News Section Vol. 25, Issue44 January 7, 1999
Deerfield surgeon pioneers
Process uses titanium
for bone flexibility
By Christie Caliendo
Breakthrough: Deerfield Beach surgeon Peter Merkle is shown with ankle replacement patient John Fogleman after performing a pioneering new technique in surgery using titanium.
For many South Floridians who suffer from ankle problems, the future now looks a little brighter.
On Dec. 12, medical history was made when orthopedic surgeon Dr. Peter Merkle, who practices in Pompano Beach, performed the first ankle replacement surgery of its kind in the area. Until now, ankle surgeries had been performed by fusing bone directly to bone, which eliminated ankle mobility. In the new ankle surgery, diseased bone is removed and the Agility Ankle, a device which imitates cartilage and is made of titanium, is inserted to give the ankle movement.
"The future looks promising," Merkle said. "It's not really making medical history, it's just another little step in the process of making things better."
The surgery was performed on John Fogleman, St. Andrew's School's physical education teacher and its tennis, football and girls' basketball coach. Fogleman, 57, originally injured his ankle when he broke it playing basketball in college. Over the years the pain persisted and he went to Merkle five years ago to seek help. Merkle told him to hold out, that technology was currently not advanced enough to correct his foot.
Then, a few months ago, Merkle returned from a workshop in Chicago with the answer to Fogleman's prayers.
He had done hands-on training with the Agility Ankle, installing the device into a cadaver, and had confidence this was the surgery for which he and Fogleman had been waiting.
"(Fogleman) was suffering quite a lot of pain just to do his daily responsibilities," Merkle said. "He's a dedicated coach at St. Andrew's, and his pain was affecting him considerably."
Fogleman was nervous about being the guinea pig in such a new surgery, but "anything was better than the way it was," he said. His ankle was always swollen and painful, and he felt that it had become a handicap in his coaching. He had stopped running in tennis and was limited in other areas of coaching.
"As much pain as I was in, it was not a difficult decision to make," he said. "I was willing to risk it."
And he is glad he did. The surgery was performed on Dec. 8, with follow-up surgery two days later. Fogleman said it all went great, and he really has not had any pain at all. His ankle is now in a walking cast and he is able to put pressure on his foot and move the joints a little.
"I think it is all good news for people like me out there, and there is a lot of them," he said. "Now I'll be able to walk, go up and down stairs, maybe even run and play golf again."
Merkle said that titanium is the most successful metal he has come across for ankle surgery because it grows into the bone well. The Agility Ankle currently has a 20-year lifespan, so it is only being used in older people.
"Total ankle replacement is not a new thing, but total ankle replacement that works is," Merkle said. "This all feels good. I'm really glad I could help John."
Fogleman went back to work on Jan. 4, and said that all was well and his healing is right on schedule.
"Dr. Merkle did a great job," he said. "Not only him but his staff at North Broward also. We were really tickled pink about them."
He continues to do a lot of physical therapy on his own at home and can put 45 to 50 pounds of pressure on his ankle.
"I think if this surgery helps people, they'll be glad there was someone out there who took that first step," Fogleman said.
And thanks to Dr. Merkle and the Agility Ankle, he is taking more and more of those steps everyday.