Mark left in 1979 South Africa for the United States where it specialized in surgery of ankle and of the foot. It has been devoted to it exclusively for 20 years and it contributed to the development of of which it is the outgoing president. He is currently Director of the private institute Medical in Baltimore which gathers a programmed and emergency surgical activity, a laboratory of biomechanics and an educational program.

 

. : In which surgical context your career does begin you it in the United States?

: My history begins when I leave Cape Code in South Africa in 1979. I had decided to continue my career in the United States. Initially I wanted to make plastic surgery and until now I am worried by the esthetic aspect of what I do.

It is necessary at that time to replace my history in the csotcina.comedic surgical context of the United States. I began my career in 1983, there were very few surgeons specialized in surgery of the foot and of ankle at the time. At the request of the patients primarily, developed care. At this period of the surgeons of the sport appeared, of the hand surgeons, the vertebral column, of the prosthesis,… To be locked up in a was a guarantee of success.

MO: Which is then your personal course?

: My medical course was the following: I made 4 years of Medical College then I was house physician, then I made 5 years of csotcina.comedic surgery, and a year of surgery specialized in the foot and ankle during my . I was thus in Baltimore in 1982 in csotcina.comedic surgery, and nobody at the time made surgery of the foot and ankle. This moment, there were 4 or 5 surgeons of the foot specialized in the United States. I thus decided into 1980 to specialize me and in 1982, I spent one year with Doctor to New York. It very interesting, was very cultivated, explained us why the innovations were rare in medicine and rather pushed us with reading the foreign scientific literature, in particular the French and German publications. It is thanks to him that my intellectual curiosity woke up. He learned how to me to have a critical eye on what I read, not to take as cash the results but to check them myself and to use if that seemed to me interesting other disciplines like the anatomy, biomechanics. He also taught me a certain form from humility by saying that so certain interventions went for certain surgeons, it would not be inevitably the case for myself. He insisted much on intellectual honesty and the integrity, fundamental qualities of the medicine, and which I try to forward by my teaching to the students.

. : Which are precisely your occupations as a teacher?

: Teaching that I lavish is the reflection in my way of thinking dating from the last years in South Africa. I am for the practical solutions, simple, pragmatic, and I find that in the United States teaching is too much theoretical and far away from realities. I adore teaching, I adore to travel. I know many languages. I have much chance because as an immigrant, when I arrived, I was on the other side of the barrier. Now, it is of my duty to teach with other immigrants, with other csotcina.comedists who did not have same opportunities in their career.

We require within the framework of , the , one year of , i.e. one year whole in the same service with the same owner. Thereafter people are free to spend one week or a month to supplement their formation elsewhere. Currently, we have with Medical in Baltimore, two American, Switzerland and three visitors foreign: a Spaniard, an Chinese and a Venezuelan.

In addition my activities of teaching are prolonged by humane medicine; last year I went to operate 15 days in Peru, it was one of my priority missions as a chairman of the .

MO: Among your impressive list of work, one notices many publications concerning the syndromes of cabins of the foot.

: I was confronted with large traumatisms occurring in the farmers, the workers of the ship. I was at the time in a center of reference for heavy traumatology. We had many patients coming for high-energy traumas, complexes, with syndromes of cabin, attacks of , we did not understand them. In 1994 nothing was written on this subject. I made many anatomical and physiological studies, and as from 1995, one started to worry a little more of the in the foot and to appreciate the disastrous complications in the event of absence of processing: unrecoverable deformations, the atrophy of the intrinsic muscles.

. : Which is the chronology of your work, and your major themes of studies?

: That starts in 1983. I was interested by the plastic surgeon and . In fact, I joined together them later in the surgery of the foot. I developed new concepts like the processing of the high-energy traumas.

From 1980, I was also interested in the flatfeet probably after my stay in Doctor . At that time the technique was dominated by triple arthrodesis. When one started to make transfers, the results were not very good because one was unaware of the anatomical elements most important. It is there that I developed the osteotomies associated with the transfers with good performances.

