Foot & Ankle Surgeon
Dr. Adams is an Indiana native. He attended Indiana University-Bloomington where he met his wife Allison. He got degrees in Nutrition Science, Biology and Chemistry. Dr. Adams then got his doctorate from Kent State College of Podiatric Medicine where he was a Dean’s List student. He then came back to Indianapolis to do his surgical residency, and was Chief resident at Community Health Network. He stayed in Indianapolis, and completed advanced training in a Fellowship focusing on Adult and Pediatric Reconstruction. During his Fellowship, Dr. Adams worked part-time for Hancock Orthopedics. He has remained there since.
Dr. Adams in the operatory
Dr. Adams enjoys teaching as he helps educate, and train the surgical residents at Community Health Network, and the Fellows at American Health Network. He actively participates in research, and peer reviewing for national journals.
He is also a consultant for orthopedic device companies where he is afforded the opportunity to help train, and design with other surgeons across the country.
When Dr. Adams is not practicing medicine he enjoys spending time with his family, hunting, snow skiing, traveling, and riding single track on his dirt bike, or mountain bike.
Dr. Adams has special interests in the following areas:
Is both a tightrope and screw overkill? Probably. However, I like this construct because the screw compresses first, then if it prematurely breaks the tightrope still holds the already purchased compression/stability the screw started with.
#MIS #anklebreaker #fracturedankle
Calc Fracture 🚨
38 yo male falls 17 ft from ladder working on his home.
Mini sinus tarsi open approach used. Nanoscope provides the visuals! @arthrexmeded
Not a finished result yet. Joint is back together though.
85 yo female w/ end stage arthrosis. Had right sided TKA, then referred for TAA. Community ambulator that wanted to retain quality of life.
The prophecy reports can be helpful as sometimes clue us in to subtleties overlooked in pre-op planning. In this case, the tib tray was cheated slightly posteriorly to cover cortex, unfortunately this left .75mm “uncoverage” anteriorly. The report shows the difference being split between the two. Low demand in this petite lady will hopefully prevent any subsidence issues.
She did have some hindfoot/midfoot arthritis that was asymptomatic. Art doppler showed good perfusion. Vanc used intra-op after irrigation; pulse lavage to prevent heterotopic ossification. TXA used, but no tourniquet. Aperture dressing made w/ ABD over incision. Sutures removed at 3 wks, Pt FWB in boot as tolerated until 6 wks.
74 yo male with persistent unstable cavus deformity. Failed AFO’s.
Neuropathic, but no hx of wounds. Non-smoking, non DM. Etiology of neuropathy undetermined.
Midfoot osteotomies, steindler, PT release, & TTC arthrodesis were procedures utilized.
Not a perfect result, but happy patient.
This sweet 19 yo female college student was hit by a drunk driver. She had a left sided non displaced Weber B, treated conservatively, and a right sided comminuted anterior calcaneus fracture.
Approximately 45-50% of her articular surface was impacted proximally, and comminuted. Rather than try to piecemeal an ORIF together which likely would necessitate multiple surgeries (very petite foot, 2nd arthrosis etc) we elected for primary arthrodesis with low profile fixation.
We used @extremitymedical IO freedom IM fixation, and a low profile staple. Biofuse Pro used for bone graft. Articular fragments were dug out of ant calc, & discarded.
Patient obviously has some disuse osteopenia but has nice union at 10 wks, and is happy to be back in sneaker at school. One surgery, and done. Left ankle healed as well.
This non diabetic 29 yo female developed multiple bulging disc after a fall on ice. This caused profound unilateral numbness, urinary incontinence and weakness of her everters in extremity, no drop foot interestingly. She was seen in the ED 3 x before she had further work-up, and was treated by a spine surgeon for severe spinal stenosis. Over time she developed a neurotrophic ulcer and attritional injury to the peroneal tendons. Both tendons were badly torn, and subluxed on MRI. She developed lateral column overload , and gait dysfunction. No bone involvement on MRI regarding infection.
We performed PL to PB transfer, Steindler stripping, DFWO on 1st met, everting STJ and TN arthrodesis and an advancement/rotation flap. By 10 wks she had great bony unions, and happy to be wound free.
Laterals can be deceiving! Not every flat foot is obvious in every plane. In this females case the sagittal plane is essentially normal. However, the AP or frontal plane tells a different story.
Her main complaint was chronic medial ankle pain (PT tendinosis), and severe tenderness focally over 2nd TMTJ.
My partner ordered MRI for eval before he referred. Her knees were also arthritic, but she ultimately decided she wanted her foot fixed first.
I saw her last week for the first time in a few years, and her only complaint is recent onset pain at plantar 5th MTP. She’s a very sweet lady that did very well with her unions.
