For this episode, Gloryren especially invites the internationally renowned master and pioneer in Germany in Foot and Ankle Surgery, Dr. Olms, for a special interview.

Dr. Olms is currently the Senior Consultant of the Department for Orthopedic-, Trauma-, Hand- and Plastic Surgery at Diako Krankenhaus Flensburg. He founded the Foot Surgery Foundation in Germany in 1996, with only 5 members back then now developing into 2,000. He founded the training system for Foot and Ankle Surgery and has been carrying courses around the world. For the past three decades, he traveled around the world performing surgeries and giving lectures. He is keen on charity and has taken self-funded flights to developing regions to operate free surgeries for those in need. He has always been fond of taking a long way to meet interesting people in the world.

1. When did you first know you wanted to go into medicine? Why did you decide to pursue a career in medicine finally and why, in particular, did you decide to specialize in foot and ankle surgery?

Re: Well, um, it took me a while, as usual, to find my career path after I left school. I started my education at the University of G?ttingen in the field of forestry at that time. As I had to earn some extra money for my life as a student, I worked at the ICU department of the G?ttingen University Hospital. And well, of course, during the night shifts, you have some time to talk to the colleagues on duty. And they kind of created my interest in studying medicine. This was one point. The other point was that when we checked for job opportunities in forestry, we found out that these jobs are very limited. So there were only forty jobs per year in Germany in the field of forestry. But there were 400 students finishing every year. So I said this is not a good way to continue. So I finally stopped studying forestry and started medicine at the University of G?ttingen. Well, in essence, I mean, this is kind of fun, is that I just changed using the saw from cutting trees to cutting bones. So it's more or less I stuck to the saw. But from the beginning, I knew that my future career had to include surgery. I was still working at the ICU at the University of G?ttingen and I worked as an assistant in surgery and the Pathology Department. So this kind of made my way to surgery. And the specific move to foot and ankle surgery, I think we can cover that in the questions later on because I was just lucky to be at the right place at the right time.

2. Who have been your greatest influences? What have they taught you and how have they inspired you?

Re: Well, my greatest influences in the field of surgery were, of course, my teachers. And I had very different teachers. One of my teachers, my first teacher in trauma surgery, he told me that once you have blood on your fingers you have to leave the OR. Just use the instruments in a very delicate way. And he showed me how to reduce the fractures without sticking your hands and fingers, always in the surgical field. And I learned how to behave in the OR. When I saw some surgeons throwing instruments during the case, I learned that this was not the way to speed up the case and increase the attention of the scrub nurse. You have to behave in the OR and because you are a team member. And most important was my training in hand surgery. I learned to handle soft tissue very gently and experienced my knowledge in anatomy which is as important in hand surgery as in foot surgery. Furthermore, and even more influential were the outpatient clinics. Finalizing the indication for the surgery was something that was really important. And I have to make sure that I'm not following my personal desire to do surgery in every case. I had to consider the personality and other life circumstances of my patients. And I learned to send away patients. My feeling was that the chemistry between me and the patient wasn't ideal. Sometimes I knew in advance that the outcome of surgery would not be optimal so I sent the patient away. And we have to keep in mind that this is something that is very important for me, that we are not treating a disease or a pathology, but we are treating a patient. And that really influenced my surgical life quite a bit.

3. You founded the foundation of Foot Surgery with five members only, but now it has grown to one of the largest in Europe - the German Foot and Ankle Surgery Association with more than 2000 members nowadays, what is your motivation to found it? What's the biggest challenge to manage such an association?

Re: Yeah, this is a very interesting question because it really covers my whole surgical career. I have to start with a little hospital in my hometown in Bad Schwartau, which is close to the city of Lübeck. This hospital has 75 beds, so it's just one ward in a Chinese hospital. It's very, very small. This hospital was bought by a group of investors. They owned a hospital in Atlanta, Georgia in America. They asked me if I would like to do foot surgery. (At that time, foot surgery was almost, I wouldn't say unknown, but was very unpopular and underdeveloped in Germany.) So I said, of course, I like the challenge, let's go to the U.S. and learn about foot and ankle surgery. This is what I did in 1990. 

