Swiss Foot and Ankle Society SFAS

Swiss Foot and Ankle Society SFAS

PD Dr. Dr. Victor Valderrabano
Orthopädische Universitätsklinik
Behandlungszentrum Bewegungsapparat
Universitätsspital Basel
Spitalstrasse 21
4031 Basel
Schweiz
Tel. +41 61 265 71 97
Fax: +41 61 265 78 29

Email: vvalderrabano@uhbs.ch

About US

The "Swiss Foot and Ankle Society (SFAS)" represents the national Swiss association of physicians and academic people specialized in the treatment, medicine and research of the foot and ankle. Its members are not only orthopaedic surgeons but also members of other disciplines such as biomechanists, rheumatologists, angiologists, general surgeons and others.

The goal of the SFAS is to maintain and promote a continuing education of its members and to ensure an exchange of scientific and technical knowledge about foot and ankle research and techniques on a national and international level.

by P. Scholder, Lausanne

From 1929 onwards, a certain number of members of the International Orthopaedic Society here in Switzerland gradually developed the habit over the years of focussing on those subjects covered by congresses held in their field; in July 1942, they finally set up the Free Association of Swiss Orthopaedists, the forerunner of the SSO.

As far as the Swiss Foot and Ankle Society is concerned, there are some who might assume that its creation were similarly linked to the already existent International College of Medicine and Surgery of the Foot (CIP), that Jean Lelièvre was instrumental in founding in 1960; but this would amount to a severe misrepresentation of the facts, and would falsely assign to this College a role which it did not in effect play in our country.

In fact, in Switzerland as in Germany and in the Anglo-Saxon countries, the foot has always been considered to constitute an integral part of the domain of orthopaedics, and it was in the context of the SSO that the initiative to bring together those colleagues more specifically concerned with the foot first began to take root in 1969 at the close of the Sion Congress for which I had been asked to prepare, provide the relevant structure, and organise the topic area devoted to ''The forefoot''.

At that time, therapeutic concepts relating to the foot varied somewhat throughout the country; but above all, such concepts were greatly removed from the dogmatic view held of Jean Lelièvre by members of the CIP, which merited a number of sarcastic remarks on the part of eminent figures in French orthopaedics.

As by definition a congress is a forum for debate at which an exchange of ideas is to take place (in which confrontation can sometimes make a positive contribution), Jean Lelièvre had been invited to participate in the Sion Congress, and we were expecting a great deal from discussions related to his contribution. However, as he died unexpectedly a few weeks earlier, the organisers were forced to replace him at a moment's notice by Robert Meary, the defender of a conflicting doctrine that Prof. A.N. Witt, representing the University of Munich, attempted to mitigate.

Following publication of 'The forefoot' one and a half years later, covering the congress proceedings, Swiss orthopaedics then became aware that, in the field of the foot as in many other medical areas, it stood at the crossroads of the languages used and views advanced in the countries adjacent to Switzerland, but that, in order to clarify matters, it would need to give priority to those persons wanting to focus more specifically on this sector of the human motor system.

Finally, three years later, following the impetus provided by H. Fredenhagen and the SSO Committee, by the Consilium Orthopaedicum and by five former presidents of the Orthopaedic Association, I was put in charge of setting up and leading a working party devoted to the foot towards the end of 1974, in which all the orthopaedic departments in the country had been invited to participate.

The explicit demand raised by Dr. A. de Wulf (President of the CIP) to support the creation in Switzerland of an Independent Foot and Ankle Society was therefore averted; but it should be stated immediately that the working party in question was also to be open to colleagues from other specialised disciplines, so that it would not be penalised if at some point it wished to link up with the International College of Medicine and Surgery of the Foot.

The Swiss Group for Study of the Foot (Studienkreis Fuss) was therefore established on May 30th 1975, on the occasion of the Orthopaedic Society Congress held in Soleure. Its twelve founding members were as follows: M. Barbier, R. Baumgartner, H. U. Debrunner, A. Gächter, N. Gschwend, M. Mesgarzadeh, H.R. Meyer, F. A. Naghachan, , P. Scholder, W. Taillard, C. Urscheler, soon to be joined by D. Pelet and T. Tank. - From then on, for the next four years, I had the privilege of heading the group, with a position that was variously described in the minutes book as Co-ordinator, Group Leader, Chairman, Presiding Officer, etc., with the combined duties of organiser-guide-secretary-treasurer.

