Local doctor's exclusive fix for chronically injured ankles gets raves

Mallory Fisher first broke her left ankle in second grade when she slipped off a stool. A year or two later, she broke her right ankle rolling it off a low balance beam.

Years of subsequent injuries in gymnastics left Fisher with a pair of chronically weak, painful ankles.

As a 15-year-old gymnast and diver at Palatine High School, Mallory had to wrap and ice her ankles, and take Advil to reduce the pain and swelling, as if she were an aging prizefighter - and still her ankles would sometimes buckle.

When she heard about a doctor who has developed a special procedure for such cases, Mallory decided to have surgery on not one, but both ankles.

Dr. Robert Lim of Naperville performed each surgery separately in December. Mallory was back on her feet after just a week on crutches and in a protective boot following each procedure.

Just a month after surgery, she was practicing gymnastics again, whipping around the uneven parallel bars like an Olympian.

"It didn't even hurt," Mallory said of the surgery. "My ankles are not completely back to normal, but they're feeling really good. I didn't think I'd be back that quickly."

Lim claims a startling 100 percent success rate with the operation he calls the Lim procedure. He is praised by doctors who know him and professional athletes he's treated. There's one catch: he's never published his results in a medical journal.

It's an omission that raises serious questions in his profession. With the success he claims, how much does it matter that he's not published?

Chronic problem

Lim, who has offices in Naperville, Westmont and Chicago, is a team podiatrist for the Chicago Fire professional soccer team and U.S. National soccer teams.

On his Web site, Lim gets endorsements from soccer stars like Chris Rolfe and Tony Armas, who praises his professionalism, expertise, sincerity and class.

For soccer players and other athletes, the ankle sprain is one of the most common injuries in sports.

Repeated or severe sprains or breaks can cause chronic lateral ankle instability, in which the ankle is weak and prone to roll over.

Lim said he sees patients who have had lifelong problems twisting their ankles, yet attribute the problem to klutziness, when it's actual a medical condition. Sometimes they come in for some unrelated problem, and he'll tell them he has a way to fix their condition. He diagnoses them by taking their medical history and a physical exam, sometimes with an MRI and sometimes without.

Traditional surgical procedures for ankle instability call for either sewing together a torn ligament, or taking a tendon from elsewhere in the body to fix the ligament.

The methods were developed in the 1950s and '60s, and can take half a year or more for recovery that may leave people able to walk, but not play sports.

Lim thought there had to be a better way. Ten years ago, he came up with an idea to create an artificial ligament. He uses tiny screws with metal eyelets to anchor suture material from the fibula, the bony bump on the outside of the ankle, to the talus, the joint on which the ankle pivots. Collagen or scar tissue can form along the new ligament and reinforce it.

Lim tried the procedure, made some refinements, and says he has performed it successfully on 252 patients.

"It's such a different procedure, not a lot of doctors even know it exists," he said. "Older doctors who don't know me think it can't work because it's so radically different. But I rely on the happiness of my patients."

Take his word?

Typically, when a surgeon develops a new procedure, he or she will conduct a study comparing the results to standard treatment, and send it in to be reviewed by a major publication in the field, such as the Journal of Foot & Ankle Surgery.

Specialists in the field will review the study and critique its methods, and make recommendations to improve it, perhaps by asking for a bigger sample or further analysis. The submitting physician will answer the concerns and make the changes before it's deemed ready for other doctors to consider it.

In this case, other doctors are intrigued to hear about the Lim procedure, and congratulate him on developing a new technique. But they say unless he publishes a peer-reviewed study of his results, they have no way of knowing whether it works.

Dr. Sean Grambart is a board certified foot and ankle surgeon and clinical instructor for the University of Illinois at Champaign-Urbana, and a team physician for the Fighting Illini.

"Ultimately, we want to see a randomized controlled study comparing a new procedure to the gold standard," he said. "It always makes me a little leery when you hear 100 percent effective, especially with no scientific background."

Dr. Alan Jacobs, who chairs the management committee for the Journal on Foot and Ankle Surgery, went further.

"In all of medicine, credibility and the acceptance of procedures comes by publishing one's work and submitting it in a peer-reviewed journal," he said. "Otherwise everyone would be making claims that may or may not be true."

He also said it would be better to share the information so that other patients could benefit from it.

Lim says he has prepared a study, but is holding off seeking publication on the advice of his attorney, while he talks to orthopedic manufacturing companies about marketing his invention. While a procedure cannot be patented, medical equipment makers contract with doctors to market procedures that use patented materials. The companies also fund studies, which can be expensive to conduct.

One he has his intellectual property protected, Lim said he hopes to publish within the next year.

Lim's Web site - drrobertlim.com - lists him as a Fellow of the American College of Foot and Ankle Surgeons, which said he is not a member. He said it was an honest mistake because he is board certified by the American Board of Podiatric Surgeons, the specialty association that certifies podiatric surgeons. Board certification is required to be a fellow in the American College of Foot and Ankle Surgeons. a dues-paying professional organization.

He has supporters among his colleagues, even among those who'd like to see his procedure scrutinized. Dr. Spence Harper, a podiatrist in Salt Lake City, who worked under Lim as a resident, agreed that the results should be published, but said he's tried the operation and has confidence in it.

"I think he feels the proof is in the pudding," Harper said. "His patients speak for themselves, and he can refer you to them."

Mallory Fisher, the high school athlete, doesn't care about publication in medical journals. She and her mother were impressed by Lim's thoroughness and expertise, and excited to hear that after years of therapy and exercises with numerous other doctors, someone could finally fix her ankles.

The quickness of her recovery is helping her to rejoin her gymnastics team in midseason. Then she hopes to continue with diving, a sport in which she was the top sophomore in the state this year.

All she knows is, when she springs off her feet, the surgery seems to have worked wonders for her.