Most doctors will agree that the technical component of medicine is the less complicated part. What truly makes medicine and surgery challenging is the patient. It's relatively easy to figure out the appropriate bunionectomy or flatfoot reconstruction. If the intermetatarsal angle is 20 degrees, you might choose a base wedge procedure or Lapidus. If there's significant hindfoot degeneration or rigidity with that flatfoot, you might choose a triple arthrodesis. This part is pretty straightforward - in a perfect world. Now enter the real world, outside of the classroom and the theoretical, where our patient's needs and limitations smack hard into "the textbook" version. The procedure we want to perform is not always the procedure we can safely perform. Two of the most troublesome issues as I see that impact my choice of procedures are weightbearing and age.

See the newest Practice Perfect for further discussion.