It would be a gross understatement to say that modern medicine has made great advances in recent decades. Examples abound, from artificial joints to opening clogged blood vessels through tiny incisions. It’s difficult to read any popular magazine without finding some new medical discovery or the development of some amazing new piece of technology. Let’s examine for a moment those fields in which the greatest advancements have been made.

Likely the area of study that should immediately come to mind is that of genetics. In the last half century, the molecular basis of our genetic code has become intimately studied and, to some degree, is understood. The completion of the Human Genome Project has contributed a great deal to the knowledge of genetic factors and their impact on life and disease. Thousands of genes resulting in disease have been identified. This has allowed us to create hundreds of biotechnology-based products. Novel technologies, particularly next generation sequencing, have dramatically accelerated the pace of biological research, while at the same time increasing expectations.

Another branch of modern medicine continuing to make enormous strides is that of orthopedic medicine, the identification and treatment of problems with our physical support system, the bones muscles and tendons that enable us to stand, to move through space, providing a framework for our internal organs. The discoveries in orthopedic medicine in the last half century have been staggering. Did you know it is possible to lengthen or straighten limbs? The replacement of damaged joints is a routine occurrence, performed in almost every hospital in America. Bone-like substances are now grown in a lab, available at a moment’s notice enabling us to repair and fill gaps in a damaged bone like glue.

We are now able to utilize the regenerative power of amniotic membrane to repair tendons and ligaments damaged by trauma or disease. This effort comes under the auspices of regenerative medicine, an exciting new field, with tremendous potential for new uses in the years to come. The basic concept behind the promise of regenerative medicine concerns the ability of stem cells. These are cells which have the potential to become almost any type of cell in the body, whether it is bone, skin, or perhaps even nerve tissue. As the population ages, the opportunity for the production of body parts to replace those that have become diseased becomes more and more likely. This seems likely to be the future of regenerative medicine. The progress in both adult and embryonic stem cell research in recent years has been breathtaking.

One of these possibilities is in the regeneration of articular cartilage. This is the material which lines the functional joints of the body. It is quite vulnerable to injury and has poor potential for repair. Damage to articular cartilage can lead to pain and disability years after the inciting injury. The management of damaged articular cartilage has been challenging task for all physicians treating joint pain.

The ideal treatment would replace damaged articular cartilage, restore joint function, and prevent the development of arthritis. We have the ability to stimulate the body to produce fibrocartilage, but this is different from hyaline, aka joint, cartilage. Fibrocartilage is unable to withstand the high mechanical loads within a joint; only hyaline cartilage can do that. Transplantation of hyaline cartilage has been used for years and is an effective technique. Unfortunately, there are insufficient sites on the body where donor articular cartilage can be harvested without damaging the joint from which the joint cartilage is taken. This is a topic of tremendous interest, and research is on-going.

Magnetic resonance imaging, more commonly referred to as an MRI, is a technology that has provided tremendous benefits in exploring the human body atraumatically. Once called nucleo-magnetic resonance (NMR), the name was changed because of the connotation that there was harmful radiation involved. No one thinks of a nuclear bomb as being benign. Not only can an MRI study look at both soft tissue and osseous (bone) tissues, it does so without any harm to the body. A recent development in MRI imaging is that of fMRI, with the ‘f’ standing for functional. This technique allows us to study brain activity, and the changes that occur during speaking, thinking, or some other neural activity. The possibilities for increasing our understanding of brain function appear almost limitless.

Since we are on the subject of neurology, what of other aspects of the study of the nervous system. Ask any of the millions of people afflicted with some type of neuropathy. Although diabetic neuropathy is the most common example, there are a multitude of causes for malfunctioning peripheral nerves, which are those nerves found outside of the brain and spinal cord. Nerves have a unique physiology, and function by a highly specialized electro-chemical process. When this complex system malfunctions, whatever the reason, a variety of problems may develop.

How do we treat these common problems? Poorly, if you ask me. We have little to offer them. In fact, many diagnosed with a peripheral neuropathy are never able to learn why they have this challenging, often painful malady, much less what can be done for it. For the most part, some type of pain reliever is prescribed, the sufferer is told they must live with it, and that is about it. Not exactly a definitive treatment. It is no exaggeration to say that there is much we have yet to learn about the causes and treatment of many nerve problems. (And don’t get me started on the lack of science behind psychiatry and psychology. Have you heard of the term a “soft science”?)

Humor me, if you will, while I provide an extremely brief comparison of our therapeutic capabilities for treating bone versus nerve conditions. I have previously alluded to our advanced techniques in the treatment of osseous pathologies, but that only scratched the surface of the topic. Nerve tissue, on the other hand, undergoes a unique and irreversible process when traumatized, resulting in a non-functioning nerve. This is why after some kind of accident or motor vehicle injury, the paralysis resulting will be permanent after a limited period of time. We can not change that and have no means, as of yet, of preventing this chemical process.

Closer to home, a common nerve affliction occurs when a nerve is trapped or pinched. This is similar to carpal tunnel syndrome. When the structures causing the physical impingement can be moved, the pain will often resolve. When this occurs in the ball of the foot, it is termed a Morton’s neuroma, which can be a very painful condition. A variety of conservative measures are available and do have an excellent success rate. Naturally, there are failures and surgery should then be considered. Strangely, this is the only place in the human body where a problematic nerve is simply cut and removed surgically. Once again, the cutting of a nerve too often leads to a variety of painful repercussions, with one of them being the same kind of discomfort.

If the release of the structures pinching the nerve is successful elsewhere, why isn’t this performed in the foot? I am happy to report finally the older method is falling out of favor. An endoscopic release of the ligament trapping this foot nerve is gaining in popularity and, like most minimally invasive procedures, the recovery period is simple, easy and fairly pain-free. It is most gratifying to have available a surgical option that entails an easy recovery AND a high success rate.

Modern medicine has come a long way. We now have greater understanding of so many disease processes in the body. And yet, it seems clear to me there is much we have to learn. A multitude of maladies have no cure and little insight into their development. Unfortunately, funding for many valid research topics is lacking unless there is a clear and obvious profit to be made. Clearly, in our current system of research and discovery, the financial aspect of medicine and the science are inextricably intertwined. Indeed, medicine and money make strange bedfellows.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.