January 1, 2017

We woud like to share with you the article published in the Foot and Ankle International magazine by Dr. Michael Pinzur, editor of the magazine and world reference in the treatment of Charcot foot, although he put us as authors by deference. This article describes the training we did in Loyola’s Hospital in 2015, in the beautiful city of Chicago, and how this impacted our practice and our patients.


The article is obviously in English, so I attach a translation of it.

“Those of us who live in the United States rarely stop to think how easy it is for us to access new medical knowledge or technical skills. Our professional societies offer a myriad of courses to complement educational offerings at annual educational meetings. If we want to acquire a new skill, we have easy access to the AAOS Learning Center and a large number of hands-on learning centers sponsored by educational institutions and our industry colleagues. Orthopedic appliance manufacturers offer industry-sponsored hands-on courses or sponsor a visit to observe an expert.

What happens when you live outside the United States and do not have access to some of these new technologies? The ability of foreign physicians to obtain training grants in the United States is limited by many academic medical centers. Citing medical liability, many centers restrict postgraduate training only to observation. I have never appreciated the value of an observational stay until I received an update from Juan Rios Ruh, a young orthopedic surgeon from Barcelona, ​​Spain, who spent three weeks as an observer a few years ago.
Juan Ríos Ruh is a young orthopedic surgeon from Barcelona who has expressed an interest in learning how to cure diabetic foot disorders, especially the deformities associated with the foot of Charcot. Due to liability concerns, our institution limits the training of foreign graduates without local license to observation only. These doctors are not allowed to “touch” any of our patients. “Handy” treatment is not allowed. Despite these restrictions, Dr. Rios Ruh chose to spend 3 weeks at our institution noting our methods of treating diabetic foot disorders. I was very interested in learning the method we used to treat Charcot’s foot deformity with a one-stage correction of the deformity and maintaining that correction with a static circular external fixator.
Dr. Rios Ruh had no prior experience in circular external fixation. During the 3-week period, he observed patient care in the outpatient clinic and in the operating room. We spend an afternoon applying the static circular fixator to an anatomical model. Although having visiting doctors is very enjoyable, I never really felt that I made any impact on their careers. In this situation, he was clearly mistaken.
After his 3-week visit, Dr. Ríos Ruh returned to Barcelona and with his team, applied his new surgical skill to 8 patients during a period of 9 months. I enjoyed his frequent e-mails where we discussed each of the first cases. I was proud to be informed recently that the 8 patients have achieved successful healing, with only minor surgical complications. The 8 patients are currently free of ulcers and walk on commercially available therapeutic footwear. In addition, he reported that before acquiring his new skill set, these patients would probably have needed amputation.

His proud phrase was: “It is the correction in a single stage of the deformity and the maintenance of that correction with circular external fixation a reproducible ability.” The answer from Barcelona is … An emphatic YES.
I learned a valuable lesson from Dr. Rios Ruh. While I take easy access to information and technology for granted, many of our colleagues around the world do not have so much access to some techniques. A simple period of observation is all that a brilliant and talented surgeon needed

Such as Dr. Ríos Ruh. The second question we have to ask our local institutions is whether it makes sense to limit doctors trained abroad to receive specialized training in our country. Should we re-examine the policy of so many of our institutions that block these bright, highly-trained physicians from sharing the work effort of being a graduate apprentice (either at the resident or fellowship level) with skills they can take back To their native countries. ”