So, I got my first exposure in foot and ankle surgery. After I returned home. I started my first case immediately. In the first year, I had 65 foot and ankle cases. Very few years later, I already had 300 foot and ankle cases. It was an extreme, rapid gaining of experience. And I invited American surgeons to visit me so I could participate in their experience and lower my learning curve. In 1994, I decided to offer the first practical course in foot and ankle surgery in Lübeck, which is about thirty minutes away from Bad Schwartau. At that time, we used saw bones. The courses were very successful, so I started organizing more courses. In 1996, I was more or less pushed to found the association of foot and ankle surgery by other colleagues, and we needed five people to sign the foundation paper.

At first, I didn't want to do that because I knew the responsibilities of a founding president. But fortunately, the courses and the annual meetings were supported financially by an American company. The company was called DARCO who manufactured the first shoes in China. So that was already the connection to China. And everything else had to be achieved by personal effort without making any money-I had to pay a lot of money out of my own pocket for travels and different meetings. When we had meetings in Lübeck, we had the final meeting of the group and of the faculty in our private home, just to lower the costs for the group. And I was actually driven by the fact that I wanted to really give the best way of training to other surgeons, to give patients the best treatment of their foot problems. 

The biggest challenge to organize such a big group (and I had a lot of helping hands) was that we had another foot and ankle association in Germany, which was founded under the orthopaedic umbrella at the same time. My goal was to bring them together.  because these two groups had the same goal, so why should we not have the same umbrella, the same organization, the same annual meetings? But there were a lot of political issues between the two groups, and when it comes to politics, everything becomes difficult. Until now, I did not manage to form one association in Germany. However, both groups are now under the umbrella of the EFAS, the European Foot and Ankle Association since 2022. 

4. You are called "Mann der ersten Stunde"- the man of the first hour in foot surgery, what is your thought on this and how this title affects your whole career?

Re: Well, actually, when it comes to discussing this point, I must say I was just lucky to be at the right place at the right time. You know things that happened. The group that bought our hospital, they had this strong foot and ankle affiliation in the U.S. They opened the door for me. But on the other hand, there must be somebody who steps in. I was young, I was active, I love to see new challenges. And I said, okay, let's go on. If there's a new project, a new field of surgery, for me, I will just step in and start doing my work. To me, it was almost very important to serve the goal of establishing modern foot and ankle surgery in Germany. I knew from very traditional procedures in the hallux valgus surgery, which destroy the joint more or less. And now from the U.S. experience I learned that this is only necessary in very rare cases. There are many other techniques through which we can preserve the joint and give the patients a better life. My colleague in my hospital, the elder colleague, he did the hallux valgus surgery in this traditional method, and the patient had to stay in bed for three weeks until they could go out of the bed. Now, with the new procedures, they can leave the hospital the same day, which was an extraordinary and good development for the patient. 

And you asked me about the title, how does it influence my career. The title is just a formalism for me. It never influenced my career. I lived with what I love to do and I actually didn't care about my title, because I never worked in a university hospital. I worked in a teaching hospital, but never in the university where the titles may be more important. However, our small community hospital with 75 beds served as a global teaching center for foot and ankle surgery. I had many many people from all over the world, actually from all over the world I must say, that wanted to visit me and participate in the development of modern foot and ankle surgery. It was far more than just foot and ankle surgery, it was an exchange of cultures, it was an exchange of views to life. The foot was for me, in the nucleus, or an extraordinary development of my life and my surgical career.

5. What is your proudest career achievement to date and why?

Re: Well, actually everything comes back to foot and ankle. I think the proudest achievement I had was this foundation of the foot and ankle association. Especially because we were creating a format for the education of young surgeons, and this format still exists. It was unique at the beginning, and education is one of the fields where I really want to focus my energy. I want to educate the rising stars. I want to educate the young surgeons and kind of transfer my enthusiasm14:00 to the young surgeons, so they can pick up and follow the path that I may be open for them as well. So, I think creating the education format and teaching the young surgeons successfully were probably the things I most proud of.

