Fall 2006

UCSF Builds Foot and Ankle Clinic

Orthopaedic surgeon Stephen Pinney, M.D., has taken the lead in building a strong foot and ankle subspecialty clinic at UCSF Medical Center and hopes to use the program to advance the current state of knowledge in the field.

"We will focus on the clinical management of foot and ankle problems, but I am also interested in pursing evidence-based medicine by finding out which approaches work best," Pinney says.

Pinney's dedication to evidence-based medicine extends to his role as assistant editor of Current Concepts and Topical Reviews in the journal Foot & Ankle International. "We try to generate articles that are accurate reviews of what we do and do not know about particular clinical problems," he says.

Orthopaedists trained as foot and ankle surgeons are rarer than surgeons trained in other orthopaedic subspecialties and the complexity of the weight-bearing joint also can be intimidating for surgeons who lack the training, Pinney says. "We want to create a situation where physicians know that they will be able to phone us at any time and get their patients seen," he says. The foot and ankle clinic even has a dedicated telephone number — (415) 885-FOOT or (415) 885-3668 — to make it easier for physicians to get consultations and make referrals.

The foot and ankle practice at UCSF sees a wide range of orthopaedic problems, from chronic debilitating conditions such as flatfoot deformity and bunions to acute conditions like trauma. The practice sees a lot of ankle problems requiring surgery and does both total ankle replacements and ankle fusions.

Total ankle replacement surgery hasn't yet revealed how well the replacements hold up in the long term. Revision surgery also is more complicated than it is for total knee or hip replacement. For the time being, ankle replacements are indicated for older patients who have a low activity level and may have a lot of pain due to arthritis in the surrounding hindfoot joints. Pinney notes that it is important to spend time with patients to determine which approach is best for them.

In addition to doing clinical practice and research, Pinney has an interest in medical education. "I did a master's degree in adult education and I'm trying to create a fairly coordinated teaching program for the residents," he says. "When people talk about education, there is the individual instruction component and the programmatic component — setting out the means by which people can learn a discipline. When you look at education, this aspect is probably more important than the actual teaching."

Pinney finds the foot and ankle subspecialty especially rewarding because it is still in its early stages of development. "Foot and ankle research as a discipline is really exciting because there are still a lot of fundamental questions to be answered," he says. "For instance, there is still a lot of research on hip replacements in terms of what type to do. But foot and ankle surgery is more like hip replacement was in the 1970s, when the questions were about when to do the operation and whether to do it at all."

Stephen Pinney can be contacted at (415) 885-3668.

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