Board Certified Foot & Ankle Surgeon

52 yo female smoker presented with severe Cavus foot, and unstable ankle deformity. She was unable to tolerate an AFO, had rigid hammertoes secondary to previously failed recon surgery and Charcot-Marie-Tooth disease (CMT). The patient was hesitant to redo everything as she had originally been told it would be a definitive outcome at index surgery. She had extra-articular bone work, and ancillary soft tissue procedures done.

We uniquely performed:
Modified Bröstrom, STJ/CCJ arthrodesis, Gastroc recession, Steindler Stripping, PL to PB transfer, DFWO, Hammertoe repairs, 1st MTP arthrodesis, and hardware removal.

Quite a lot in one go. We always want to keep these more involved cases under 3 hours, and thankfully we did. Yes, the DFWO screw is intentionally in good bone, but inadvertently crosses the TMT joint - non painful. She did have a delayed union at the 1st MTP, and CCJ so we ordered a CT after 6 months to prove unions. 13 months out she is very happy and planning to revise left foot this winter.
Imperfect result, but stable foot, and appreciative patient.

#charcotmarietoothdisease #footsurgery #acfas #anklesurgery
anklesprain ...

Case update: our 60-year-old, hearing impaired male, with severe neurogenic cavus deformity, thankfully now has a nicely healed TTC fusion via IM nail. This patient was so happy the interpreter could hardly keep up at his office visit when we told him to ditch the walking boot. He lives alone and is very happy to have his independence back. Not a perfect result, but very happy patient that desperately needs some lotion 🙈

DynaNail , @3m incisional vac, and good surgical team for the win. @kelpeasy

@enovisfootankle ...

60 yo female presented with a very rotated, and painful bunion deformity. (Many apologies for not having pre-op clinical picture 😭). She is a colleague, and on her feet daily. We discussed a 1st MTP fusion because of its predictability and durability, but ultimately she did not want a stiff great toe joint. We did not consider a Lapidus because of the unpredictability, and guaranteed stiffness at the 1st MTP, but with possible pain. With a 1st MTP fusion there is the possibility of painless stiffness at the MTP level. But in my humble opinion, a Lapidus in later aged (6th decade and beyond) females often causes symptomatic stiffness at the MTP level. Additionally, due to the extreme frontal plane position of the toe, I felt a Lapidus would be quite difficult to perform. Anecdotally, I have seen quite a few Lapidus post op that radiographically look acceptable, but clinically the patient does not like the way the 1st ray feels and functions. Thankful this patient was thrilled with her result and said, “I’m surprised it turned out as well as it did”. 😂 Not perfect, but happy patient.

#bunion #bunioncorrection #acfas #footsurgery #minimallyinvasivesurgery ...

This case isn’t finished, and is not healed yet— thats always the most difficult part of patient care. This was a TTC arthrodesis for a hearing impaired 60 yo male with a hx of some alcohol & nicotine abuse. Very nice guy — wanted to be able to walk on the right leg without falling.

In extreme varus cases like this one, it can be really challenging to get the deformity to reduce, with the tibia plafond that has changed shapes, and a talus that wants to escape anteriorly. Because this individual’s bone was osteopenic, temporary fixation was challenging. Ultimately, we used the entry reamer to help reduce the deformity. We started the drill at ideal location in the heel, then advanced until the ankle joint, then manually reduced the deformity, attempting to fully seat the talus under the plafond and reduce the varus, while simultaneously aiming hard medially with the drill, to correct it from “wandering” out towards the lateral tibia cortex.

It’s important to mention you cant do this maneuver with a flexible drill or reamer. Its needs to be a 7-9mm drill, that is stiff, and can withstand a ton of force without breaking inside the tibia.

****The fibula doesn’t need to be taken down. The blood flow the fib provides is a good thing for the fusion sites, and taking it out also costs time (A TTC should be 120 minutes or less). In the video we demonstrate nice access to the joints with a lazy hockey stick type incision. We did make an additional small window medially to remove huge loose bodies.

Not a perfect result, but much improved. we will follow up once this gentleman hopefully heals the procedures.

We used the chin-up bar technique with the Dynanail which provides beautiful, unparalleled compression across the joints. ...

59 yo diabetic male (A1c 7.0 at time of surgery) with moderate neuropathy presented due to repeated ulceration to the plantar medial arch secondary to arch collapse/rigid PCFD. This patient was understandably extremely anxious about a reconstructive surgery, but ultimately he had failed multiple AFO’s and accommodative orthotics. The wound care center would heal him, then 2-3 months later he would re-ulcerate. In these cases, it’s all about getting a union as quick as possible. We try to place a bone stimulator at time of surgery for higher risk cases like this. We also use an incisional wound vac which helps tremendously with dehiscence avoidance. His post op films are 12 weeks out. He is still healing…He likely will need an anterior ankle debridement in near future. typically would prefer to do this at same time, but it took considerable OR time to get his subluxed cuboid relocated….