6. After you retired, you have been paying high attention to charity work. We also learn that you fly to many less developed countries and regions performing surgeries for the poor without honorarium, what contributes your passion of it?

Re: I started my contribution to charity work during my active work time, not only after my retirement. I had to do all this in my vacation. So, it was my vacation that I took to go to charity work, to go to different underdeveloped countries. Again, this has to be supported by your family. I mean, if you spend your family with your work, it's sometimes not the best idea. But due to my exposure to the U.S. colleagues, both orthopedic and podiatric. I heard about the group from Seattle called Healing the Children. The deal for the participation in that group was that every team member had to pay everything out of his own pocket, which means travel, accommodation, food, transportation, everything. The organization only sponsored one dinner with the hospital staff and our group. Our group usually consists of surgeons, anesthesiologists, scrub nurses, interpreters, photographers. It was quite a big group about fifteen to twenty people. During that time, I just met wonderful teachers who were experts in the treatment of club foot deformities in children, really tremendous teachers and wonderful persons. I went with this group to different countries in southeast Asia. On one of these trips, I took my son with me. Because I thought it was very important to expose your own kids to underdeveloped countries, to really appreciate what they have at home. This was something that I was able to show him, my son, that even very poor people can be content and happy. And what I learned is that they are extremely grateful. During these trips, again, we always had students or young surgeons with us to expose them to surgical procedures without these luxurious technical support that we have in the western world.

7. Do you have suggestions (to the directors in China) on how to train the young generation? What advice would you give to the young foot and ankle surgeons? And how do they balance their clinical works and scientific research? 

Re: To give suggestions means that you know the system of education in the country. And this is what I don't know. I'm not familiar with the training programs in China so far. However, I will know the principles after some more visits. My suggestion is, first, we should pick the right students to study medicine and use more criteria than only grades in school. There must be something else that makes a medical student a surgeon. There are many different tests in that field can show whether somebody is able to really work in the field of medicine and in surgery. And there are cognitive tests if a student is capable to perform an operation. For example, three-dimensional view tests, endoscopic test modules, virtual reality glasses, and of course the tests of your manual dexterity are extremely important. If students pass that tests and are selected to become medical students, then we should establish kind of a system where there is a mentor and a student all through their education. Ideally one to one, so one mentor per student. Studies show that specific hands-on training on a human specimen before going into real surgery will give better results. So, this is very important. And the presentation of the theoretical background, and video presentation on a procedure before performing the procedure under the guidance on a specimen, case discussion and real surgery always under the umbrella of a mentor could be the education in the ideal world. It's the mentor-ship for a young surgeon that makes things different and improve the knowledge and the capabilities of a young surgeon. Then we of course need a fixed curriculum that, should be the basis for future education. What I learned from my American colleagues is that in very early stages, the advanced surgeons, even though they are not specialized, should take over responsibility to educate their younger colleagues. They should be involved in scientific research. It's not a matter of surgical capability to give a talk on literature review, everybody can do that. But they have to be exposed to that and they have to give presentations and train the younger surgeons. That is very important at very early stage. Training others has a huge effect on our personal understanding. Training is always better than learning because it upgrades your own knowledge. And becoming a surgeon always influences your private life. Finding a balance on that is very difficult. However, with a stable family background, the surgical career should be possible.

8. In your opinion, what's the trend of foot and ankle surgery in the coming decade? What are the most exciting new developments in foot and ankle surgery that we can expect in the next five to ten years?

Re: In foot and ankle, I'm very sure about the fact that minimal invasive surgery, both in elective and trauma cases will find its place. People don't want to have big scars; they want to have fast recovery. There are some signs that minimal invasive surgery can improve our outcome. Then we will have, of course, robotic assisted surgeries that may optimize our results in the future. During my visit in the Second People's Hospital in Shenzhen. I learned that there are many robotic assisted surgeries, and it's still more or less in the beginning more or less. But this is what's going to influence our work in the future. And then we have a lot of interventional and hybrid techniques which will definitely influence our daily work. And of course the technical development on the industry side will change our techniques a lot. I mean we saw that in the past, we have so many new products on the market that make our lives easier. We must not forget that we are not treating diseases but we are treating patients. There are many influential facts that will have great influence on our daily work. For example, concomitant diseases like diabetes, which is increasing incredibly and will change our surgical needs in the future. Basically, whatever the techniques allow us to do, biomechanical understanding, knowledge of the Anatomy, and your manual dexterity will always be the basis of our work.

