Podiatric researchers apply a healthy skepticism

Curiosity is creating an audible buzz among students and faculty engaged in DMU’s increasingly robust research enterprise. This story is part of “Research Engines,” a series on the questions being asked and investigated by DMU researchers.

When they ponder the application of accepted, traditional practices in podiatric medicine and surgery, Mindi Feilmeier, D.P.M.’05, FACFAS, and Paul Dayton, D.P.M., M.S., FACFAS, say, “Show us the evidence.”

Re/Search Engines: the pursuit of new knowledge  at Des Moines University That’s the common theme of the research the two assistant professors in the College of Podiatric Medicine and Surgery (CPMS) have conducted and published in recent years on a variety of foot and ankle surgical procedures.

“The global overview of our research is to change from ideas and traditions handed down from generation to generation to an evidence-based perspective,” Dayton says. “There are so many traditions that haven’t been proven, yet they become the standard without evidence or fact.”

Case in point: treatment of bunions. In an article published in 2014 in the Journal of Foot and Ankle Surgery, Dayton, Feilmeier and Merrell Kauwe, D.P.M.’14, noted that most of the more than 100 procedures proposed to treat this foot deformity involve surgical realignment of the first metatarsal, the bone extending from the ankle to the big toe, combined with soft tissue balancing. This has been so commonplace, the researchers stated, that “any argument for a fundamental change to the approach becomes uncomfortable and seems unwarranted to most foot and ankle surgeons.”

Paul Dayton, D.P.M., M.S., teaching students in the Surgery Lab
Podiatric physicians and faculty members Paul Dayton, shown, and Mindi Feilmeier ask a lot of questions, and they encourage students to do the same.

However, multiple studies in recent years show 30 to 70 percent of bunion surgeries are problematic — “yet we continue to treat them in the same way,” Dayton says. He and Feilmeier recommend viewing the problem through a different lens.

“Most published papers put kind of a Band-aid on the procedure and the problem by proposing minor modifications,” Feilmeier says. “Where we’re starting is not by looking at the procedure, but at what’s happening with the foot’s anatomy and how we can get it back to normal.”

In their published works, Feilmeier and Dayton — often working with CPMS students and other researchers — have applied such critical analysis to other topics, from treatment of Charcot foot (a condition that weakens the bones in the foot) to the accepted-yet-unsupported “wisdom” that patients should keep incision sites dry at least two weeks post-surgery to avoid infection. Their presentations around the country have attracted significant attention, both positive and negative, among their peers.

“It’s difficult to hear ‘the way you’re doing it may not be the best way,’” Feilmeier says. “But with each project, we’re trying to come up with another question and collect long-term data on the approaches we’re taking. Ultimately, it is not about us as the surgeon but about the patient.”

The pursuit of evidence, long-term, will benefit students and patients, the two faculty members say. “We want students to question the knowledge that’s out there. We want them to be able to look at the anatomy and say, ‘Even though I got the answer right on a test, does that procedure make sense based on what I’m seeing?’’’ Feilmeier says.

“It’s all about driving true change,” Dayton adds. “That keeps me excited, because we see real-world benefits in patient outcomes.”

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