Samuel devoted his life to the surgery of the foot. In spite of a mode of liberal exercise, it worked much for the diffusion of innovating techniques. Its demanding and esthetic approach of the correction of the deformations of the before-foot referred impossible to circumvent of it. After the account of its professional path, it gratifies us of a very complete item on its speciality.

 

 

. : Where did you make your studies of medicine?

. : I made my studies in Bordeaux with the project be a country doctor: read “the men in white” of A. ! then I passed the boarding school because thereafter I wanted to be a pediatrist. During my military service in the Sahara, I had to reduce and plaster the leg fracture of one “called”. The commander made call me the following day to tell me: “it is well what you did there ”. That gave me the spark and decided to me to make csotcina.comedic surgery. The content, I envied the dynamic and truculent surgeons whom I ran alongside.

 

. : At which was held your boarding school?

. : At Louis where I made two years of boarding school of 1965 to 67 and three years of until 70. It was which a completely remarkable owner. He associated the great rigor of the behavior of the observations with an open-minded which enabled him to tolerate a young inventive but facetious collaborator like me. I brought a certain imagination to the service!.

 

. : Which kind of csotcina.comedy did one make at ?

. : They was the beginnings of current csotcina.comedy with open sky. One operated the slipped discs, the hips with the prostheses of Mac and Robert whose was the close friend. The external fixers and the with chamber closed of the femur were begun. We had the nail of the Rock, end, without boring and the nail of , with boring. told: “One needs the security in the chambers”. One day, to ensure the safety of the chamber, instead of a nail of Rock which passed well, I had inserted a large nail of , and the Owner looked by the blister with the top of the operating table. At one time, I could neither insert it any more nor to withdraw it, and it left while telling: good luck, goodbye! It is as at this period as I was discovered an interest for the foot.

 

. : Of what did consist then the surgery of the foot?

. : It was the surgery of the foot, the surgery of the clubfeet and advanced osteoarthritides and it was or for the hallux valgus, and already the resection of the side heads . There was also the foot of the and the paralytic foot because at the time there was much polio. One made surgery, transpositions. It is there that I had discovered that it was for a spastic foot to better do transpositions rather than the conventional double arthrodesis or triple arthrodesis. For me, that was the beginning of a step which I then developed and adopted: it is the articular conservation which I put forward, with others undoubtedly.

 

. : Which was your project at the end of the ?

. : I like freedom. I badly did not make replacements and I observed that the “private” surgeons were at the time like “lords” and especially who they were free. What struck to me it is that at the hospital one was not free and that even the owner was tied up by the administrative stresses. proposed to me to contribute for aggregation and behind there were vacant services. I could have been a department head it is sure, but I lived all that like an alienation and I told him: not Mr I do not want, I want my freedom.

 

. : Was Mr full-time?

. : Not, part time like all the owners at the time. I helped it the afternoon with his private clinic. I was very carefree because I often arrived whereas it had already installed the fields. He told “you are still late! ” but he forgave me.

 

. : Whereas do decide you?

. : To install me in Bordeaux. I adore Bordeaux, I was born there and certainly I will die there! I settle in a private clinic, but I had a first extremely difficult year and I changed installation at the end of one year. This time that went very of a blow. Quickly I did many feet and I am make a name in this field. At this point in time I meet in a congress, one of large of this speciality, B. . I am subjugated by this character, large lord who catched his specific aircraft and especially new ideas, original. I become completely .

 

. : Which was its route?

. : It was a surgeon of Nantes, internationally known in the surgical discipline of the foot, he belonged to the circle of large of this time J. , A. , De , , and fabulous and its castle in Italy, etc all were men of great general culture; here are which would tend to lose nowadays… B unfortunately. was with the gap of the because he was not former intern. He had techniques very innovating: it was necessary to dare, all the same, to put the phalangeal basis or even the heads on the table before . What also rained me in it is that he saw the foot as a whole. I made his technique completely during 4 years, from 78 to 82.

 

. : It cut the basis of of the big toe in the form of stopper of carafe and it D encompassed in the shortened phalange: didn't that go?