Thereafter, I developed the of ankle. Ankle was my passion. I was very interested by the deformations and their corrections. I worked much on the arthrodesis with open sky, and under . Besides I have the first worldwide publication on this technique. Nevertheless, I was not very gifted in and in addition I had the permanent concern of the respect of vascularization, with the result that I developed with my team of then of novel methods which we called it minicomputer-arthrotomie for arthrodesis of ankle.

In the years 1990, I started to occupy me of the severe deformations of the back foot, after-effects of heavy and alternative traumatology of arthrodeses. I deal in particular with the surgery of recovery after triple arthrodesis while trying to find solutions in the rebuilding.

That occupied me during a few years, then I turned towards the neuro-muscular deformations. I was very interested by the disease of Marie , very frequent in the United States with his multiple problems of deformations. I worked much on the transfers and the rebalancing of the muscular balance.

. : Does the frequency of this disease increase with the frequency of obesity in the American population?

: Not, it is a sensitive of hereditary origin. On the other hand, I was interested much in the diabetes and with obesity, very frequent with the United States and I have many publications with regard to them.

. : You seem to make simultaneous heavy gestures combined on the back, the and the before-foot 

: When you have a deformation of the back foot, for example a foot-dish with rupture of leg posterior, there exists much of consequences to the valgus: brevity of peroneal, instability of the column interns… You must take all that in consideration and make sometimes multiple gestures. My concept is to balance forces being opposed to the American concept which is rather to make triples it arthrodesis, source of many complications. My philosophy is based on the biomechanical study, the balance of the forces is carried out by osteotomy associated with transfers. For the flatfeet, the only indication of arthrodesis is the rigid foot. When it is flexible, the conservative therapy should absolutely be privileged. Now, when I correct the back foot to make it neutral and that before foot is in supination, I am obliged to make an osteotomy of of the first wedge-shaped one with open sky.

. : And your work on the before-foot?

: I worked much on the before-foot at the same time on the biomechanical and surgical level. I made osteotomies of , , …. But honestly it is not what impassions me, it is the , the back foot as well as ankle, it is of that of which I want to speak to you.

.: You are today the Director of Medical in Baltimore. Made you always of the heavy surgery urgently?

: We always make traumatology, but rather regulated, cold, or of the fresh traumatology of fractures type of the , of seen in . We have an emergency department which does not have, of course, the same activity as at the hospital. We are only two experienced surgeons, but sums very helped by my “ Training”, animated by the visitors coming from different countries and by my . In any event, at my age, I prefer being at home the night that at the hospital.

. : How do you make to make, within your private institute, as much of biomechanics, and to have as many corpses for your anatomical studies?

: With regard to biomechanics, I have a laboratory with engineers within my institute who are paid partly by the hospital, and partly by the laboratories and foundations. I specify that is completely original. With regard to the corpses, it is rather easy to get some in the state where I work, but it is necessary to pay for that.

. : In France there are very few surgeons whose activity is exclusively devoted to the foot and with ankle. What is he currently in the United States?

: There are currently in the United States 38 posts of which are offered a year, therefore 38 specialized surgeons are formed every year. We have embers with the , whose embers are foreign. With regard to the 700 American surgeons, ake only surgery of the foot and ankle in an exclusive way, and ake some among other activities.

. : How created for itself the of which you were the Chairman until recently.

: The of which I became member in 1980 was then an small group of surgeons of the foot and ankle. The essential interest was to even carry out a teaching intended for us and the whole of the members. The mission was, of course, to improve quality of care. The mission has changed for 10 years because of the considerable increase of the members. The primary goal is always teaching, but the second objective today is to educate the public to state that we are specialized ultra surgeons. This considerable increase of the payrolls, obliged us to solve big problems of organization, infrastructure, budget amounting to million dollars. We organize two congresses a year that it is necessary to plan.

. : From which does the money come?

: It comes from the members, the donations, the laboratories of implants, subscriptions for the newspaper… We have financial needs for our own organization, but also for our philanthropic mission. We are with personal capacity very privileged on the financial plan, economic, intellectual, and professional, and as a chairman, I find that it is an obligation for us to take part in humane missions.

