KISS (Keep it Simple Stupid) or Older, Wiser, Simpler
Updated: May 26, 2020
Malcolm Gladwell in his book Outliers popularized the theory that anyone can master a skill with 10,000 hours of practice. When you have been practicing podiatry for over 30 years, like I have, you can at least claim to be a master of the most common foot problems.
So what words of wisdom can I give you from 30 years and countless hours of experience in dealing with common foot problems? The first principle in dealing with any foot problem is that treatment needs to be individualized to each patient. The second principle would be that often the simplest treatment proves to be the most effective.
When an 85-year-old patient has a painful area in the front of her foot, it is far better to avoid surgery with a simple insole in the shoe to balance the pressure on the foot, rather than to risk potentially serious surgical complications. There must be a risks vs benefit consideration done. (This is true even though Medicare you and insurances may not pay for the insole and would pay for the surgery!) On the other hand it is a great injustice to perform a temporary removal of a painful ingrown toenail when someone has had that problem many times in the past. That person is much better served by permanently removing the portion of nail that has caused this problem over and over again. They will be done with the problem and not risk future infections.
The doctrine of simplicity was recently driven home to me by a patient who had bunions removed on both feet by two different doctors at approximately the same time. (Neither of them me) She told me that both bunions look the same before surgery. I only saw her feet and x-rays about five years after the surgeries were performed. One bunionectomy was performed with a very simple procedure using one small wire to hold the bone in place which was later removed. The second surgery used two screws in one bone and one screw in another bone in order to hold everything in place. The second surgery involved more bone cuts and three permanently implanted screws. The results couldn’t be more different. The great toe on the simple bunionectomy foot moved freely and was straight - and looked excellent. But in the foot with the complex bunionectomy procedure the bunion had returned somewhat, and the great toe did not move well. The joint was painful. On x-ray the joint looked arthritic. While this may not be typical, it is not the first time I’ve seen this kind of result. These two bunionectomies drove home the principle that sometimes simple is better. In surgery there is an old maxim that the enemy of good is better. Sometimes simple is better and complex is not always good!