Friday, June 2, 2023

Mariano de Prado, author of minimally invasive surgery: “After the health of the mouth is the time to take care of your feet”

9 Castilla y Leon Foot and Ankle Conference this Friday four surgeons live with minimally invasive techniques at the Hospital de Leon. They had the special participation of the introducer of these arts in Spain and Europe. the surgeon Marianus de Prado trained more than 170 artists from different parts of Spain and Portugal.

– Opt for minimally invasive foot surgery with scientific associations doubting its effectiveness.

We started 25 years ago. At first it was only used to expand the knowledge of a few types of surgery and the technology and expertise of surgeons. The technique is not against open surgery, which I don’t like to call traditional because it seems old. Minimally invasive allows us to use gentler techniques for patients and similar outcomes. When we started, there was no causal method to validate its use and it asked for a reaction from scientific societies that the results were impossible due to the short time it worked. The number of publications and scientific evidence is growing exponentially today and it is one of the major weapons in the hands of foot and ankle surgeons to solve problems.

– He was the first.

-Not only in Spain. This surgery began in the late 1940s in the US. It has been used by podiatrists with very poor results. In the 1980s, orthopedic foot and ankle surgeons said it should not be used. What happened was that the technique was abused. In 1994 I was with Stephen Isham, a surgeon from the USA, one of the few who were allowed to do this. Because of this and the anatomical work of Pau Golanó, who died a few years ago, all the anatomical studies that allowed us to show that if things were done through the right roads and access doors, the complications disappeared. the results of the show. . This was what changed foot surgery.

– From this prohibition of artifice to imagine the results can be spectacular, it is necessary to be a goal to convince the scientific societies.

“This is done.” Stephen Isham was one of the few who continued with the art despite the ban. That got my attention. I thought, in the legal issues in the US, if someone uses a technique that doesn’t work well, it won’t last long because of the lawsuits. I thought if someone in the US did it, even if it is not accepted by scientific societies, because it works. And indeed. What happened was that it lacked scientific and anatomical support, and that it deservedly had. From this almost all the arts arose.

-Perseverance despite initial failure.

– What must be avoided, from a scientific point of view, is that morals invade our profession. We must be careful that our leaders, who have the power of change, do not walk in the wrong direction. We owe a lot to Paul Golan.

– Leo’s foot and ankle have a unique unit and minimally invasive techniques are used when necessary. Are there all hospitals in Spain?

– Starting to be another weapon and in Castella y Leon they can be very happy with the quality of the foot and ankle unit at the Hospital de Leon. And above all, it was hardly necessary for me to be here.

What percentage of the foot will rise already at the least invasion?

It depends on the schools. In medicine, there are many alternatives to solving the same problem. I do almost 100% of anterior surgery, all that deals with toes and bunions, with minimally invasive techniques. It has a part of the show that attracts the most, and that is that the patient walks out of the operating room. Before I had to stay long without supporting my foot. But I never want to do open surgery myself, minimally invasive surgery. I went around the world saying this in conferences and interviews because I always sat down with a surgeon who used open techniques. The above, thankfully. This is one more weapon. It’s when we started the arthroscope. You told a resident 30 years ago that it wasn’t necessary to remove the torn ligament in his knee and he didn’t know how to do it. Now he has to work on a painful bond, opening the knee, which he does not know.

-Technology has helped all these developments.

-Clear. What we have done is develop a large part of the tools that are used today, such as types of motors, cutters… but above all we have to change the mind, because you have to learn to work without a third system. We work in two dimensions with a fluoroscan system, which is like a flash, but you don’t see the third dimension. The learning curve is a bit slower.

“How long does it take to learn these skills?”

– It is calculated that you are ready when you have worked on the first 150 cases. That’s the training to consult with an assistant always at your side, like all serious training.

– Feet always feed us, sometimes with little attention to us.

– The feet will look like teeth at thirty years old. Thirty years ago, no one thought that children would have to go to the dentist every so often, buying appliances was not seen and we decided that oral care should be health education. I always give the example of the demonstration of women who asked for the vote in the US. Who was going to tell us that they are the most changed feet in the world? It was a struggle for civil rights, which would connect them to social life, not remaining at home, but ceasing without aesthetics. Women’s foot problems are asking to be solved without abandoning aesthetics and that led us to develop skills. There is no cosmetic surgery, you can never operate a foot for aesthetics. It is another thing that you get an anatomical, functional foot, and if it is beautiful, the better.

– How many problems can be avoided if we pay attention to our feet?

-In women, over 65 years of age, 87% have foot problems, and it is due to footwear. In humans it is about 40%. The shoe and the heel are from the similarity of the sharp foot, that is.

And overweight?

– Also. And there is another thing, and this is that we live longer than we are built, which is about 40 years. Scientific progress has conquered many diseases. The time comes when the foot fails and the so-called adult flat foot appears, a pathology that was not seen before. There are those who never have flat feet and from the age of 50 their feet have stopped. It is necessary to carry out a good biomechanical study, which shows us what are the forces that favor this deformity: it allows us to perform surgical interventions and to use certain shoes or insoles that help us to avoid the development of deformities.

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