. : If, “it went” because this technique united the advantages of or , i.e. to unpack hinge by the of short flexor; and that one cannot do it with an osteotomy of shortening of the phalange which leaves intact this court flexor). It is that the secrecy of this business, i.e. why finally that went. In more in its technique, the cartilage being preserved and had one second life… But of course the moved back about as in or , and this in spite of the efforts of and to retain them by points, etc, and that created an insufficiency of the 1st department. This insufficiency was compensated by the shortening of the other departments by D enclavement of the heads , it is a technique which has clarification, but that it was obliged to finally rather often make.

I made this technique of D enclavement of the heads during years, it walked as well, for the same reason of decompression of métatarso-phalangeal of the side pallet: but these heads could necrose and there was much stiffness because one without adhering to soft-tissues, then that made beautiful radios but finally it was difficult to make and that gave stiffnesses.

So that in 1982, I told myself, nevertheless this Mac Bride it is well because that the foot; I want to tell transversely. I.e. that decreases to a significant degree the round feet and the metatarsalgias of the side pallet. And then this Mac Bride adhered to the hinges. I thus returned to Mac Bride but by adding the phalangeal osteotomy to it and at this same time Bernard Baudet had as noticed as this phalangeal osteotomy improved the result well of Mac Bride: it fixed it with fasteners at scaphoid, me with a screw
“dedicated” then with fasteners “dedicated” also because oblique, and finally it was not badly but of course one did not correct the obliqueness of the cartilage, one could not thus shorten the 1st metatarsal one did not unpack the phalangeal hinge . Lastly, on this too tended cord, came to be grafted of course or corrections, métatarso-phalangeal stiffnesses and that everyone knows it, Mac Bride is not a technique which can be implemented in all the cases, it is monolithic.

 

. : And then?

. : Then after I go to the United States to San Francisco in 1991, to publish on Mac Bride and it is one crucial moment. I went much in the international congresses and I had known there , podiatrist in Chicago. One is re-examined in San Francisco, and he tells me: on the return stop you in Chicago, I will show you something of interesting. I thus spend a few days in his service to Chicago and there it shows me an original osteotomy of the first metatarsal which it calls . It had made some for a few years but not much. That challenged me and as of my return I put myself at it. At that beginning did not go because I was not caught there as it was necessary: I did not arrive, to move the lower fragment laterally in particular because my transverse features were not directed behind: I discovered it later. But, I persisted, I was at the laboratory of anatomy, etc

 

. : It is what ?

. : It is a longitudinal osteotomy in the axis of the first metatarsal and which at each end ends in a feature in bevel or herringbone. That gives an overall pace of the feature in Z, or, for the imaginative ones, in flash, from where undoubtedly, the name of “feature of Jupiter” which the carpenters give him who are the first inventors of this feature. is the English translation of the Jupiter feature.

 

. : Who had the idea to make an osteotomy of it?

. : Apart from which made a similar osteotomy but without feature in “Z”, it is and . The history is the following one: published, but with and this last in a bar in Los Angeles at the court of a congress meets: he speaks to him about it and thus is put at it. It was glad to show me this technique which filled with enthusiasm me. I thus make my experiment that I publish in the the year according to, therefore in 1992. knew very quickly a great success. Why? Because people were not very content with Mac Bride and did not know well the osteotomy out of distal herringbone strongly in vogue in the United States and practiced in France especially by . In addition the osteotomies of the basis did not give satisfaction. The French csotcina.comedists thus “jumped” on this osteotomy of the first metatarsal.

 

 

 

. : Because it is very unstable and difficult to consolidate and when that consolidates badly there is a rise of the 1st head and thus a metatarsalgia of transfer. I even developed at the time a special plate with a corner out of steel to support solidity, but that did not go.

 

. : How fix your ?

. : I fixed them with screws , then with my screws “dedicated” to small head. Thereafter I made knowledge with society , in particular C. and A. , and we designed the threaded capscrew together and currently we develop with the screw which is a great progress in the fixing of the , as in that of other osteotomies.

 

. : At the same period, had you already thought of a specific shoe?

. : Yes. I had observed that the operated patients of the before-foot went on their bead. Thus I told myself: let us try to make a shoe with the back which marries a little the foot and which carries all the support on the bead. I made this shoe with an industrialist of , , and then this shoe, I carried it me even. And, by making the race in the staircases with my son, after being operated of an hallux rigidus, to show him that it functioned well, alas, I missed a functioning and I broke my fresh osteotomy with the two screws.

