As orthopedic programs balance innovation, value and patient outcomes, few areas have advanced as quickly as foot and ankle surgery.
Ettore Vulcano, MD, chief of Columbia University’s division of orthopedics at Mount Sinai Medical Center in Miami Beach, Fla., is helping lead that shift through minimally invasive techniques, technology and patient-centered care.
Minimally invasive foot and ankle surgery has expanded rapidly since 2017, when bunion correction first gained traction. Now, small keyhole incisions are used for flat-foot realignment, hammer toe correction, and treating ankle arthritis and diabetic foot deformities — with faster recovery and fewer complications.
“It’s not the new Kool-Aid,” Dr. Vulcano told Becker’s. “There are actual advantages over traditional techniques.”
Adoption, however, remains a challenge. Younger surgeons are learning these methods in training, while established surgeons must develop new tactile skills. To close that gap, Mount Sinai works with industry partners to create implants and instruments that simplify smaller-incision procedures.
“We’re trying to democratize minimally invasive surgery,” he said.
Technology is also reshaping care delivery. Mount Sinai uses AI to guide diagnosis, surgical planning and postoperative management.
“We don’t see AI as a threat to medicine, but as an ally,” Dr. Vulcano said. “It helps us choose the right procedure, predict risk and tailor antibiotics — all of which improve recovery and reduce complications.”
He sees robotics as the next major step.
“Companies are developing robots that could perform procedures independently or even be controlled remotely,” he said. “Imagine the impact in rural areas or less developed countries. This isn’t something we’ll see in 2080 — it’s coming in the next decade.”
Mount Sinai’s value-based strategy starts before surgery. Educating patients about recovery reduces unnecessary readmissions, allowing most orthopedic procedures to be performed outpatient.
About 80% of joint replacement patients now go home the same day. Infection prevention and efficiency are key, too.
“The quicker the surgeon is, the less time the wound is exposed to air,” Dr. Vulcano said. “High-volume surgeons tend to be faster and safer.”
Pain management has also improved through Exparel, a delayed-release anesthetic that provides up to five days of relief. “When we use Exparel, patients basically have no pain for five days,” he said. “That’s reduced admissions, improved satisfaction and nearly eliminated narcotic use.
Most patients, he added, take only two Oxycodone tablets after surgery, compared with an average of 27 previously.
As a mentor, Dr. Vulcano encourages curiosity and broad thinking among residents.
“Students are often too narrow-minded,” he said. “They focus only on their subspecialty, but first and foremost, you’re a doctor. Talent matters, but curiosity drives growth.”
Having trained in both Europe and the U.S., he brings a blended approach to patient care that incorporates the holism more common in Europe into the more procedure-based care of the U.S.
“In the U.S., I trust the treatment plan more, but sometimes the visits feel rushed,” he said. “In Italy, I feel more cared for as a whole person. Neither is better — they’re different.”
For Dr. Vulcano, the future of orthopedics lies at that intersection.
“Medicine is changing fast,” he said. “But if we stay curious and keep patients at the center, those changes will make care better for everyone.”
