Dr. Fellner was first introduced to this non-bone breaking alternative after reading the work of two British orthopedic surgeons, Irwin & Cape (1999). In this article the authors describe their surgical and clinical experience. The origin of the syndesmosis procedure is traced to the work of Botteri & Castellani (1961) two Italian orthopedic surgeons, who described the osteodesis procedure (same  procedure, different name)  In 2007, Dr. Wu, an Orthopedic Surgeon in Hong Kong, published his results. All of the authors report excellent outcomes and agree with the Italian orthopedists Pagella & Pierleon (1971) who state conclusively 'the procedure deserves to be better known'.

With over 1400 successful outcomes, the  leading authority today on the syndesmosis procedure, is the orthopedic surgeon Dr. Daniel Wu, who has never performed an osteotomy for bunion deformity.  Dr. Fellner started a correspondence with Dr. Wu over a 2 year period, discussing and debating the merits of the procedure. Finally, in 2014 Dr. Fellner travelled to Hong Kong, China  to work with Dr. Wu, in his clinic and in the operating room, to learn all about the syndesmosis. He is the first international foot surgeon to do so.

The China experience proved uniformly good results, and high patient satisfaction. The restoration of the anatomical segment, back to the native position, may also achieve much more than to correct the bunion.  Time and again, Dr. Fellner observed additional beneficial effects. Painful forefoot callus is improved, hammer toe deformity is corrected. All without additional surgery. The syndesmosis procedure, it would appear, can help restore the mechanical distribution of pressure across the entire forefoot more consistently, in a way that traditional surgery cannot. The syndesmosis procedure, he concludes, is a powerful tool in the management of such deformities.

See Dr. Fellner's journey with Dr. Wu here : https://www.bunioncenternyc.com/dr-fellners-journey.html