I had thus the idea to improve this shoe by prolonging it to protect the before-foot. I was shown to make trade, but here are the facts. I created this shoe all alone, I made run moulds out of steel and that is very expensive. I worked with Elf Aquitaine, with the technical center of leather, during three years. It was the time when I wanted to make implants dedicated to the foot and I created a small firm. I had the fasteners, the prosthesis button which is a phalangeal or interphalangeal, a screw punt and small. But I learned with my costs what was the management of a society, and which a doctor doesnot can make this management!

 

. : You have a reputation of musician, of …

. : It is true that interested me to work the drawing of the shoes and their form. I learned what it was a form, I worked with last-makers, I drew the plate; for the forms, it is necessary to take a normal form to add paste to wood until there is place for the big toe and the others, to study the anatomy according to that and the whole was to be esthetic. It is there that the content and the form meet!

I passed from the shoe Type I to Type II, a shoe with variable volume but whose plate and form adhere to the operated foot.

After I said myself it would be although the operated women or who have problems of before foot have elegant shoes and I tried to carry out this dream. During 5 years, I made my forms myself, I drew the plates, I spent my Sundays there, and I drew shoes “of mode” I used also designers and this world of the mode they is enthralling. That went one moment. We had even in 1987 a store in full center of Bordeaux which made a good figure of businesses, but that did not prevent the bankruptcy. What occurred? I had one managing which did not make the weight and then I wanted to go until the end of my desires with a collection spring/be, autumn/winter with fashion parade! If I had been really the commercial one which one shows me sometimes, I would not have gone bankrupt. What saved me, it is the society Romans Industry which dealt with my shoes and which, after beginnings where all the range “Comfort/elegance” was represented is returned obviously: it was necessary to stick to the products refunded by the social security.

At the very least, this adventure taught me two things: with better knowing what did not go between the foot and the shoe, and modelling feet so that they re-enter better in female shoes.

For the screws and fasten them it is the company which took again the implants and developed them, then finally the co. .

 

. : At all events, brought new surgical possibilities?

. : Of course, Mac Bride it is a monolithic surgery, one retightens, one tightens the metatarsal, but one does not adapt to the case: the cartilage remains oblique if it is oblique before and the metatarsal is not shortened. With one can adapt. It is what rained. Of course there are still some reserves, but it is with my direction only dependant on one defect of training. It is a very powerful technique but it is necessary to learn how to control it. Of course, I was not to only develop . There be B. , Mr. , the group members “foot innovation” *. And then many other surgeons, the list would be too long, that they forgive me not to quote them.

 

. : Which are your indications?

. : They rise from the multiple possibilities of displacement of the fragment understanding the head, therefore amendment to each case: thus very broad indications; for an hallux valgus, I almost always make . This technique forwards possibilities enormously: with us surgeons to exploit them.

 

. : It is how not well not to make ?

. : It is to make the osteotomy without reflecting. Too many surgeons do not move well and not enough: one wonders why they put screws! One needs a preoperative reflection but also operational because of the multiple possibilities which are offered to us and if the does not go well it is that his possibilities were not well exploited. Moreover , with its double herringbone and its 2 screws, it is the insurance of solidity: all the statistics give a report on that and when, in these items one reads insufficient results, it is only to look at the radios forwarded to find the explanation of it. The failure comes from the insufficiency of technique of the surgeons, not of the insufficiency of the technique itself. I have now
14 years of experience and more than 3500 carried out and I see some much made elsewhere; I believe that I can speak about it…

 

. : You think that one can do without today all the other osteotomies?

. : For the hallux valgus and the first department, yes. The distal herringbone preserves some indications in the moderate hallux valgus because it is a small osteotomy. It is a little more with the mode that the invasive mini surgery. is “invasive” but with the two screws it is so solid which that allows
to take again the functioning immediately thus it is an advantageous “invasion”, a little like the Romans as a Gaulle…

In any case, if I am if
“” it is not fault of calling me into question for my convictions or of seeking novel methods elsewhere.

