Length of Training:	One year
Dates:	August 1st through July 31st
Application Deadline:	September 1; Early applications are encouraged
Affiliated Institutions:	Barnes Jewish Hospital Barnes Jewish West County Hospital Veterans Affairs Medical Center
Clinical Faculty:	Jeffrey E. Johnson, M.D., Director Sandra Klein, M.D.

The Orthopaedic Foot and Ankle Service at Washington University School of Medicine provides state-of-the-art care for all types of problems related to the foot and ankle, including but not limited to trauma of the foot and reconstruction of post-traumatic problems of the foot and ankle, foot deformities related to neuromuscular and arthritic conditions, tendon injuries of the hind foot and ankle, foot complications of diabetes mellitus and sports-related injuries.

A more detailed listing of the depth and breadth of the foot problems treated by the Foot and Ankle Service includes:

• Sequelae of arthritis - ankle, hind foot and midfoot fusions, forefoot reconstructive procedures, comprehensive foot orthrosis and bracing services by a certified pedorthist or orthotist.
• Foot and ankle trauma - fractures of the ankle, calcaneus, talus, midfoot and forefoot, including complex bone and soft tissue injuries.
• Sequelae of trauma to the foot and ankle - fusions of the ankle, hind foot, midfoot and forefoot, corrective osteotomies for deformity.
• Diabetic foot - A comprehensive team approach provided in the Washington University School of Medicine/Barnes-Jewish Hospital Diabetic Foot Center, focussing on prevention, salvage options, amputations, pedorthic and orthotic management and state-of-the-art wound management. In addition to the orthopaedic surgeon, team members include physical therapists, nurses, advanced practice wound care specialists, cast technicians, certified pedorthists, certified orthotists, and certified prosthetists.
• Arthroscopic surgery and sports medicine - Treatment for sports-related bone, tendon and ligament problems of the hind foot and ankle, including ankle instability, Achilles' tendon problems, ankle and subtalar arthroscopy, and reconstructive surgery.
• Acquired problems - forefoot deformities, such as bunions, hammertoes digital neuromas, heel pain, tendonitis, acquired flat foot deformity, foot tumors - benign and malignant tumors of the foot. 
• Neuromuscular disorders - Primarily treatment of the foot deformities associated with Charcot-Marie-Tooth disease, stroke and head injury.

The Foot and Ankle Service is located primarily on the main campus of the Washington University Medical Center at Barnes-Jewish Hospital as well as at The Sports and Orthopaedic Center in West St. Louis county. Surgery is performed both at Barnes-Jewish Hospital South and the Outpatient Orthopedic Center in Chesterfield on a weekly basis. Additional services are provided at the Veterans' Administration Medical Center and Shriners' Hospital for Children.

The Foot and Ankle Service performs approximately 250 surgical cases per year with about two-thirds of these procedures being either outpatient or less than 24 hour admissions. There are approximately 2800 outpatient visits per year to the Foot and Ankle Service which represent approximately 1000 new patients per year.

The Foot and Ankle Service is made up of two primary faculty members, Jeffrey E. Johnson, M.D. and Sandra E. Klein, M.D.  A third year orthopaedic resident, an orthopaedic nurse with a large experience in both inpatient and outpatient orthopaedic nursing and medical assistants round out the service. Additional evaluations and services are provided by a registered physical therapist with a special interest in lower extremity problems and certified pedorthist. A certified orthotist (for brace fabrication) or a certified prosthetist (for prosthetic fabrication) are available in the office on an as needed basis. This provides a "one-stop" visit for the patient to obtain comprehensive foot and ankle evaluations and treatment.

Some foot and ankle problems are initially screened and treated non-operatively by a nurse practitioner or physical medicine and rehabilitation physician with a special interest in foot and ankle problems. Referrals to Drs. Johnson and Klein for either further evaluation or surgery, are made as appropriate.

Clinical Research

Clinical research is currently underway or recently completed in the areas of surgical treatment for diabetic neuropathic foot and ankle deformities, acquired adult flat foot deformity, osteomyelitis of the calcaneus, gait analysis following calcaneus fracture, three-dimensional motion analysis of normal walking, and the treatment of acute ankle fractures in diabetic neuropathic patients.

Industry-Sponsored Research

Industry-sponsored studies are currently underway on the use of "Shock wave therapy (lithotripsy) for the treatment of chronic plantar fasciitis" and the "Effects of pulsed electromagnetic fields (PEMFs) for the treatment of the diabetic midfoot neuropathic (Charcot) foot.

NIH-sponsored Research

"The effects of percutaneous tendo-Achilles' lengthening on diabetic patients with forefoot ulcers".

"Use of computed tomography and plantar pressure measurement for management of neuropathic ulcers in patients with diabetes."

Application

For information and an application, please write:

ATT: Foot and Ankle Fellowship
Department of Orthopaedic Surgery
Washington University School of Medicine
Campus Box 8233
660 S. Euclid Avenue
St. Louis, MO 63110
Phone: (314) 514-3552

Or, send an email to foot@wudosis.wustl.edu