April 01, 2014
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Pioneer: Mark S. Myerson, MD

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In this month’s column, we feature Mark S. Myerson, MD, an international leader and pioneer in foot and ankle surgery. His devotion to improving the care of foot and ankle conditions is humbling and inspiring to me. Myerson has educated, trained and mentored generations of surgeons, leaving behind a legacy of excellence throughout his career. He embodies the qualities of a “Pioneer in Orthopedics” through his dedication to research, education and surgical innovation.

Andrew R. Hsu, MD
Rush University Medical Center, Chicago

Andrew R. Hsu, MD: How did you decide on a career in foot and ankle surgery?

Mark S. Myerson, MD: My education and training began in Cape Town, South Africa. Unlike the United States, students were able to begin medical school directly from high school. I chose to serve in the army and from there went to a university where I studied sociology and psychology. I decided to go to medical school with psychiatry in mind, but soon found that I had little aptitude for that specialty. I completed my internship and came to the United States, planning to start a career in surgery. Serendipitously, I was offered a residency position in orthopedic surgery.

Mark S. Myerson

Mark S. Myerson

My residency was affiliated with a number of hospitals and I rotated through hospital systems in Baltimore, meeting outstanding surgeons in both private and academic practices. During my third year of residency, I gravitated toward trauma surgery, thriving on the excitement, unpredictability and novelty of cases. However, I yearned for a niche to explore and at the time it was clear that foot and ankle surgery was the best choice for me. At the time, there were only four foot and ankle fellowship positions available in the United States compared with approximately 68 positions that are currently offered by 44 programs today.

Hsu: Who have been your most important mentors and what were the most valuable lessons you learned from them?

Myerson: In the early 1980s, the icons of foot and ankle surgery were Roger Mann, MD; Melvin Jahss, MD; Kenneth A. Johnson, MD; and Andrea Cracchiolo, MD, to name a few. My mentor was Dr. Jahss, one of the founding members and an early president of the American Orthopedic Foot and Ankle Society (AOFAS).

Dr. Jahss was instrumental in guiding and shaping the way I think about taking care of patients. A common mantra that he used to say to me was “Do not accept anything that anyone says. Go out and prove it for yourself.” This was invaluable advice as I realized then that while certain procedures and techniques work well for some surgeons, this does not imply that these are universally applicable. Dr. Jahss critically evaluated everything, and was skeptical of much of the published literature despite his position as editor of Foot and Ankle. He had a phenomenal memory and an exceptional understanding of the literature, often times citing articles in other languages as far back as the early 1900s. To sit beside and learn from him at meetings was a delight. He would constantly remind me in his own unique way that “This work is not new, the presenter just does not know the literature.” In this way, Dr. Jahss channeled my enthusiasm and focused my interests to be more thoughtful and engaging. At the time, the field of foot and ankle surgery was in its infancy and there was little if anything done or taught that was based on anything other than anecdotal experience.

During my fellowship year and subsequent early years of practice, I frequently visited William Hamilton, MD, in New York and bore witness to an entirely different side of foot and ankle surgery. Through his intense passion for ballet and the fine arts, Dr. Hamilton introduced me to the field of athletic injuries and inspired me to become a fan and aficionado of cultural pursuits. Dr. Mann and Ted Hansen, MD, also influenced my thinking and perspectives of the foot and ankle along with those of many generations of surgeons.

Hsu: What has been your most important contribution to your specialty?

Myerson: I have been fortunate to pick a subspecialty that has undergone an exciting evolution of surgical practice during my career. Where do we draw the line between innovation and experimentation? Where is the right balance between drive, creativity and consistency? I have always desired to experience new things and have applied this idea to my both my personal life as well as my practice of foot and ankle surgery. The 1980s and early 1990s were a vibrant period of innovation during which many of the procedures we now take for granted were first successfully established. The AOFAS consisted of a less than 100 members, and the camaraderie and sharing of ideas was paramount to everyone involved. I was able to openly express myself and share my ideas.

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Many procedures that are standard of care today were born out of arduous work with many mistakes and a steep learning curve. In the mid 1980s, I studied the effect of neuropathy on patients with diabetes and formulated an aggressive approach to manage neuropathic ulcerations and Charcot deformity that is now the standard practice. I remained interested in severe trauma to the foot and ankle and established criteria for managing the crushed foot, and in particular injuries associated with compartment syndrome. Much of my clinical and research work during the late 1980s focused on the adult flatfoot. We were only beginning to understand the biomechanics of the deformity, and although I popularized many procedures, some of these have since been replaced and surpassed. During the past decade, much of my energy has focused on reconstruction of end-stage arthritis and deformity, in particular that of the hindfoot and ankle. The unique challenges of ankle replacement and revision of failed arthroplasty are currently areas of great clinical and research interest to me.

Despite my experiences in product design and surgical innovation, that which I hold most dear to me is my contribution to education. I feel blessed to have been exposed to a multitude of talented surgeons from the United States and abroad, and education and humanitarian work have always been a priority. My interactions with hundreds of visitors and fellows during the years have filled me with a pride and purpose and I am honored to have trained surgeons who are now leaders in the field. We hold a bi-annual alumni meeting that is one of the most stimulating and educational events.

Teaching is not unidirectional. We cannot serve as effective educators and mentors without also learning from those around us. The audacity of enthusiastic, bright young minds has been a source of motivation and inspiration throughout my career.

Hsu: What advice do you have for the next generation of orthopedic surgeons?

Myerson: In his book Outliers, Malcolm Gladwell skillfully details the factors common to different fields of endeavor and concludes that 10,000 hours of practice is necessary to achieve success. If one applies this to our specialty, it logically follows that nothing will replace repetition. For the young surgeon, there is nothing that will substitute for hard work and perseverance. The changing work hours for residents have negatively impacted their ability to fully engage in repetition. However, practice must be supplemented by sustained education and mentoring in order to achieve excellence. The practice of orthopedic surgery requires patience, diligence and planning in order to not burn out prematurely. While the practice and care of patients is always a priority, I have found solace and direction by embracing outside interests such as literature, creative arts and the study of other languages and cultures. As an immigrant to the United States, I am humbled by my beginnings and constantly remind myself of how fortunate I am to be practicing here. One of my fundamental beliefs is that we should try to push ourselves to the edge of our comfort zone and embrace change as this can help produce new ideas.

My advice to the next generation is deceptively simple, yet challenging. Take on humanitarian causes. The pedestrian truth is that change is inevitable and time is limited, so stay vital and focused. Keep yourself honest and stimulated and never accept monotony or routine. Ask difficult questions and reflect on what you can do better. We are ultimately judged not by how we begin a journey, but how we end it.

I find myself at the end of one chapter, yet at the beginning of another as I have decided to move my practice to Los Angeles and embark on a profoundly new adventure. Following the advice I have just given, I hope to push on and continue my search for new ideas and advances in our field. In the end, you will be defined by your actions, dedication and work ethic. Bravely go forward, stay focused and work hard, and always remember that success is a byproduct — not an end goal.

For more information:
Mark S. Myerson, MD, is the director of the Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore.
Disclosure: Myerson receives royalties from Biomet, DePuy, Tornier and Elsevier, and is a paid consultant for Biomet, BME, Paragon, and Tornier.