But for the the results are there and according to what I do and according to what I see I think that they are the best results on the processing of the hallux valgus.

 

. : You make support immediately?

. : Yes, but not on before foot, because there is not only the osteotomy. Four times ago to reduce an hallux valgus: it there with the side release, the osteotomy of the such as for example , the tissue and the phalangeal osteotomy. That made nevertheless not badly of gestures on soft-tissues and I think that one needs three or four weeks with shoes in support heel maker. Those which support too early can demolish, not because is solid for him, but the point of for example.

 

. : Do you always make the phalangeal osteotomy?

. : Almost always, 97% of the cases. When it is not done it is often regretted. However, the phalangeal osteotomy, it are not more as time of which did only that in the processing of the hallux valgus. In fact the phalangeal osteotomy is there only to supplement a result already not bad over various previous times, i.e. side release, osteotomy of , capsular . 5 years ago I published in the on these phalangeal osteotomies and I said that they were like “icing on the cake”: at this point in time P. which was moderating, answered me: “if the cake is really bad, the cherry will not save the cake! ”. It was right completely.

 

. : Summers you always faithful to fasten with memory of form?

. : Not always. For the small deviations one can fix with the small one fastens oblique with 27°, but if one wants to be solid in the great corrections, it is to better use fasteners with memory of form which is dedicated to the surgery of . There is only one counter-indication with this implant, it is the shortening of the big toe at the osteoporotic people: the fasteners grips too much into side and that gives again valgus.

While speaking about shortening, when I began the surgery of the foot one spoke only about the shortening of the big toe because it was thought that the Egyptian big toe was responsible for all the evils. In fact, it is not true and one can leave a a little Egyptian toe, it is not for that it Re will be deviated in the shoe. It is if one wants to shorten, to better shorten the metatarsal, which as one saw, slackens really the , and with the and the feature of , it is easy and solid.

 

. : One shortens the metatarsal and one leaves the length of the first phalange?

. : In fact, one needs especially the first phalange and to very little shorten it and after a shortening of the first metatarsal, if it is a little short, as one lowered, that does not generate metatarsalgias. If on the contrary, it is very short, it is necessary to shorten the others and one returns from there in . I was always preserving articular and there I realized that if one wants to preserve the hinges, it is necessary to give longitudinal decompression, he is necessary to shorten the metatarsals. Thus, that relates to on the level of the first department the two powerful courts flexor, on the level of the side departments, the intrinsic muscles plus the “long” tendons, all these beautiful people is slackened by shortening the metatarsals.

It is a concept that I discovered in 1993: I realize at that time that one can preserve the hinges by making a great shortening of the harmonized metatarsals but, i.e. with respect of the parabola . But until where to shorten? Up to the point ms, , which one will determine into preoperative and will refine into per-operational. It is, I think, which I could bring of more effective in the technique of correction of the great deformations. I explain that in my book “ rebuilding” and in the following item.

 

. : And the osteotomy of ?

. : In 1992, I made come to Bordeaux at the Days from . One made surgery in “direct”. It made on a side and me of the other. On his side, the patient had a metatarsalgia and a syndrome of the second department and without anything to tell to anybody makes an access of the second metatarsal and it cuts it obliquely. In the room, general outcry and general opinion that was not to go, the feature being too vertical, but that went and my patient was very well: it is there the beginning of the osteotomy of in France. Since, one worked much there with Mr. , T. , , , Jarde, etc

Of course the osteotomy of belongs to the therapeutic arsenal, with the experiment, one can tell: firstly, that the good performances are almost primarily in the great shortenings with adhered to parabola and double feature. Secondly that the post-operative stiffnesses can be avoided and especially corrected by a lysis secondary, practiced in particular into percutaneous or invasive minicomputer.

Then, it there with the osteotomy of de in the hallux rigidus, which avoids many arthrodeses, but it is another history…

 

. : What do you think of the current mode of the percutaneous one?