As Dr. de Wulf had been duly informed of our special focus, we were prepared for the CIP to show us the cold shoulder, and assumed that we would have some difficulty in contacting those key figures who apparently had things of interest to convey to us. But on the contrary, the College proved to be a remarkably good loser, and immediately invited us to its 1975 Congress in Brussels. A large number of our members attended, and we had the honour of being welcomed and treated in the same manner as the national associations that were participating. - The dies had been cast; and as our congress communications were fortunately well received, the GEP was henceforth declared to be the Swiss partner of the CIP.

However having yet again noted the extent to which doctors from different regions and cultures tend to contradict one another, not least due to the different meanings being assigned to the same word, the Swiss Group for Study of the Foot first of all embarked upon the task of reviewing and unifying its own terminology. Thus, when it met up in Berne on the 29th November 1975 (following an SSO advanced training course), it was decided that with only three or four minor modifications, Antoine Denis' work on ''The painful foot'', distributed by Documenta Geigy, would henceforth become its reference glossary, and that an amended version of this publication was to be given to each new member. The next meeting was planned to take place in conjunction with the SSO Congress in St. Gallen in May 1976, where a series of findings gleaned from abroad were to be presented before deciding where and how we were to organise our first study trip in the same year... -Unfortunately, the unscheduled duration of the Orthopaedic Association Congress reduced this meeting to a five-minute briefing, time enough merely to accept the Co-ordinator's word at face value and to decide to visit Professor Antoine Villadot in Barcelona.

Five months later, six of the fifteen members who had originally decided to participate were indeed in Barcelona, lodged for next to nothing in the fine building owned by the Barcelona Medical Association; and from the 3rd to the 9th November 1976 they were able to follow, step by step, the daily activity of this eminent foot surgeon who put so much time and unstinting effort into his work. From the point of view of what we had come to see, we noted that Professor Villadot operated on hallux valgus by the Keller-Lelièvre method, with the further inclusion of a fixation from the short to the long flexor of the big toe, that he performed metatarsal alignments by the Lelièvre technique via the plantar route, achieved classic and complete correction of club foot, and had just introduced original or Silastic arthrodesis of the anterior sub-astragalus for cases of flat foot that had not responded to treatment. - Like all eminent orthopaedists, he had his own special way of doing things which he showed us without hesitation, presenting in detail all his therapeutic diagnoses and allowing us to check the results. He then revealed to us a whole spectrum of ongoing investigations led by his brother concerning the development of a shoe without supporting arch or shank that would be really physiological and suitable for sports activities. - We passed six well-filled days, during which we were given a remarkably warm welcome, and were extremely well guided and looked after.

The SSP advanced training course then took place in Lausanne on 13th November 1976, organised by Professor L. Nicod, on the occasion of the 100th anniversary of the Orthopaedic Hospital of French-speaking Switzerland; the subject covered was ''Feet problems in current orthopaedic practice''. - The GEP members were given the opportunity to familiarise themselves with a number of ideas, which were sometimes expressed in an extremely curtailed form and which unfortunately could not be discussed: ideas concerning articular physiology and baropodography, and their respective roles in the treatment of hallux valgus, club foot, diabetic foot, or cases of metatarsalgia.

Following the disappointments of the St. Gallen meeting, the GEP decided that in future it would hold its gatherings separately; and on 5th February 1997, it met in Berne, where H.U. Debrunner had been able to reserve the auditorium of the Maurice Muller Foundation and had in addition prepared an extremely interesting agenda on dynamic and static examination techniques for the foot.

A number of approaches were examined: from direct observation to the podogram, from fast-motion film to electromyography or electromyo-kinesiography, from the use of articular goniometers to pressure sensors used in conjunction with radiotelemetry, and finally the analytical possibilities offered by computer-assisted gauge platforms for the determination of three-dimensional constraints.

