For Arianna Gianakos, DO, the future of foot and ankle surgery may be defined less by what surgeons can do than by what they no longer need to do.
Among these are smaller incisions, less disruption to healthy tissue and fewer barriers to recovery. Increasingly however, it may also include procedures that do not require general anesthesia or even a traditional operating room.
It is a philosophy Dr. Gianakos has spent years advancing through minimally invasive surgery and international research, and one she intends to bring to New Hyde Park, N.Y.-based Northwell Health as she prepares to build a foot and ankle division in the White Plains and Westchester, N.Y., market.
Dr. Gianakos will join Northwell Nov. 1 after leaving New Haven, Conn.-based Yale Medicine Orthopaedics and Rehabilitation, where she served as an assistant professor. Her ambitions extend beyond expanding specialty care to rethinking how patients recover, prevent injuries and maintain mobility throughout their lives.
“I want to make this more than just foot and ankle,” Dr. Gianakos told Becker’s.
Making surgery smaller
The foot and ankle present a particular challenge for minimally invasive surgery. Dozens of bones, tightly packed joints and delicate soft tissues leave little room for error, while even successful procedures can require substantial recovery.
Dr. Gianakos believes advances in needle arthroscopy are changing that equation.
The technique uses a 1.9-millimeter camera, compared with approximately 4 millimeters for a traditional arthroscope, allowing surgeons to access confined spaces through smaller incisions. By limiting disruption to surrounding tissue and cartilage, the approach may allow appropriately selected patients to bear weight sooner and return to their activities more quickly.
But Dr. Gianakos is pushing beyond incision size. During her time in Connecticut, she began performing select minimally invasive procedures under local anesthesia, allowing patients to remain awake without general anesthesia or a full peripheral nerve block. Some can even watch their procedures on a monitor.
Depending on the operation and facility capabilities, certain procedures may also be performed in dedicated procedure rooms rather than conventional operating rooms. The broader shift, she explained, is toward “less invasive, less medicine” during surgery, potentially reducing anesthesia-related side effects and postoperative narcotic use.
For Dr. Gianakos, a former All-American who competed in collegiate basketball and track and field, the goal has always been to help patients regain the activities that matter to them.
“I always tell my patients, everyone’s an athlete that comes in,” she said.
When innovation outpaces evidence
Despite her enthusiasm for emerging techniques, Dr. Gianakos believes minimally invasive surgery carries a risk of its own: adopting something new before proving it is better.
“If you are doing the same thing that you did 10 years ago, then you’re not really pushing the needle forward,” she said.
But progress, she argues, must begin with evidence. Before introducing a technique into clinical practice, Dr. Gianakos tests it in the laboratory, often using cadaveric models to evaluate instrumentation, biomechanics and whether a smaller approach can achieve the same surgical correction as conventional techniques.
She also emphasizes that surgeons must first master open procedures. Smaller incisions introduce different technical challenges, and minimally invasive operations can sometimes take more time. That uncertainty shapes how she counsels patients. Although she may plan a minimally invasive procedure, she remains prepared to convert to an open approach if necessary.
Her research on needle arthroscopy for plantar fascia release followed a similar progression, moving from laboratory evaluation and technique development to collecting and publishing clinical outcomes.
For Dr. Gianakos, the measure of innovation is not how small an incision becomes, but whether the patient ultimately benefits.
When the world’s best surgeons disagree
That commitment to evidence also inspired one of Dr. Gianakos’ most ambitious projects.
After completing her foot and ankle fellowship at Massachusetts General Hospital in Boston, she pursued additional sports medicine and minimally invasive training in New York and internationally, working with specialists in London, Amsterdam, Greece and Italy.
The experience exposed an unexpected problem: Even surgeons treating the world’s top athletes often disagreed about the best way to manage the same injury.
“If I have the most brilliant people taking care of these athletes, and they’re somewhat agreeing and somewhat disagreeing, how are orthopedic surgeons across the country and around the world supposed to know the right thing to do?” she said.
That question helped inspire the International Foot and Ankle Sports Consensus, which Dr. Gianakos directs. The group now includes approximately 30 experts across six continents, selected for their experience treating elite athletes, research contributions and professional leadership.
Using a structured Delphi consensus process, members evaluate questions surrounding imaging, surgical indications and treatment strategies before convening to debate recommendations. Their discussions have addressed conditions such as Lisfranc injuries, while highlighting a broader shift toward arthroscopic techniques, smaller incisions and fixation strategies that preserve mobility.
For athletes, achieving stability is only part of a successful operation. Treatment must also preserve the ability to run, jump and change direction. Dr. Gianakos believes those lessons can extend beyond professional sports, helping surgeons evaluate emerging techniques and identify where stronger evidence is needed.
Building beyond the operating room
At Northwell, Dr. Gianakos sees an opportunity to translate that philosophy into a regional clinical program. Her immediate focus will be expanding specialized foot and ankle care in White Plains and Westchester, working with physicians across Northwell’s network and assessing where additional specialists could address unmet community needs.
The division will encompass sports injuries, trauma, deformity correction, and other foot and ankle conditions. But she is equally interested in what happens before patients require treatment. She envisions outreach to schools, colleges, physical therapists and community organizations, emphasizing injury prevention, strength training and long-term mobility.
Women’s musculoskeletal health is another priority, particularly the needs of female athletes and women navigating perimenopause and menopause.
“We need to look at how we get people back on their feet, prevent injuries and make them stronger,” she said.
She also hopes to continue community service initiatives, including shoe and sock drives for people experiencing homelessness, while maintaining an academic role through an appointment at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
For Dr. Gianakos, building the Westchester program is an opportunity to put a broader vision of orthopedic care into practice, one that measures success not simply by how well an injury is repaired, but by how fully patients can return to their lives.
The ambition is straightforward, even if achieving it is not: to help patients spend less time recovering from injuries and more time doing what they love.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
