Sole Purpose 104
Global Healing and Surgical Mastery:
A Conversation With Dr Bhavesh Shah

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For today’s Sole Purpose article, I am joined by a very special guest! I had the immense privilege of speaking with Dr Bhavesh Shah out of San Antonio, Texas. I am personally a huge fan of Dr Shah’s unwavering dedication to global health and surgical education. Whether he is presenting at the CFAR (Complex Foot and Ankle Reconstruction) lecture series or traveling across the globe to reconstruct the most complex pediatric deformities, Dr Shah embodies what it means to lead with both unparalleled skill and incredible heart.

Introduction
Bhavesh Shah, DPM, EdD, MBA, is a board-certified podiatric physician and surgeon practicing in San Antonio, Texas. He is internationally recognized as the Co-Director of Operation Footprint, a non-profit global organization that provides free surgical care to indigent children suffering from severe genetic or acquired foot and ankle conditions in India, Mexico, El Salvador, and Honduras. With 26 years of medical mission experience under his belt, Dr Shah has seen—and fixed—it all, often using little more than K-wires and sheer ingenuity.

Beyond his clinical and philanthropic work, Dr Shah is a lifelong learner and educator. He serves as the Director of CFAR, bringing in expert practitioners with the diverse, high-stakes knowledge gained from mission trips into formal medical education to give the “why behind the how” for surgical intervention. He will also be co-directing the CFAR sports medicine conference in Portland this April. Adding to his impressive list of credentials, he recently completed his Doctor of Education—with a thesis focused on mentorship in medicine—and an MBA in International Logistics. Because apparently, just doing complex limb reconstruction across multiple continents wasn’t keeping him busy enough!

In this conversation, Dr Shah reflects on his 26-year journey in mission work, the brutal and beautiful realities of operating abroad, and the invaluable lessons he hopes to pass down to the next generation of surgeons.

Q: What specifically got you interested in podiatry?
You know, during my undergraduate studies, I worked for a podiatrist who was incredibly friendly and possessed a great ability to teach. He inspired me to pursue podiatry over general medicine. I saw firsthand how the field offered a unique opportunity to build a meaningful, hands-on practice while maintaining a family and a healthy work-life balance—a rare gem in the medical world!

Q: You have dedicated 26 years to mission work. What steered you toward that path?
I am a third-generation philanthropist, so my family instilled the importance of giving back early on. My first real exposure was during my residency when I went to Baja California, Mexico. I spent two years traveling there to treat children with severe genetic deformities. After graduation, I was asked to join a team in El Salvador, and I haven't stopped mission work since.

One thing I quickly realized is that you cannot just go for one year. It takes years to truly learn the disease patterns and understand the manifestations of these conditions. Returning annually allows you to review your past cases, see what works, and continuously refine your approach. It is also about learning the cultural differences, understanding geographic medicine, and building lasting collaborations with local stakeholders. It takes the time you spend over several years to figure out what makes a team function and what makes a mission trip a true success.

Q: Reconstructive surgery on pediatric patients in these environments sounds incredibly complex. How do you prepare for it?
Mastery takes years. Even mastering clubfoot correction takes a tremendous amount of time. I was an assistant surgeon for seven years after already doing it for two years! A pediatric clubfoot is tiny, the condition is genetic, the anatomy is entirely mixed up, and nothing is in the right place. Cultivating the dissection techniques for that takes immense patience. But I always say, if you can correct a clubfoot, you can operate on anything in the foot and ankle.

On one of our mission trips, you see between 200 and 300 patients in a day and a half. You must know your stuff right away, and you are constantly tested on your efficiency. Academically, you never know exactly what manifestation you will see. To prepare, I read extensively for a month and a half before a trip. During the clinic, I review everything the night before surgery, participate in the OR, and then go back to the hotel to write notes and read again. I did that for seven years as a junior surgeon (assistant), and I still do it today as a senior surgeon. Academically, you never know the exact question you are going to get and must be prepared for it all. This not only benefits the patients but also the people you are teaching and yourself.

See the video for just how complex a club foot deformity Dr Shah and his team are treating.
CLICK HERE

Q: What has been your most impactful mission case, and what is the biggest challenge you face on these trips?
The most impactful case was also the most heartbreaking. I operated on a 16-year-old polio patient in Honduras. It was a bilateral case, so a colleague worked on one leg while I worked on the other. He was cleared by medicine to undergo surgery, the surgery went smoothly, and he was cast. Post-op, he was eating, smiling, and doing great.

The next morning, we found out he had passed away. The hospital lost electricity overnight, the machines shut off, and his heart failed. It had nothing to do with the surgery itself, but there were no monitors to alert anyone. The family had already left for their village, so we had no ability to speak with them, apologize, or offer condolences. The hardest part of mission work is experiencing a loss like that, composing yourself, and then walking back into the OR to operate on the next child.

