to do that as optimally as possible.
N: So when you’re talking about building bone in the foot, say a child gets an injury, a significant injury and as they develop and grow, are we talking about being able to repair that foot and as the child grows, make sure that that bone is growing properly with them?
D: Well, foot and ankles come a long way in the last 20 or 30 years. And whereas back then, we were reacting to foot and ankle problems and trying to figure out what to do after the fact. Nowadays, we are being proactive. So now, we would try to address things much earlier and oftentimes much more differently than back then so that you wouldn’t have those problems. Now so for example, patients with a bad flat foot or a very high arch, some patients were born with those problems and years ago, we would wait till they got into their 40s, and 50s, and 60s and by then, they will not only have worn out everything around their foot, they will have worn out their ankle too. So now, you have two or three problems instead of one. So today, we would try to manage the high arch or the collapsed arch by reconstructing it so that down the road, those types of other problems don’t happen. It’s as if you had a car with a bent rear axle. You could probably drive the car very slowly but everything would wear out a bit more quickly. And so instead of waiting a year or two and then replacing the tires, or the CD joint, etc., our goal nowadays is to say, “Hey, we should straighten the axle and then maybe the car will last longer.”
N: When it comes to sports medicine, what are your thoughts on the shoe technology as far as protecting the foot and promoting foot strength and safety.
D: Well, that’s a controversial topic. I think that there are societies that can’t afford shoe wear that have fewer foot and ankle problems arguably than we do in America. So I want to start by saying that shoes can be protective and they can be safe but they can also be problematic and cause deformity and instability. So to summarize, I would tell you that the shoe has to fit the foot. The foot can’t be put into a shoe not designed for that foot and since feet come in many shapes and sizes, the choice of shoe wear must be a bit flexible. The shoe industry is evolved and the sneaker and other types of shoe wear industry has evolved quite significantly over the past decade and I think they’ve become much more practical and I think they’re leaning more now towards form and function rather than fashion. So we see patients every day where we will prescribe all kinds of different types of shoe wear depending on what their problem is and that’s a very, very important thing to understand.
N: Where can we go online and our listeners learn some more a bit about Mass General and the foot and ankle service there?
D: Mass General has a website on which you can find the division of foot and ankle and there are a lot of different links that you can go to from there. I would also suggest that the American Orthopedic Foot and Ankle Society has a number of very useful links that are very patient and user friendly and I think that would be another excellent resource for patients.
N: Thank you so much, it’s been a pleasure.
D: Likewise, thank you. I hope you have a great day.
N: You too. You’ve been listening to Health Professional Radio. I’m your host, Neal Howard. Transcripts and audio of the program are available at healthprofessionalradio.com.au and also at hpr.fm.