Finally, even for those practitioners who do not have recourse to sophisticated equipment, a great deal of information was obtained on this day, even if it was merely the demonstration of the excess weight that the patient on crutches suddenly places on his foot on the moment he moves forward (hence the value of developing Pelimit), or the use of supports to stabilise the tarsus in athletic track events.

Then the Dijon Seminar was held from 2nd to 4th March 1977 in Professor Piganiol's department, at which Dr. A. Voutey gave an exceptionally interesting and instructive seminar on foot surgery, involving a group of patients who had given their prior informed consent and who exhibited an enormous range of foot complaints; these cases were operated on by over ten different surgeons, who had been invited to demonstrate their personal techniques, the entire procedure being televised live.

We were able to observe the treatment of hallux valgus by the Keller-Regnaud method, metatarsal alignment by dia-epiphyseal re-pinning as performed by the aforementioned Bernard Regnaud, the treatment of hammer toe by the lateral route with distal tenotomy of the long flexor, a McBride operation process, a Silastic plug implanatation in hallux rigidus, a basal osteotomy involving the raising of the first three metatarsals, for cases of metatarsalgia a sub-astragal arthrodesis for fixation of a paralytic foot, a post-traumatic arthrodesis to bypass the ankle, a chillean blockage for spastic foot, not to mention the prior presentation of the patients' case histories and an explanation of the procedures that were going to be used, as well as a vast number of bio-mechanical, pathogenic and clinical demonstrations. - In three days, we acquired the same amount of invaluable information as we would have obtained from visiting six to eight foot surgery centres; a significant number of CEP members were certain not to miss attending this event, and it should also be added that Burgundy cuisine has an excellent reputation. At the Congress held by the French Foot and Ankle Society in Lyon on 5th March, which re-examined the subject of cases of metatarsalgia, the GEP delegation was not quite as numerous, as our practitioners did not feel that they could abandon their patients for too long a period of time; and moreover, other festivities were planned for the following month.

After a seminar on nomenclature held under the auspices of the CIP and organised in Alba from 4th to 7th June 1977, during which two GEP members presented the results of our work during 1975, the Study Group actually participated in the 12th Congress of the International College of Medicine and Surgery of the Foot held between 8th and 12th June 1977 (cases of tarsalgia - ambulatory quality estimated on the basis of energy expenditure - fractures of the calcaneum), following which it took a three-day complementary study trip to see Prof. Pisani in Alba (pressopodostatigraphy/ basal MI osteotomy associated or not associated with shortening of the basal phalanx/advantages of the ''V'' approach for osteotomy of the bases of the intermediate metatarsals/functional longitudinal subdivision of the foot, with reciprocal liberty of the ''astragal foot'' and the ''calcaneal foot'', etc.

By going abroad in this way, one runs the risk of having to reciprocate; and it was thus, even before it had put its own house in order somewhat, that the GEP was obliged to organise, lead and accompany the return visit of Professor Pisani's Piedmont group, who were shown the departments headed at Balgrist by W. Schulthess and Felix Platter (from 10th to 12th October 1977).

The following year was just as fruitful, but possibly more significant for our members, and the GEP Seminar held in Fribourg on 4th February 1978 on the treatment of hallux valgus long remained in our memories as the symbol of a common pooling of individual experiences. All formality was out of the question, and thirty or so of our colleagues were fully able to express their opinions, their enthusiasms and their disappointments in a simple and straightforward manner; for four hours, they gave their answers to some fifty questions which had been submitted to them beforehand, and which they been able to mull over for several months. - The results were published in the form of a collective report in ''Chirurgia del Piede''; this had a significant and long-lasting impact, so that even now, ten years later, it is not completely out of date.

The 1978 SSO Congress was swallowed up by the first Congress of the Union of Surgical Associations that H. Friedenhagen had organised at the Swiss Samples Trade Exhibition in Basle, and where the subject proposed by A. Debrunner, ''Ten-year results of orthopaedic treatment'' was immensely successful. The subject of the foot was of course well represented, and several of our colleagues participated most effectively in this event.