As for the biggest surgical challenge? It's fighting the urge to make the foot "perfect." As a surgeon, it is very easy to use sheer strength to force a foot into the alignment we want. But the hardest part of genetic reconstruction is acknowledging what the foot is giving you. You must know when to stop and when to stage the procedure. Overdoing it can compromise the entire function. Everything is easier in the U.S. with our C-arms and large rooms but knowing when to stop is paramount.

Q: How does operating abroad differ from your practice in the United States?
Well, in the U.S., you can figure out what you are going to do for most of our patients ahead of time. On a mission trip, there is no true preparation. You are doing complex reconstructions with K-wires because you don't have plates and screws, or even staples. You are planning for surgery without CT scans, MRIs or even radiographs and just relying on a thorough biomechanical and gait exam and your own anatomical knowledge. You have what is in your bag. If you don't have a staple, you make one. You pass tendons with sutures instead of anchors. You also must keep in mind this is surgery on kids with complex genetic deformities, often their bone is so soft you could cut it with a spoon, one wrong turn and you make an accidental osteotomy. You work in so many atypical situations that you eventually stop getting flustered in the OR. The people who adapt are the ones who survive.

This also changes how I teach in the U.S. We are traditionally trained to correct deformities by fusing bones statically. But with pediatrics, you must align the foot while the patient continues to grow. It is easy to do a medial column fusion, but it is exponentially more difficult—and more functional—to reconstruct without fusing. I always challenge my students: question why we are fusing joints without arthritis. Look at the biomechanical root of the deformity, don't just treat an X-ray.

Q: What do you wish more residents and practitioners knew about mission work?
I honestly wish doing a mission trip was a requirement for every residency program. It opens your eyes and strips away all the fancy gadgets we usually rely on. It is disorienting, but it shows you exactly what you don't know. I have experienced amazing surgeons coming on these trips and say, "I didn't know what I was doing for the last 20 years; I need to rethink the way I do the foot and ankle." It is profoundly humbling. You learn about cultures, how others surgery, and how we are truly all in this together. Most importantly, the people we work with teach us just as much or even more than we teach them. It is teamwork, its culture, it’s just everything. I think every resident should experience it.

Q: Speaking of complex reconstructions, can you share a challenging case from your practice back home?
Absolutely. I recently treated a female in her mid-50s who drove three hours to see me. She was five months post-trimalleolar fracture, and honestly, nobody else wanted to treat her. She was in terrible pain, and her ankle had healed misaligned. She had been told she would never move her ankle or walk again because the initial injury was so bad and she wasn’t a surgical candidate. She had well-controlled diabetes, hypertension, and obesity.

We got a CT scan and saw that there wasn’t very much arthritis; the subtalar joint, ankle joint, and talar dome looked fine. So, instead of going straight to a fusion, we decided to try and salvage it. I staged it: the first surgery was an ORIF to address the trimalleolar fractures and fix the syndesmosis. Because it was five months old, everything was in highly abnormal positions, so we essentially had to break everything up and realign it. Six weeks later, we did the second stage: an ankle scope with lateral ankle stabilization, repairing the ATFL, CFL, deltoid, and a peroneal tendon tear.

She did wonderful post-op. We got her into therapy with a CAM walker, made her custom orthotics, and now she is walking with good range of motion and is incredibly happy. It just goes to show what a staged, thoughtful reconstruction can do.

Q: If you could give one piece of advice to your younger resident self, what would it be?
Learn the business of medicine. It doesn't matter how good of a doctor you are; if you don't understand the business model, it will be very difficult to succeed.

Q: What is one clinical practice every podiatrist should prioritize?
Watch your patients walk. Everyone should do a thorough gait analysis. Once you understand true gait analysis, you can figure out what is wrong before you even lay hands on the patient. Look at how they compensate, look at their calluses. If you are going to perform surgery, watching the patient walk will tell you everything you need to know.

Q: Finally, what is your favorite place you have visited during your travels?
The Taj Mahal in India, near our mission camp in India. It is truly one of the wonders of the world. I’ve seen it at sunrise, midday, and by moonlight. You just marvel at the gems on the wall, how it was manmade, and how it has withstood the test of time. It is unbeatable.

Conclusion
My conversation with Dr Shah highlights what it truly means to practice with adaptability, humility, and a profound dedication to the craft. I know I am extremely grateful to have gotten to learn from him in our brief conversation. Whether he is performing a complex pediatric reconstruction with nothing but K-wires and sutures in Honduras or salvaging a "hopeless" trimalleolar fracture back home in Texas, Dr Shah reminds us that the true essence of podiatry lies in our ability to adapt, learn, and restore function against the odds. His emphasis on biomechanics, continuous learning, and the importance of giving back underscores the values that will elevate our profession worldwide.