She has since had bilateral TKAs.
Our index surgery was STJ, 1st and 2nd TMTJ arthrodesis, FDL transfer to Navicular with whipstitch & anchor technique, BMA harvest from Calc, and Baumann Gastroc Recession.
Her PT tendon was mostly excised as intra-op findings according to op report were worse than perceived on MR. Remaining tendon was sewn into FDL.
She is now in her early 70s and thankfully has no hindfoot complaints.
(We no longer use Homer Stryker’s hardware)
Failed Swanson converted to bone block arthrodesis!
As usual the implant was in multiple pieces, and the canals of the met/phalanx were filled with film and debris.
This case was posted back in October well before final results manifested. This 82 yo female had complaints of painful failed Silastic and contracted 2nd digit.
Her great toe was elevated and contracted due to implant fracturing and allowing shortening and therefore contracture and advantage of EHL tendon.
We took an Evans wedge by @extremitymedical — a non-cortical wedge, and trimmed it down into a dowel. We then wrapped it with Infuse, and press fitted it down the very thoroughly debrided canals of the metatarsal and phalanx. We manually compressed with a dorsal locking plate by XM. We did Z-lengthening of EHL tendon to prevent resultant IPJ elevatus.
It took 4.5 months - but CT confirms “50-60% solid bone bridging”.
The patient had done well clinically, but despite that we agree with @ankl_man that post-op CT allows confidence the construct worked, and gives patient peace of mind she’s finally out of the woods permanently. She’s an avid gardener, and happy to be cleared from her “damn walking boot”.
In an 82 yo female would you have gone for Calc autograft vs the allograft wedge?
57 yo female — well controlled DM-II. Non smoker.
CC of painful dorsal midfoot “bump”. Severe DJD of 2nd and 3rd TMTJ. 1st TMTJ was okay….No complaints regarding “bunion”. No hindfoot complaints despite skew foot.
Jigs are cute, but you truly just need your fulcrum death grip, and a compressor/distractor instrument to reduce the adducted mets.
Because the hintermann will hold static compression, it allows “hands free” fixation while simultaneously reducing & compressing joints so only a locking plate vs staple is needed.
We prefer locking plates for DM patients.
@indyfootandankle
@kelpeasy
@dsved
@extremitymedical has a beautiful hintermann that is free of charge in set, and uses track/dial to afford precision distraction vs compression and accommodates steinmann pins vs K-wires.
This 58 yo female had previous Calc slide, PT augmentation, and gastroc recession.
The large synthes screw was errantly placed into the STJ. As usual, the slide was not powerful enough along with ancillary soft tissue procedures to restore decent alignment.
MRI showed spring ligament damage, and large defect in posterior facet.
Triple and TAL were performed to revise and realign. Patient is 10 wks out in after photo showing nice unions.
@extremitymedical hardware, and biofuse pro allograft were utilized.
Happy New Year! Thanks to all for a great 2022.
Thanks to @extremitymedical for great metal
47 yo male falls from tree stand.
Unremarkable pmhx aside from 1/2 ppd smoker.
Sinus tarsi incision is the ticket.
Nanoscope nicely aids reduction.
Its nice to get the calcaneus out of varus, but ultimately , its all about the joint surfaces.
The nanoscope allows easy access/visualization to the entire joint. Being able to show a patient the joint surface clinically is a nice practice adjuvant.
This patient healed great with zero incision healing issues.
@dkblacklidge taught me this technique - ideal for application at a county hospital. Its prevented need for flaps, I&D’s and surgeries that go with lat extensile.
@indyfootandankle
The midfoot arthrodesis sometimes gets a bad rap…and there isnt a ton of literature on the NC arthrodesis specifically.
Regardless, in this 54 yo female factory worker her chronic midfoot arthrosis was under appreciated on plain film. After failing injections - some specifically aimed at diagnostically blocking the deep peroneal nerve with US guidance, and getting incomplete pain relief, she decided to proceed with a fusion after a MRI further delineated what all articulations were involved
At 12 wks she had nice unions. She was kept immobilized/NWB for 7 wks.
She is pain free and back to work. She is a smoker but stopped for surgery. She is non DM.
Our current fellow @dsved @indyfootandankle has assisted with some of the lit thats out. …. We used @extremitymedical hardware to build a low profile compressive construct.
Does advanced age effect union rates? Some studies suggest so.
In this 61 yo male that installed custom floors for a living, we treated recalcitrant sinus tarsi syndrome and posterior tibial tendinitis with a double arthrodesis + TAL.
He complained of 1st MTP arthrosis as well, so we elected to avoid fusion for now with joint sparing cheilectomy as this may better allow kneeling required at work.