9. There is still gender disparity among the top researchers in foot and ankle surgery. And this is probably one of the reasons why we are not having enough surgeons. How well do you think institutions/hospitals are doing to encourage more women to pursue a career in foot and ankle surgery or the whole orthopaedics, and could this be improved?

Re: I can only give you the insight of my German view on this problem. In Germany, about 70-80% of the medical students are female right now. So, a lot of medical students, the majority of medical students are female. We will see a natural increase of female surgeons just because of the demographics. When you try to differentiate what a surgeon must be fit mentally and physically, like he has to make fast and correct decisions, all these things. These are totally independent from the gender. In my point of view, the gender disparity will decrease in the future. Although the ratio of female and male surgeons is one to three, we have triple the number of male surgeons than female surgeons. But the technical execution of the procedure is getting more and more important than pure physical power. There are a lot of little technical things. Like in airplanes, for example. When you started with flying airplanes, there was a big steering wheel they have to move, and now everything goes with a joystick. This will happen in surgery as well. And I'm sure that this gender disparity will decrease in the future. When you go through the literature, and there's a lot of literature on female surgeons. The reason is always the family. If they want to have a family then that influences the timing of the training. But in many of these papers, female surgeons said that females have to become more ambitious in the future. And then female surgeons will occupy more leading positions. So, it's not really a problem of a male-female conflict, but it is a problem of the females themselves to become more ambitious and try to occupy more leading positions in surgery. I think there will be a natural increase of female surgeons due to demographic circumstances.

10. What's the most fascinating part of your profession as a medical doctor? And what would you have been if you had not been a medical doctor?

Re: I think this question comes back to my personality. And I must say that the charity work was the most fascinating work in my career. Experiencing the gratefulness of patients which is to certain extent more or less unknown in the western world, I wouldn’t say unknown, but is much less than in the underdeveloped countries. That was a wonderful experience for me to just be able as a surgeon, to give people a life worth living. That is just wonderful. We had this little boy in Indonesia who was disposed in a trash can after birth, because he had club foot deformity. Due to our surgical skills, we were able to do surgery on this little boy at the age of two years. The boy is fifteen now, he's an excellent soccer player. It really causes goosebumps on your skin when you tell the story. This is what influences your life and shows possibilities to change lives in a very short period of time. It is one of the advantages of the field of surgery that you can have success in a very short period of time. This is really what influences me most. 

And if I had not become a surgeon, I wanted to become a pilot first when I was a kid or a young student. My goal was to become a pilot. But I failed the entrance examination so there was no way to become a pilot. So I started studying forestry which seems to offer few chances in the job. Luckily enough, I had to make some extra money at the university hospital. That made me change my way. And I think the choice to become a surgeon was the best choice of my life.

11. What are your hobbies during your leisure time?

Re: If there is leisure time. Well, I learned this in my visit in Shenzhen, that the value of leisure time is totally different in our countries. It was very, very interesting that one of the young colleagues told me that he cannot go on vacation if there is any patient that needs treatment. It's much more important to treat a patient than going on vacation, which is totally different in the western world and especially in Germany. When I have leisure time, family life is the most important. With my kids and my granddaughter and my family. I do a lot of sports and travel. I do a lot of gardening as a reminder of my interest in forestry. I love cooking, reading, everything that time allows, and traveling. Taking challenges to find new cultures, new people that really influences your whole life and makes you independent from what you read and see in the media. I never believe in the media; I only believe in what I see. And this is why I used to travel a lot to many countries in this world to just improve my sights of life as much as possible.