. : It is the mode! in shoulder surgery and knee the disadvantage of opening it is the postoperative pain or it is the stiffness. In surgery of the foot, by making operated do not have a pain and they are not stiff. The interest to open it is that one sees what one does. I refer to Robert , at the time of an intervention on line on big screen with . It was imposing and during the operation he had told: “in love as in surgery is necessary to see what one does! ”. Into percutaneous, for the moment one does not fix the osteotomies, and that makes the results unforeseeable, apart from some virtuosos, like Del (or for the !). With everyone can reduce except for the millimetre. I estimate that with the century one has the duty to be precise in surgery, and to consolidate this precision by the fixing of the fragments.

However, for soft-tissues, in surgery of the foot, then there one can be much mini invasive even percutaneous. I have practiced this surgery for 2 years, and I put that forward in the 2nd edition of my book. Thus one can make successfully into percutaneous or out of invasive minicomputer on the stiffnesses after osteotomy of , the sections of tendons, the plantar release of hinge IP, etc the percutaneous surgery makes me think of the closed or open fractures: it is not the same world!

 

. : Is the surgery of the hallux valgus a cosmetic surgery?

. : Let us tell: one makes surgery anti-pain and functional calculus, but with a notorious esthetic slope. And then, it is the correction of a deformation, but there is also what occurs in the head from the patient. There are many women who have an hallux valgus and which does not suffer from it. In addition they consult because they have a pain, but explain readily why the pains disappear when they withdraw their favorite shoes. If they like the fine shoes, their choice should be adhered to. What I brought in surgery of the foot, it is also this search for a foot able to carry this type of shoes.

 

. : Is it necessary that the surgeon yields with the whims of fashions?

. : The surgeon does what he wants, but if the mode is with the pointed end and high-heeled shoes, its role is not to tell “one should not! ” but rather
“Which shoes do you want to carry? ” In any case, two observations: firstly, the operated foot does not go inevitably with pointed shoes or with bead, especially with . Secondly, the women do not carry these shoes all the time, the mode is with comfort, as much as the seduction!

It is the photograph on first page of the “small guide” which we give to each patient, it is a pointed shoe and to high heel and one says to the patients that are operated they to allow them if they want of it to carry this type of shoes: in any case they will not put them all the time!

 

 

 

. : It is what I tried to do, since I tried to create shoes which go to the deformed feet. I worked much on top but one is not able at all to solve. One can mask certain things, but one cannot all reduce. It is to better operate the contents.

 

. : Do you believe in the erotic function of the foot?

. : Yes, of course! during the post-operative dressings. I lay out the toes of my patients like flowers in a vase. It is certain that a foot with hallux valgus and toe out of claw is not erotic and that a beautiful foot is already erotic in itself, and after one does what one wants!

 

. : Apart from that, which did you bring to the surgery of the foot?

. : If you want, one can make a chronology: there thus was the improvement of Mac Bride with the osteotomy of the big toe, and that with B. Donkey, then , then , then the with all that there is around.

But I did not stop there, and these last years there were the , the release of the twins, the osteotomy of in the hallux rigidus and more recently the local surgery of the toes out of claw. Lastly, the abolition of the Taboo of the “Rework”

 

. : What the ?

. : are the initial ones of , and : little story: I was not content with the herringbones practiced in the processing of the metatarsalgias, therefore with , one gave forward an oblique feature which had already been made formerly, but that one did not fix well: now one fixes it with screws of , and more recently with this new screw which one will be able to have with the .

I thus will see my friend P. in Zurich, and I speak to him about this osteotomy, it was in 2000, after the Days of spring in Bordeaux: he tells me that he makes him also this osteotomy and that he fixes it with a screw . We decide to make an exploratory study on this osteotomy, which we will call : this study was published at the time of Congress of Beirut in June 2004, and it should now be put on paper. It shows that the results are good, in any case much better than with the herringbone, because one can control perfectly the osteotomy which is stable.

 

. : Twins?

. : That leaves by far in what relates to me since with
J. , since 1973, we are saw that in young people , there were equinus which disappeared when the knees were bent: that was due to the twins and I put myself at the twins of the femur, with excellent results. But it was at the .

In fact, I started to do that for static disorders, some ten years ago and gradually I did it more and more: currently I operate 2 patients per week with the release of the twins, that is well described in the first edition of my book, and on top also, the results on an exploratory study will be published in Congress in Toulouse into 2006 which we organize ave B. Donkey. The results are really astonishing, at the price of an intervention which is completely alleviating, at all iatrogenic, that it removes no force with the triceps, etc With regard to the before-foot, it makes it possible to discharge it and from the etiologic point of view, it is really to correlate with the hallux valgus congenital, like besides had shown we it at the time of the symposium made with P. with the Congress of Bordeaux in 1990.