Besides taking part in the CIP Seminar on Nomenclature in Alba, which examined the characteristics and definition of the normal foot, the GEP again left its native soil for a third study trip (from 25th to 30th September 1978). Impeccably organised by J.M. Meyer, the group included 15 participants who successively visited Nantes, Rennes and Paris, where they saw Bernard Regnauld and Pierre Grassin at work; our colleagues were then taken to Cochin Hospital in Paris, where they were also made most welcome by Professors G. Maurer and B. Tomeno. - Here, they were presented with two complementary concepts on foot surgery, more or less based on the reciprocal conditions of private practice and experienced university hospital departments: 1) measured display of audacity, combined with the mastery of mobile surgery of the forefoot, an approach already prepared for by the previous demonstrations in Dijon; and 2) a rational, systematic and thoroughly considered study, almost invariably long-term, and in which the variables to be examined are strictly limited in number. - In short, a particularly enriching contrast.

Then, as the International College of Medicine and Surgery of the Foot had been recognised as the spokesman for Orthopaedic Surgery of the Foot as part of the International Orthopaedic Association, the GEP attended the SICOT Conference held in Kyoto (15th to 29th October 1978) with a Franco-Swiss presentation on cases of metatarsalgia.

Finally, to complete the year on 8th and 9th December 1978, a large GEP delegation participated in yet another event, the International Conference in Charleroi on the treatment of the hollow foot on the one hand and the syndrome of sinus of the tarsus on the other; we had information to contribute on both subjects.

As the Fribourg meeting had been most successful, the following year we tried to adopt the same approach, and the GEP meeting of 3rd February 1979 attempted to provide answers that were just as precise and comprehensive to problems of metatarsalgia. But as the auditorium was bursting with observers of all sorts, attracted by the somewhat excessive local publicity, quite a few of our members were disturbed by the atmosphere of the place, which had again become ''academic'' in tone, and so were not able to express themselves as freely as they had done the previous year. The subject required somewhat less examination and was covered until it was exhausted; but our colleagues returned home with the feeling that they had been spectators rather than participants, and were unable to retain such a lively impression as they had done previously.

Some observers were sent to the Symposium on Medicine and Sport at Font-Romeu in the Pyrenees from 4th to 10th March 1979, while others attended the third course on foot surgery organised in Nantes by B. Regnauld (from 8th to 10th March 1979); then two months later, the SSO Congress took place at Wolfsberg in Ermatingen (from 24th to 26th May), on the subject of ''Traumatic lesions of the foot''. However, although a GEP member participated in the organisation of the debates, the subject was of short duration and became lost in bookish presentations and a profusion of unconnected details; so as far as we were concerned this event did not provide the opportunity for a valuable examination of the topic in question.

In the succession of events taking place during that year, the CIP Congress in Eastbourne (5th to 9th June 1979) was next on the agenda, which we attended it in large numbers to see what the British had to offer us, and to test out our linguistic capacities for making ourselves understood by the subjects of Her Gracious Majesty, the Queen....then, immediately after this, two delegates again attended the Austrian Orthopaedic Society Conference in Graz (from 14th to 16th June 1979), which should have focussed on foot complaints, but where we were unable to determine whether everybody was really concerned with the same subject.

Thus, over a space of time amounting to only three or four years, the Group for Study of the Foot had become firmly established in Switzerland, and its numbers had risen rapidly from 25 to 32, 37, then 43, while abroad it had gained a reputation for dynamism and esprit de corps. - In fact, in a minimum period of time, the majority of its members had found themselves very widely informed on the practice of orthopaedics of the foot in Europe, and most of the contacts forged in Belgium, France, Spain, Italy and the United Kingdom were maintained to the benefit of all the parties involved.

We were off to a running start, and from this moment on we only had to ensure that no breakdown occurred and that things ran to schedule, which scarcely posed any problems given the advantages associated with belonging to the Swiss Orthopaedic Association (free access to the SSO bulletin, possibility of having inserts included, guarantee of professional credibility when contacting publishers and other communications professionals, arrangement of accomodation for meetings, financial support for specific activities, financial and moral backing, possibility of avoiding certain undesirable external pressures...to mention but a few). -The GEP has experienced all this with much gratitude, without ever feeling that it has had to compromise or that it has been put in an awkward position; all our requests to the SSO Committee have been well received, and have benefitted from this organisation's favourable impression of our activities.

