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Division of Orthopaedics

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Division Chairs for Orthopaedics - University of Toronto Orthopaedic Chairs 1976 - Today.
From left to right - Ben Alman (2006-Today), James Waddell (1996-2006), Robert Salter (1976-1986), Allan Gross (1986-1996).

Daniels, Dr .Timothy R.

TDaniels 

MD FRCSC
Associate Professor, University of Toronto
Head, Division of Orthopaedic Surgery, St. Michael's Hospital
55 Queen St. E. Suite 800, Toronto, ON M5C 1R6
Tel: 416 864-5392
Fax: 416 359-1601
Email:danielst@smh.ca

Clinical and Applied Basic Research

I have been actively involved in supervising clinical clerks to PhD students: i.e. medical students during their summer research projects, orthopaedic residents enrolled in a two-year Surgical Scientist Program, fellows enrolled in a Masters program and students in a PhD program.

In the academic years of 1996-97 and 1997-98, I was the primary supervisor of a full-time resident who was enrolled in the two-year Surgical Scientist Program and obtained a research grant from the Canadian Arthritis Society. Our project examined the biomechanics of the tarsal tunnel, identifying increased tension on the tarsal tunnel contents with progressive pes planus deformities. This study was done in cooperation with the Anatomy Department and Sunnybrook Biomechanics Research Laboratory under the supervision of Dr. Trevor Hearn (PhD). Four papers were published during these research years and a thesis on “The Effects of Tarsal Tunnel Release and Stabilization Procedures on Tibial Nerve Tension in a Surgically Created Pes Planus Foot” was successfully defended. This thesis was published in 1998 and is available for review at the University of Toronto Medical Sciences Library.

Since 2008, I have been collaborating with Dr. Geoff Fernie of the Toronto Rehabilitation Institute, more specifically in a Challenging Environment Assessment Lab (CEAL) – a one-of-a-kind, state-of-the-art laboratory to study the impact/effects of ankle arthritis on gait in various environmental settings and climate. Currently, I am supervising a 2-year Masters of Science student as well as a PhD student working on this project. The PhD student has applied for and received a two-year grant from the Physician Services Incorporation (PSI) for a study entitled ‘Patients' perspectives on total ankle arthroplasty: A qualitative study exploring pre- and post-operative experiences.’ Other projects completed and presented at both national and international meetings to date centre on the topic of assessing the accuracy and applicability of validated outcome scores for foot and ankle pathologies: (i) ‘Reliability and validity of 5 lower extremity outcome measures in ankle arthroplasty and arthrodesis’ and (ii) ‘Do lower extremity outcome questionnaires used to assess ankle replacements and fusions really capture what patients want us to hear?’

In addition to basic science research, I have implemented and published several clinical trials such as (i) a clinical comparison between Interpositional Arthroplasty vs. Cheilectomy Phalangeal Osteotomy for the management of hallux rigidus and (ii) the clinical results of major hindfoot reconstruction for severe deformity related to Charcot arthropathy and (iii) the mid-term outcomes of fresh talar osteochondral allografts for large talar defects. Currently, I am involved in several multi-centered clinical trials: (a) Gait analysis in patients that have undergone an ankle replacement vs an ankle fusion; (b) mid-term functional outcomes of ankle fusions vs ankle replacements; (c) functional and radiographic outcome of patients who have undergone an ankle replacement with a pre-operative coronal talar deformity (varus and valgus) vs those without talar deformities; (d) clinical and radiographic outcomes of first metatarsophalangeal fusion vs cartiva hemiarthroplasty for hallux rigidus; and (e) gait analysis of patients with end stage ankle arthritis on handicap ramps vs flat surfaces at the CEAL’s gait laboratory in the Toronto Rehabiliation Institute. My research activities and involvement in medical education conferences have allowed me to attract clinical fellows from all over the world.

Residency and Fellowship Experience

I have established an active foot and ankle program at University of Toronto and St. Michael's Hospital; currently, I serve as the Inaugural Head of the Foot and Ankle Program (U of T). The program has a wide provincial, national and international referral base by attracting elective residents as well as clinical and research fellows. Current research focuses on biomechanics and clinical studies. The foot and ankle course for the Orthopaedic residents and fellows consists of a series of one-hour lectures beginning with foot biomechanics and gait analysis, followed by common foot/ankle problems consisting of their presentation, natural history and management. The research residents/fellows will be required to attend these lectures during their year of research; they will be expected to meet with me on a weekly or biweekly basis to ensure that the project is progressing as planned and to discuss any topics that require clarification. They will also be provided with a list of current and pertinent papers that review the foot mechanics as well as the research topic in question. They are also expected to attend my clinics to learn more about the clinical presentation, natural history and management of foot and ankle pathology – essential for identifying and/or enrolling new patients suitable for any research project. The results of the studies, both surgical and non-surgical, will help establish standard practice guidelines for the management of the foot and ankle pathology so as to provide the groundwork on which to base prospective studies. Starting in July 2013, the fellowship program will become a joint program with fellows rotating amongst the four foot and ankle hospital sites affiliated with University of Toronto.

Supervisor's Credentials

Associate Professor, University of Toronto.

Past-President and CoFounder of the Biennial Canadian Orthopaedic Foot and Ankle Society (COFAS) Symposium – a joint CME event by the COA and University of Toronto.

Since September 2005, Reviewer for the “Journal of Bone and Joint Surgery” (American edition).

Since 2009, Inaugural Head of the University of Toronto Foot and Ankle Program.

Since 2010, Chair of the Research Committee of the American Orthopaedic Foot and Ankle Society (AOFAS).

In July 2011, I was awarded the Canadian Orthopaedic Association’s Award of Merit.

Medical School
University of Saskatchewan

Specialty Training
Foot and ankle surgery

Fellowship Training
Foot and ankle surgery

Clinical Focus
Foot and ankle pathology

Academic Focus
Gait mechanics, ankle arthritis

Publications
www.ncbi.nlm.nih.gov/PubMed/

Updated: 9-2012