#acfas #footandanklesugery #orthopedics #podiatry #bone #footpain #diabetes ...

39 yo female born with club foot unfortunately had an isolated CC arthrodesis to treat her lateral column overload by index surgeon, and chronic pain secondary to deformity, but also secondary to occupation as factory worker.

To treat both nonunion, and in attempt to provide definitive correction we revised with the following:

Triple arthrodesis — CCJ revision with wedge resection (as pictured)
Steindler stripping
PL to PB transfer
Gastroc Recession (yes, even in cavus feet equinus is real)

She is now 12 weeks post-op and requested to go back to work. She is thankfully happy with her correction. Not perfect, but better.

we used Neo MTX allograft to help with the biology considering previous nonunion. @extremitymedical

Picture resolution is iffy thanks to my Meta glasses 🤓 😂 ...

57 yo female presented as a 2nd opinion due to a non-union following a Workmen’s Comp injury. Patient stepped in a drain hole at her restaurant while working. She was treated with conservative measures initially — cast immobilization for 4 weeks (pt chose cast), followed by 4 wks in walking boot, followed by 4 weeks in a lace up brace. At 12 wks due to symptoms, & lack of consolidation across frx site, a bone stim was ordered, & used for 2.5 months. The pt was still symptomatic at 5 months, & xrays were unfavorable. At this point the surgeon that initially treated her referred her to us for ORIF/Nonunion repair.

We agree, a screw and washer would have been a good, cheaper alternative to the hook plate. We preferred the plate because of the stability afforded, & its ability to capture graft. We used the syndesmotic screw to compress through the eccentric screw hole. Obviously stabilizing the syndesmosis was not a worry with this Weber A frx (Orthobullets states <10% of Weber A’s involve syndes disruption). We initially placed that eccentric screw through fibular cortices only, but the screw did not purchase good bone, and did not compress. We then elected to place the quad cortical screw to achieve compression.

Her vitamin D was initially 23.6. This was treated for 3 months to aim for 60.

Pt was casted again 4 wks after ORIF/nonunion repair, and 6 wks in boot. Pt had bone stim ready to go immediately post-op. Pt back in sneaker by 10 wks, and thankfully happy.

We used @extremitymedical Stable AF system, and Neo MTX bone graft (mixed with calc auto) by @ossium_health /XM collaboration. The allograft provided BMP 2 & 9 aka GDF2, to induce those osteoblasts to DO WORK!

#anklebreaker #acfas #orthopedics #podiatry #footsurgery #anklesurgery ...

Arthroscopic Haglund`s surgery is a big improvement for patients. No period of NWB, extremely low chance of skin dehiscence, and less disruption to the Achilles interface versus traditional approaches. Could this be the new standard in the next 10 years?

#acfas #footsurgery #podiatry #arthroscopicsurgery #orthopedicsurgery #MIS @arthrexindianapolis @15blades_ ...

Metastatic cancer, and a career smoker can lead to disaster in a simple ankle fracture, but that`s where fibula nails have transformed care. This patient was very pleased to avoid NWB. Keeping a patient like this walking immediately after surgery is a game changer.

@henry.community.health

#acfas #anklebreaker #minimallyinvasivesurgery #ortho #podiatry ...

MIS arthroscopic Haglunds makes for a happy holiday season!

@kelpeasy @arthrex_foot.ankle @crossroadsorthopedics

#arthroscopysurgery #podiatry #orthopedicsurgery #footsurgery
#acfas ...

A more unusual rotational ankle fracture pattern in a late aged female patient. CT demonstrated a less common posterior malleolar component that had both medial, and lateral extension. More often than not, posterior malleolar fractures are biased laterally, not medially, but if they are medial, they generally are not also lateral. .... In this instance, both sides were involved. Additionally, the medial malleolus was also fractured, and subluxed.

Would be happy to entertain different approaches on this one. Probably not a perfect answer. We elected to start posterior lateral and fix the posterior lateral PM first, without the fibula HW obscuring the reduction. We then fixed the fib. We closed and flipped patient supine, and maximally externally rotated to then use a central, slightly posterior medial incision to fix the posterior medial tibia, and medial mall. We retrieved a lot of hemorrhagic debris from the joint by addressing the posterior medial tibia. We did not use arthroscopy here* We did do a lot of vanco sprinkling here, and used a Prevena vac. @3m as well as our favorite @extremitymedical STABLE AF system.

#anklebreaker #anklepain #orthopedics #podiatry #footsurgery #anklesurgery #acfas #aofas #bonesurgery ...