In what relates to me, I give much time for that. I am certainly not a good bureaucrat. The main aims are the indoctrination, the humane missions, the communication to enlarge our group, search. The money is unfortunately the search engine and that belonged to the role of the chairman to find some.

. : What did you make 20 years ago, and who does not walk?

: I do not operate any more any patient likely to have a tumor of . I think that it is necessary to be very vigilant on the personality disorders, “the predisposition to the pain” and that it is thus necessary to avoid operating them. I made some besides much at the hospital in the past. Now, on the medical level, most important in the event of repetition is to be able to affirm the diagnosis, to prove well that it is about a repetition sitting in the third space or with ankle. The solutions are the again or a transposition, but the results are poor. On the technical plan, it is necessary to avoid the plantar incisions absolutely, even if it means to take again a dorsal access and to hide the nerve in the muscle, detail capital. Here typically an example of what I did and which I do not make any more.

I established of ankle in the treatment of osteoarthritis of ankle, or I carried out interventions of joint replacement of interposition in the same indications. All that be a failure.

To the level of the phalangeal , the arthroplasties do not give good performances because the improvement of mobility is poor, about 30 to 40 ° to the maximum. The only advantage is to preserve the hinge, to relieve the pain in 50% of the cases what is not sufficient.

MO:  In the current field, which do you think of the percutaneous surgery? Know Manuel Del ?

: I know it very well, it is a friend with me, it makes almost all the surgery into percutaneous. I speak very quite Spanish and I make run to Spain once a year. The techniques about which you speak are not possible that by very good surgeons. They are not even popular in Spain and are practiced in very few centers. I think that apart from expert hands, the percutaneous techniques can give disastrous results, and the prospective series were not published yet.  It is a true problem in the United States in particular with the podiatrists, interested by small incisions of course very in the mode.

. : Which are by the way the relations which you maintain with the podiatrists?

: It is about a very significant subject. Historically, the quality of their work in the Eighties was very poor, but it gradually improved. There is not much program of for them. But certain surgeons, like , were very active for the reconciliation. There is nevertheless much hostility of certain csotcina.comedists in their connection. We currently try to help us mutually, to adopt common strategies and one can say that the intellectual quality of the items which they currently publish is much better than front.

. : Towards what goes one in the future with regard to the surgery of the foot and of ankle?

: It is probable that the development is done more and more towards the respect of physiology. One goes probably worms of the biological procedures which should make move back the arthrodeses and preserve the mobility of the hinges. They are gristly farming techniques, of . Of course, I do not eliminate therefore the total prosthesis from ankle, but it is necessary to do much progress in the comprehension of joint mobility, to make more preserving osteotomies in the future.

M. O.: How the French surgeons are perceived by American?

: When I made my in 1982, Doctor insisted on the need for studying French work and German between the Thirties and 1950. I read all that Doctor , , had written. It practically obliged us to do it. That is very enriching and little of American surgeons currently, unfortunately, know them. I consider that without that, you cannot exert, and I must say that Doctor influenced us much in the United States with regard to the surgery of the before-foot. The Americans are open and receptive with the international thoughts in particular with those of the French. Unfortunately, few American surgeons speak other things that American.

. : Do you make another thing that surgery of the foot? 

: I do many things, and always with passion: sport, kitchen, gardening, the study of the foreign languages, the wine tasting… In sport, I make Motocross in competition, ski, I adore to be made deposit in the helicopter in top of the runways, of the jogging and now I have put myself at the golf for 4 years.

I have a passion for the wine and since 1981 I collect the bottles. I have much wine of Bordeaux, currently about 400. I in addition adore to cook and I once receive at home per week my foreign interns and my visitors. I have a restaurant besides and once or two per week, I cook for the customers. It is a unique opportunity to release me from my surgical activities. That besides is considered like the surgery. It is necessary to plan what one will do, to prepare it, create, avoid the problems and to face.

I am impassioned by the different cultures. Besides I adore the foreign languages, I speak usually Spanish, some dialects south africans, I begin Italian, but unfortunately I did not put myself yet at French.