The Architect & His Tools: How Weight-Bearing 3D CT Technology Revolutionizes Foot & Ankle Surgical Planning

Imagine a complex structure, composed of multiple moving parts controlled by a network of pulleys and levers. Imagine this structure can withstand high pressures and weight levels, without failure throughout its lifetime. This type of structure comes in many diverse shapes and sizes, and can take many different mechanical forms.

What did you see?

Virtual Architect, Foot Surgery, University Foot and Ankle Institute

A podiatric surgeon is in many ways an architect, constructing a foot and ankle instead of a building

If you said the human foot, then you’re no crazier than a foot surgeon! The foot is not only an incredible biological achievement; it’s an architectural marvel.

In many ways, a podiatrist is one part surgeon and another part architect. But you don’t have to be either to appreciate the engineering genius that is the human foot. Let me tell you about the newest technology in both of these fields that can show us just how similar they are.

The Virtual Architect

The modern computer has brought significant advancements to the field of architecture in recent years. What used to take several months to years to plan and design with hand drawings, slide rules, and calculators can now be done in mere hours with the right computer-aided design (CAD) software.

3D schematic designs are so advanced that a building can be virtually rotated, sliced, and pulled apart like an onion, showing every minute detail as part of the planning process. Advanced computer renditions allow the architect to place each static and dynamic component of a large structure in its proper place, and model the ways the components – elevators, waste disposal, electrical outlets – will interact.

I always wanted to be an architect. I loved building things as a teenager, especially making improvements to my bike and dreaming about what it might take to build a house or a skyscraper.

As I became drawn to surgery of the foot and ankle, however, I remembered my childhood love of architecture and slowly realized that a podiatric surgeon is in many ways an architect, constructing a foot and ankle instead of a building. The endeavor takes about as much creativity and vision as it does planning and execution. Surgeons had the same design needs as architects; so why didn’t we have the same tools as architects?

The field needed a major technological advancement in pre-operative surgical planning. We needed CAD for foot and ankle reconstruction. We finally got it in weight-bearing 3D CT scanning.

CAD for Podiatric Surgery

Curvebeam CT Technology

The Curvebeam CT technology is a huge step forward for surgical preparation, giving your surgeon the best possible “view” of your foot and ankle in order to plan your reconstruction before making the first cut.

The Curvebeam CT technology is a huge step forward for surgical preparation, giving your surgeon the best possible “view” of your foot and ankle in order to plan your reconstruction before making the first cut.

Much like CAD software’s ability to draw up multiple drafts and 3D renderings, the Curvebeam CT allows for multiple angle and plane images and 3D virtual imaging that make the surgical planning process much easier.

Before Curvebeam, I had always believed that surgery is more art than science. “You have to have good hands to be a surgeon,” I told myself. Curvebeam allows us to balance the art-science scale, combining sophisticated planning with surgical technique. Now, I can use 3D models to guide my good hands and artistic vision. I can ensure all of the pieces make sense and conduct the surgery as close to the plan as possible.

What is the benefit of Curvebeam Weight-Bearing 3D CT?

After I started using the computer-guided system, my surgical time for full ankle replacement decreased by 40%. That’s huge. My surgeries became far more reproducible. What’s more, the 3D CT imaging saved me from some surgical close-calls.

I can remember one time when I performed a replacement on a healthy, active patient with an arthritic ankle. I ordered 3D CT scans in preparation for the surgery, and found to my surprise that he had a completely hollow distal tibia and talus: absolutely no bones in the regions. Had I operated on this patient 5 years ago, I would have found myself in the operating room with a disaster on my hands. This case taught me that the planning phase is no longer an option – it’s actually the most important phase of treatment.

No contractor would build a building without a full set of plans, including cross-sectional diagrams and 3D renderings. As surgeons who care deeply for the wellbeing of our patients, we owe it to ourselves, our field, and most of all our patients, to make 3D CT imaging a priority before any foot and ankle reconstruction.

Dr. Bob Baravarian, DPM, FACFAS

Dr. Bob Baravarian, DPM, FACFAS

Dr. Bob Baravarian is a Board Certified Podiatric Foot and Ankle Specialist. He is currently a member of UCLA Medical Group, Chief of Podiatric Surgery at Santa Monica/UCLA medical center and Orthopedic Hospital and an assistant clinical professor at the UCLA School of Medicine. He also serves as co-director of University Foot and Ankle Institute. He is Editor Emeritus of the international medical journal, Foot and Ankle Specialist.

Dr. Baravarian been involved in athletics his entire life and played competitive tennis in high school and college. He has an interest in sports medicine, arthritis therapy and trauma/reconstructive surgery of the foot and ankle. He servers as a consultant to the ATP (Association of Tennis Professionals) tour, multiple running organizations and several shoe manufacturers. He is also fluent in five languages (English, French, Spanish, Farsi and Hebrew),

Podiatrist Dr. Bob Baravarian is available for consultation at the Santa Monica, Sherman Oaks and UCLA Westwood offices.
Dr. Bob Baravarian, DPM, FACFAS

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