 

. : in the hallux rigidus?

. : 6 years ago, a symposium with the directed by Bernard , gave already a report on this technique, there was besides which published. Since Bernard this technique practices, and, in Bordeaux, with my Pierre son often let us do we it. As known as one makes a “longitudinal decompression” which gives astonishing results, avoiding many arthrodeses: I have well that forward in the 2nd edition of my book.

 

. : And toes out of claw?

. : It is last work in date, it relates to the local processing of the claws. Disappointed by the interphalangeal arthroplasty or its arthrodesis, we conceived with my Pierre son and E. a system in particular containing the plantar release of the IP, the shortening of the 2nd phalange, I tell well 2nd and not the first, by distal or sometimes diaphyseal resection, because one should not leave a long toe if it were out of claw into preoperative, to which we add lengthenings. In these gestures the percutaneous one has a considerable place, with this technique there are astonishing results for a very frequent pathology and it is thus a progress I think. In this number, I expose this technique, helped by an excellent anatomical study of Paul of Barcelona.

 

MO. : “Reworks” is an taboo subject?

. : It is true that for many surgeons the rework is a subject about which one speaks little. However especially in surgery of before foot, it is necessary to make some sometimes. Currently more than one quarter of my patients were already operated elsewhere… I still will quote Robert and the School of : what had struck me at the time, in the talks on the foot, it is that they did not tell “we have this percentage of goods and poor performances”, they told “we had insufficient results: here the rework that we practiced and at the end the result is either good, or better”, but it was nevertheless the rework on the level of the foot.

There are two kinds of rework:

- those where it is necessary all to remake, does it of it is a recovery, with two notable points: initially to make the ablation of the hardware, it is not always easy, but easier when one has screws . Then, to largely move back the whole of the metatarsals: thus one can preserve the hinges in practically all the cases of these great reworks.

- those, and they are the true reworks as in the tailor, where one will make a generally tiny but complementary surgery to improve the state of the foot. My patients are thus informed they will not be disappointed; and then one will operate 10 toes and they come to speak to you at the end of one year only from that which is not well, even if it is one on 10, but they are right: one can and one must go until the end to improve their state.

An example among so much of others: must one say “stiffnesses after ” or “indication of an invasive mini after stiffness on ”. I lean for this second sentence; at the prices of an intervention “light” one transforms these before-feet …

 

. : You operate only before-foot?

. : I do nothing any more but that. I did a little all until there is a score of years, then that foot and since 8 years only of before foot. My customers are made up to 95% women.

 

. : You operate still much?

. : Yes and I am supposed to stop me in a few months. But I work much because the patients, knowing more or less that I will stop, want all to be made operate, or to have their small rework, before my departure. After I pass the hand to my Pierre son who works with me since 2003 and with which we make a very complementary team. Pierre is undoubtedly one of the rare surgeons to have targeted as of his installation his activity only on the foot.

 

. : What go to be done with the retreat?

. : With Edith we come to adopt an adorable little girl Vietnamese who has a year and half now and I think that it well will occupy us, just as my small children! In addition I write items and books, I prepare congresses, in short I am with the “carbon” as if I were 40 years old. I estimate that it is time to carry out a calmer life which will enable me to re-examine patients, to make publications, to make teaching, to occupy me of my Internet site and also of my family! But apart from the foot, which is already a passion, I have two others of them: music and wine. We make wine. We live with ilometers of Bordeaux and we replanted vine. Currently, we have one hectare of vine, which is completely with the retreat!

 

. : You crush the bunches with the feet?

. : Not, but as in the large castles one cuts very short, one does not leave that 8 to 10 bunches per foot thus one eliminates the third party from the production. One makes macerate cold and ferment hot and of course, breeding out of barrel! I thus have two other passions: wine and the piano, what to still take some notes…

 

. : Rather than to operate the foot, couldn't one operate the shoe?

 

. : How do you explain this disinterest for the osteotomy of the basis of the ?