“Every Millimeter Matters,” A Q&A with Dr. Bradley Lamm
Dr. Bradley Lamm is a fellowship-trained reconstructive foot and ankle surgeon at the Paley Institute in South Florida. He’s an innovator in the specialty — he’s invented and patented five different orthopedic surgical devices —so he was just the kind of collaborator that MedCAD wanted when we started developing our AccuStride Foot & Ankle product line. He’s been with us since our very first steps in the project.
We caught up with Dr. Lamm after a post-surgical consultation with a MedCAD design team, where he was talking them through how a calcaneal osteotomy procedure had gone and offering suggestions for more streamlined approaches and millimeter-sized improvements. Though his procedure was quite successful, he’s passionate about translating his experience into templates that doctors facing similar situations can follow flawlessly.
In this Q&A, he talks with us about patient-specific medicine, the future of truly custom approaches, and what drives him and his successful practice.
Q: You’ve worked with MedCAD to iterate approaches for our AccuStride™ Foot & Ankle products. Can you talk about your experience in helping develop this technology?
Dr. Lamm: As surgeons, we create things every day. We fix things like crooked bones or tight soft tissues, and we pass on that knowledge generation after generation, and that’s how we learn. But these anatomically specific guides have really revolutionized these surgeries, so that not only can we do all these great things to improve the alignment and the position and rebalance these feet and ankles, but we can do it much more accurately and so much more efficiently.
By being the one of the pioneers of this system, we are basically developing a track record and log of each individual foot and ankle deformity that we are fixing. So we have a template of how these cases can be done successfully with MedCAD technology, not only to help the surgeon but to help the outcomes.
Every millimeter matters, every degree matters. And the more precise we are as surgeons—and this device allows me to be as precise as the CT scan is—the bigger difference for the patient’s outcome.
“Every millimeter matters, every degree matters. And the more precise we are as surgeons—and this device allows me to be as precise as the CT scan is—the bigger difference for the patient’s outcome.”
Q: As this sort of technology comes online, it’s first going to be used in the cases where it is needed most. How far into more general surgeries do you see this patient-matched approach going?
Dr. Lamm: I think with the progression of technology, patients are demanding minimally invasive procedures and are demanding patient-specific approaches. They want their own kind of personal touch, a customized procedure.
And since we have custom joint replacements now, why not have a custom plate or screw or even a technique that’s custom designed to make sure that they have the accurate outcome? Now it’s the complex cases — the deformities, the revision surgeries, the cases that are more on the complex, extreme side. But I think it will be used for even simple everyday cases like fractures and bunion cases in the future, given its accuracy and efficiency.
Q: Where do you see this sort of patient-based approach going? What else might we be able to tackle soon?
Dr Lamm: I think health care access for patients is a big thing. When they can’t travel out of their hometowns, their local doctors can treat something complex with this system. It gives better hands to those surgeons, so they’ll be able to treat more people better, whether the surgeon is two years or 32 years into their practice.
Q: How have you seen the technology advance in your 25 years of practice?
Dr. Lamm: As a resident fellow, we learned how to do these surgical techniques through a mentor or director. And then in the first 20 years of my career, there have been advances and changes that I’ve had to learn. But I really feel like the last five years, as a busy surgeon, it’s been exponentially more difficult to keep up with the technology and learn new techniques. There are a lot of new instruments and a lot of new changes that we as surgeons have to keep up with.
It’s also become more challenging trying to do the very best for my patients. I know all the other docs are doing the same as well. We’re signing the notes and trying to figure out the billing and the coding and the office staff and how to figure out the finances and dealing with hospital administrations, while we’re also trying to keep up on the cutting edge to help patients.
Q: What led you into foot ankle to begin with? What’s fascinating about it to you?
Dr. Lamm: I’ve always had an interest in fixing things. It’s in my family lineage. One grandfather was a farmer and a master carpenter, and he could fix any kind of farm tool. My other grandfather built handcrafted airplanes after he retired from the military as a pilot, and he fixed the lawnmowers of everybody in the neighborhood. My dad’s an engineer, my brother’s an engineer… so I just engineer people instead of mechanical things. I feel like I have been blessed with good hands. And my mom’s always been the socialite; she was the high school cafeteria manager and a bus driver and the girl’s high school’s varsity soccer coach. So she was really always involved and social. And so I just put all that together.
I played soccer growing up so my feet were always very important, and I had to make sure the shoes I wore were the right ones. The mechanics of the foot and ankle and the complexity of it were always very interesting to me, and that led me down the path to foot and ankle surgery.
In 25 years, I’ve written a lot of medical articles that look at angles and millimeters and translations, and a lot of the geometry of realigning bones of the foot and ankle—always trying to put more numbers to what we do rather than just the freehand kind of stuff. So it’s right up my alley to work with MedCAD because it allows me to further that mission of being more accurate during ankle surgery. I do feel that that’s tied right into outcomes.
Q: Between your engineering side and your caring soccer-coach side, what comes across when you’re meeting with patients?
Dr. Lamm: It’s difficult these days because we’re pressed for time. I tend to run my practice the way I feel is best for the patient, so I have a concierge-type practice. Bedside manner means a lot these days and staff is very important. But it’s hard to convey things like millimeter realignments quickly to patients. So it helps a lot to work with companies like MedCAD, where I can show a drawing, a bunch of three-dimensional pictures, and it shows that these are customized treatments, and they really love that. I think the patients that appreciate me the most — and who I appreciate the most — are the ones that see that I’m doing everything I can to help them out. That’s why I got into medicine, after all.
Q: What’s making you happiest in your practice these days?
Dr. Lamm: I enjoy trying to fix difficult problems. I like to be innovative. As you can tell from these conversations, I want to design and improve all the things that we do, and not only help a particular patient, but patients to come.
I also teach. I’ve had a fellowship program where I have a one-on-one apprenticeship with a young doctor who could go hang his or her shingle but chooses to spend a year with me. I’ve trained 18 fellows, who are a great help with my practice, and I’m guiding them not only on the medical-surgical aspects but giving them a lot of other advice that will help them in their careers.
“I want to design and improve all the things that we do, and not only help a particular patient, but patients to come.”
Q: Tell us a little about your family.
Dr. Lamm: I have two sons and a daughter, and I’m a very proud dad. My two sons are U.S. champion sailors. As a team, they’ve won three U.S. championships, three years in a row — that’s never been done before in the youth class, under-19 age group — and they’ve been 14th in the world at the world championship. That means I’ve been able to travel Europe and South America and all over the U.S. with them for these events. My oldest is at Brown sailing, and my second son just got accepted there, so that’s a big, big proud dad moment.
My daughter’s 13, and just in the last year or so she’s really gotten involved with sailing with the younger brother when her oldest brother went off to college. My kids are really close because they sail together a lot, so that’s been a blessing.
Q: Any final thoughts on your time as a Key Opinion Leader and innovator with MedCAD?
Dr. Lamm: I’m happy to be involved with MedCAD because I see such a bright future in this kind of customized health care. They’ve been brilliant with oral maxillofacial work, but if we can use those same ideals and inspiration to help the foot and ankle world, I think it’s going to be fantastic. I think that’s really where the future’s headed, to where everything is patient-customized.