What follows is in the same vein, so why should one complain? Besides the ''fixed dates'' of an independent annual meeting, SSO meetings (at which the subject of the foot is periodically re-examined, as in the APO workshops), and in addition to four or five congresses, courses, conferences and seminars abroad, the GEP has continued to make its study trips to other countries such as Germany, England and Scotland, then finally also to the United States. Then it felt bound to adopt a more open attitude towards colleagues from other areas of specialisation, as some of those involved had become dissatisfied with their status of perpetual guests, and were even shocked at having to become extraordinary members of the Swiss Orthopaedic Society before they were able to participate in the proceedings. Here, too, the SSO has remained remarkably open to the questions raised, and has granted an almost complete independence to its colleagues in the foot sector, even going so far as to modify (on 26th May 1979) its own statutes to include the specific conditions of patronage regarding the GEP, with the advantages that have been mentioned above.

It was thus that in 1979, the Swiss Group for Study of the Foot finally became an independent association with a committee composed of P. Scholder, President; H.U. Debrunner, CIP representative; H.R. Meyer, Vice-President; and also H.U. Zollinger, H. Zollinger and D. Pelet. It was the difficulty in finding a German equivalent for the French GEP then led it to reconsider its official name, and to adopt one that was closer to that of the other European associations connected with the foot.

On 31st January 1981, the Swiss Group for Study of the Foot became the Swiss Foot and Ankle Society (Schweizerische Gesellschaft für Chirurgie und Medizin des Fusses/Société Suisse de Chirurgie et de Médecine du Pied), and produced a logo of graphically successful design , which in its Andry tree declares that it is the offshoot of the SSO and also includes the univocal Lelièvre motto which underlines its links with the CIP. - In addition, from this moment on, it has also provided the CIP treasurers with liquidity, thus enabling the College to return to black figures. - Then on 28th August 1981, at the International College Meeting in Sao Paolo, attended by 14 of our members, our organisation was given the exceptional honour of organising and financing the 15th International Congress of Medicine and Surgery of the Foot (from 25th to 28th of September 1984; 360 participants, 280 doctors and with 25 nations represented), which was able to close its accounts to within 4.00 SFr, in spite of reduced inscription fees and the absence of any external assistance.

Others may well continue to talk of how enthusiastically the new association and its status has become appreciated:

• it thus proposed an extremely open and culturally-oriented congress on ''The foot in art'' which was held in Zurich on 31st January 1981 before a full house;
• it provided training for its members in anatomical and surgical dissection, a precursory stage before the dissemination of certain techniques;
• finally, it returned to its original approach, i.e. periodically held meetings rather than annual meetings prior to ordinary sessions of the Orthopaedic Society.

For these comments on the ''Early days in the existence of the Swiss Foot and Ankle Society'', i would just like to add the following:

• the meeting in Berne on 2nd February 1980 was an extremely successful experience; it was based on a multidisciplinary approach to the circulatory problems of the foot and the numerous participants greatly appreciated this event;
• the J.A. Venel prize, awarded for the first time to the Swiss Orthopaedic Society, was received by one of our colleagues, Dr. F. Hefti, for his impressive work on the quality of walking following arthrodesis of the ankle;
• in the same year, the SSMCP study group went to Germany, where nine eminent members were thoroughly delighted with the welcome and the quality of the programme prepared by Professor Steinhauser in Nuremberg, which differed completely from the formality encountered elsewhere;
• and finally, the subject of knee arthroscopy was examined by Professor Livio at the SSO advanced training course; however it was on 25th October 1980 in Orbe that many of our colleagues completed the meetings for that year in memory of Jean André Venel's activities

We have already spoken at length about what took place in 1981, and so I will just reiterate that the principal events were the meetings held in Zurich, Lech am Arlberg (foundation of the Austrian Society of the Foot), Charleroi, Sao Paolo (CIP), and Rio de Janeiro (SICOT Congress) ....and then, early in 1982, on 23rd January, all those persons who for seven years had aided me in steering the Swiss Foot and Ankle Society were publicly thanked for their generous efforts.

P. Scholder