His post op films were taken at 10 wks with solid union evident. Still working on MTP ROM.
We used @extremitymedical hardware, and their BioFuse Pro bone allograft to supplement.
Do you have a graft protocol in place for certain age groups?
This 74 yo male we’ll call RB4 asked we post his pictures to our website and social media as he was thankfully thrilled with his result. Not a perfect result but we obliged.
He had his left foot “fixed” years ago, and after that “gave up” on foot surgery…. We are revising that side soon. It has a failed prosthesis and more.
His painful areas on the right were the 1st MTP, plantar 2nd MTP., and 2nd toe.
We utilized a 1st MTP arthrodesis , and a FHL transfer. His great toe was so contracted when we pulled it out of valgus he immediately developed a terrible flexion contracture. Transferring the FHL to the dorsum of the phalanx remedied this.
We then did a 2nd met head resection, FDL transfer, and PIPJ arthrodesis.
In the xrays and clinical pictures he is 10 wks post op, and doing well.
@extremitymedical hardware used!
This bloody OLT (osteochondral lesion of talus) was encountered in a 41 yo male that sustained a Weber C after being tackled by a drunkard from behind. We used a k-wire to microfracture at time of ORIF. I prefer to use the 1.9mm Nanoscope due to its incredible flexibility, and field of view. Additionally, it can be run at very low pressure ingress that prevents excessive joint capsule distention and joint trauma.
It’s also a breeze for staff to setup.
Do you routinely scope your fractures (calc, ankles)? I think it both assists reduction, and also allows us to treat OCL’s. Literature shows high incidence.
Unstable tri mall fixed via traditional approach as the PM fracture was almost a wafer. This patient had Ehlers-Danlos - unsure of which subtype. Regardless, elected not to use tourniquet to avoid vascular compromise as in some EDS pts vascular fragility is an issue. Thankfully her incisions healed well, and she’s doing well.
Extremity Medical hardware used — Stable AF set. Their low profile spoon on the anatomic fib plate has been awesome.
23 yo male had a previous extra-articular, or FLEXIBLE flat foot recon (elsewhere) with a gastroc recession, anterior calc osteotomy and a Kidner. It was reported the patient also had a CN bar coalition resection.
Unfortunate for this patient a TC coalition was not identified pre or intra-operatively. Additionally, the CN bar was not fully excised either. This patient’s foot was not flexible.
3 years after this young man had his index surgery he was miserable, and did not understand why.
We repeated MRI imaging & discovered the 2nd coalition. The under resected CN was noted on plain film prior to MR.
We had careful discussion with patient that due to the lack of flexibility of his hindfoot articulations, these joint sparing procedures were not appropriate. To definitively treat his pain, and improve alignment a fusion would need to be performed.
We thankfully were able to resect both coalitions through standard ST approach. We felt removing the Evans wedge didn’t provide any benefit to the patient. Additionally, patient was in severe equinus again so we elected to lengthen again with a TAL.
Pt is now 12 weeks post op as pictured in xrays and very happy.
Shoutout to @gitasreeb for being an incredible MSK radiologist.
Extremity Medical hardware used to revise this case.
This petite 74 yo female had a tough 5 years. She has hx of DM-II.
She had a previous malunited triple by a non foot and ankle surgeon that over time became un-braceable. She had periods where her A1C drifted too high to allow safe recon, and COVID delayed surgery as she needed ECF placement post-op.
She is semi-neuropathic. Her talus had both features of AVN and Charcot. When the MSK radiologist that interpreted her films and I chatted he felt strongly AVN was not certain, and neither was Charcot.
Given the patient’s basic desire to have a limb she could stand on, and reliably wear a brace without the tendency to develop sores, I felt an ankle fusion and a multiplanar midfoot osteotomy would best allow correction.
At 11 weeks post op her ankle fusion is united, and she is full weight bearing in a walking boot. She is starting physical therapy to work on muscle tone and transition to shoe and AFO.
We used fully threaded screws to allow better purchase in osteopenic bone. Using screws also allowed smaller incisions than plating would.
@arthrexmeded
23 yo female came in last year with a bad Lisfranc fracture that she sustained at home, in a low energy twisting injury.
Pt followed up with us 18 months later complaining of hindfoot pain —she attributed to her Lisfranc injury.
After some discussion we regrettably informed her that her sinus tarsi syndrome was a result of her pes planus/flat foot deformity, and unrelated to her midfoot trauma. Thankfully her fusions healed well, and this area was asymptomatic on exam.
Arch supports and sinus tarsi injection was utilized to start….To be continued..
FOOT & ANKLE SURGERY
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Before & After Photos
Before and After correction of painful, arthritic bunion deformity
(Note: Skin color changes due to swelling)
Note: Your results may vary
