If you have a foot or ankle injury, Ray Walls, MD, is uniquely qualified to help. He is a Yale Medicine orthopaedics and rehabilitation surgeon with a second passion: Irish dance. He took his first lesson in Ireland when he was about 5 years old. By the time he was in medical school, Dr. Walls had become a two-time world dance champion, spending his summers performing with the theatrical Irish dancing phenomena Riverdance.
Dr. Walls’ career has progressed from performer to physician. In his current capacity, he has successfully treated Irish dancers, Olympic gymnasts, elite college and professional athletes, and countless others. He cares for people with foot and ankle arthritis, lower limb deformities and a variety of injuries from overuse or trauma. Dance gave him unique insights into the problems of his patients, he says, whether they are professional performers or people who never set foot on a dance floor.
So we asked Dr. Walls to tell us how his dance career helped shaped his work as a doctor specializing in foot and ankle care.
What did you want to be when you were growing up—a dancer or a doctor?
I always had the mindset that I was going to be a doctor. A lot of that might have stemmed from medical TV shows like “ER.” Then, when I was 18, I was asked to join the American tour for Riverdance. It was a simply incredible experience and we had the opportunity to perform at Radio City Music Hall, and on the Jay Leno Show and Good Morning America.
When I left Riverdance to start medical school, they developed a team called the “Riverdance Flying Squad,” made up of dancers who would be available at relatively short notice to perform at various corporate, promotional or marketing events. I was asked to be a lead dancer for this team and I had the honor of performing at events for the Queen of Norway and the President of Ireland. Soon other dancers started to say, “You’re going to be a doctor. My ankle hurts; what's wrong with it?”
Did dancing help shape the kind of surgeon you became?
It takes incredible teamwork to perform intricate steps simultaneously, in formation, in front of thousands of people. You learn to leave any issues backstage and work together as a single entity. When you’re performing surgery, it is vital for everyone in the operating room to work effectively and efficiently as a team. In dance the ultimate common goal was the performance. In the operating room, it is the patient.
Now that you’re a surgeon, what surprises do you have in your "toolkit" that can help people who have a foot or ankle injury?
Foot and ankle care is changing dramatically in terms of the complexity of the procedures and the instrumentation we use. A good example is keyhole (minimally invasive) surgery for arthritis of the big toe joint, which is an evolving technique. This surgery means you no longer need to create a long incision and open up the joint. Long incisions can be a problem because they are more painful, swell more and can frequently produce scar tissue, which can promote joint stiffness. Keyhole techniques allow us to do surgeries with incisions that are the size of a buttonhole or even smaller. For patients, this means less pain, more rapid recovery and improved range of motion.
You also provide orthobiologics, or regenerative medicine, which sounds like medical science fiction.
The role for orthobiologics has developed from our evolving understanding of the biology of tissue healing. We believe they can help patients heal faster and do a better job of enhancing post-injury function. We first obtain the patient’s own blood products and spin them in a centrifuge to create a highly concentrated solution of various growth factors, which we then introduce into the site of the injury to stimulate or enhance healing. We also use the process to augment surgery to expedite recovery and improve long-term outcomes. One example of orthobiologics is platelet-rich plasma (PRP), which uses a specialized type of blood cell that produces several vital growth factors and is especially powerful for healing injuries.
This type of treatment is relatively new, and we are still learning which orthobiologic products work better for specific conditions. We strongly believe people should come to Yale Medicine—an academic center—for this treatment, because its role is rapidly evolving. It is vital that patients are treated by expert physicians who are aware of the latest research and the best international approaches to care.
You’ve said dancing gave you a better grasp of what you call “the athlete psyche.” Does this help you treat patients?
Absolutely. A dancer or athlete has the desire, or need, to return to their sport as quickly as possible. They don’t want to let their family, their coaches and their team down. So they may ignore an injury and push through the pain. But I tell all of my patients that pain is important—it’s your body’s way of saying something is not right. Often, simple measures such as modifying your training regime or introducing an improved warm-up protocol will allow you to keep on performing before it gets to the stage where you need surgery to correct it.
Is it just athletes or does everyone want to heal faster these days?
I see it in everyone. Nobody plans for an injury and life does not stop; we all want to get better faster. We know that with an Achilles tendon repair, for example, rehabilitation is dramatically different than it was even 10 years ago. People used to be immobilized for up to three months after that surgery. Now, in my practice, we start with weight-bearing exercises six weeks after Achilles tendon surgery. With the evolution of minimally invasive surgery and advanced arthroscopic techniques, we can now have our patients back in the game or back to work in only a few weeks, where previously it could have taken several months.
Both of your children are Irish dancers. How do you help them prevent injuries?
My son is 11 and my daughter is 7. When I practice with them, we do a stretching warm-up, which is critical to prevent an injury. I always think of a cat. When we humans wake up, we just get up and move. When a cat wakes up, it stretches. I see many patients with plantar fasciitis, which causes pain near the heel, especially after a long period of rest. My first advice is to stretch their foot even before they even get out of bed.
Have you ever injured yourself, dancing or otherwise?
Thankfully nothing serious. But I’ve found a bit of medical knowledge can be a bad thing. I’ll be working with my kids and I’ll say, “My ankle is twinging. I wonder what that is.” I’ve already self-diagnosed myself with arthritis of my big toe joint. I don’t always take my own advice—I’m ignoring my injuries right now. But I am aware of them.
The 'bit of medical knowledge' must come in handy when you treat dancers.
It does. And that’s good, because dancers do seek me out specifically after doing a Google search. They’ll make their way to me from various cities—Boston, New York, Philadelphia. When a ballet dancer talks about pointe or plié, I understand their movement so, in my mind, I can think about the injuries they can get from doing those postures.
But, to be frank, all of my patients have incredible stories and backgrounds. Sometimes I’ll be in the middle of a consultation, and I’ll want to get a cup of tea and crack open a tin of biscuits, and sit down and have a full-on conversation. Then I remember we have a time limit. As an orthopaedic foot and ankle surgeon, my priorities are to relieve a patient’s pain, restore their function and get them back to where they need to be.