Thursday, December 31, 1998

Ankle replacement 'great,' relieved coach says


By Peter Donald
Palm Beach Post Staff Writer

Flexing his heavily wrapped ankle in the cool Wednesday morning breeze, John Fogleman laughed about the mistake he made three decades ago that turned him into a medical pioneer.
In 1970, Fogleman broke his right ankle playing industrial league basketball.
"I took the cast off three or four weeks early," he says. "When you're a coach you do silly things like that."
That started a 30-year odyssey of pain that concluded on Dec. 8, when Pompano Beach orthopedic surgeon Peter Merkle performed a total ankle replacement on Fogleman, a 57-year old coach and teacher at the St. Andrew's School in Boca Raton.
"I feel great," he said Wednesday.
Before he operated on Fogleman, Merkle had tried the procedure only once ˆ on a cadaver. Only 30 doctors in the country have been trained to perform the operation using a prosthetic device knows as the Agility Ankle.
When Fogleman prematurely took off his ankle cast in 1970, his tibia and fibula became mis-aligned, causing the destruction of cartilage and, eventually, the rubbing of bone against bone.
In 1990, Fogleman's arthritic pain became intolerable. Doctors told him that his only option was fusion of his ankle bones ˆ which would result in a clubfoot. Meanwhile, Fogleman's ankle had swelled to the size of a grapefruit.
"For the first three or four minutes of every day, the pain was like a broken foot," Fogleman said.
When the coach was referred to Merkle four years ago, Merkle said the technology was not advanced enough to help him.
Then, in late November, Merkle returned from an Agility Ankle training session and brought Fogleman the good news ˆ literally.
"He pulled it out of his pocket," Fogleman said. "He told me 'You'll be a pioneer.'"
Dr. Carol Frey, an orthopedist in Manhattan Beach, Calif., warned that the process is still being examined. Frey said she has implanted only one Agility Ankle and wants to see more data on how the device holds up before doing more of the operations.
The device is made by DePuy, a Johnson & Johnson company based in Warsaw, Ind. It was approved by the Food and Drug Administration in 1992.
When news of his operation broke, Fogleman received calls from other patients with ankle problems ˆ including one who had fallen off a cliff and was ecstatic to hear about the surgery.
He also heard from a patient who questioned the newness of the procedure; the patient reported receiving a successful ankle replacement decades earlier.
Doctors who use the Agility Ankle acknowledge there have been more than 25 other prosthetic ankles since 1972 but said that most failed to work well and are no longer sold. Merkle said DePuy's device is superior because it gives the ankle better mobility.
His cast notwithstanding, Fogleman felt no pain as he flexed his ankle Wednesday. He said he can carry 30 percent to 40 percent of his body weight now.
Fogleman is scheduled to have his cast and staples removed today. He's not taking this cast off until the doctor says it's OK.