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:
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..
Semi rigid flat foot in a 70 yo female. This is not a finished product. Will follow up with WB films and clinical photos.
49 yo female slips on wet stairs while on vacation.
We used posterior medial approach to fix PM and MM fractures.
Direct lateral for comminuted fibula.
Extremity Medical Hardware used.
She is one of our favorite patients!
Hallux Extensus deformity — Failed Swanson revised with Evans allograft wedge cut into dowel rod, wrapped in Infuse on healthy 82 yo female for arthrodesis.
Canals of met and phalanx debrided meticulously like scrubbing soap scum off shower walls. Prepped with fenestration drill, then grafted. We used rongeur and osteotomes to make the dowel, and press fit joint together, then dorsal bridge plating.
Will post final healed images.
Plain film does not always correlate……
This middle aged male was not ready for an arthrodesis….
6 wk post op films show union.
Patient is working on ROM
@bgelliott14 made me appreciate this osteotomy.
@indyfootandankle
@arthrexmeded
@dsved good job!
@kelpeasy
Bimalleolar fractures often do not need syndesmotic fixation. In this instance, this 75 yo female had mild non diabetic neuropathy, osteopenic bone, and an unstable fibular fracture fragment. Therefore, we elected to use transsyndesmotic fixation to help reduce the fibula, and re-align the mortise. Do you call this a low Weber C, or a Weber B fibula fracture?
Here is the link : https://www.sciencedirect.com/science/article/pii/S1067251622002150
for free access to this article we wrote on the Plantaris’ role in equinus, and why you should be sure to transect during your gastroc recessions. Nice job @kbkindred @dkblacklidge @bgelliott14 @indyfootandankle
Metatarsus adductus + midfoot arthrosis in a healthy 58 yo female.
Patient presented with obvious bunion deformity, but also complained of a painful “bone spur” to the top of her foot.
MRI revealed DJD of 2nd and 3rd TMT , in addition to the angular deformity. Arthrodesis allowed angular correction, and definitive care for DJD.
We added PL to PB transfer to help reduce FF valgus prior to positioning the TMT’s, in this cavus foot deformity.
We started at the 3rd TMT, and worked our way medial. We used a modified Hintermann that allows external compression while we placed the dorsal locking plates at 2 and 3. This allowed us to forego compression screws.
Extremity Medical includes this device in their Omni set, standard.
Pt presented with acute Lisfranc Charcot collapse w/ ulcer and acute OM in medial cuneiform.
We staged the procedures:
-I&D with biopsy + cultures (6 wks oral antibiotics)
-Mini rail application debridement and graft placement - 3 weeks later
-Mini rail removal and debridement and graft - 4 weeks later
-Triple arthrodesis, NC arthrodesis, Lisfranc arthrodesis, and TAL - 9 days later
WB xrays were taken 16 weeks after final surgery demonstrating mostly consolidated fusions
Obvious criticism is medial column beam should have been recessed further. Clinically the beam did not look proud but radiographically it does.
Extremity Medical has an excellent Charcot set with a beam and clip system. The clips straddle the beams where desired, and help prevent back out.
Note: this patient now has 2 reconstructed Charcot feet. The contralateral limb was reconstructed last year, & still healed. See post from 2/19/22
Biocartilage is an excellent adjuvant for OLT’s and has favorable MOCART scores.
Side by side xray is a case just posted recently in a 15 yo female.
Incredible to see the amount of incorporation on xrays from 1 wk post op to 6 months post op.
BioCart has good MOCART scores.
Fun to see on plain film as well.
Thankful to see this awesome young lady do so well and get back to gymnastics.
@arthrexmeded
Thrilled to have these outstanding new Fellows from Milwaukee and Chicago residencies. Both have exceptional CV’s.
They started this July, and are off and running! Looking forward to a great year with them both.
@indyfootandankle
This 13 yo female was referred due to chronic foot pain, fatigue and “toe walking”. Pt had complaints of inability to participate in athletics due to pain, and fatigue in her feet. Pt had hx of non-op tibial shaft fracture which was accredited with causing tight posterior muscle group due to serial casting.
Pt failed conservative measures, mainly physical therapy to adequately restore appropriate dorsiflexion at the tibiotalar joint.
Her hindfoot motion was abnormal, and sinus tarsi was chronically painful on exam.
Plain film was interpreted by non-MSK radiology as “normal”. A CT was ordered to further eval the coalition observed. …. And rule out pathology within the STJ.
In order, we performed Coalition resection, Evans osteotomy, and Tendo Achilles lengthening.
After the Evans is performed if no forefoot supinatus is appreciated, and looking down the “gun barrel” yields a 1st ray that looks fairly even with the 5th ray, a Cotton osteotomy is not necessary.
At 10wks from date of surgery the patient is having no further symptoms, and is back in sneakers. She is looking forward to potentially participating in sports this fall.
***Extremity Medical Non-cortical allograft wedge and staples used for the Evans
A 59 yo male presented to us exactly how you see pictured. He was 6 weeks out from bi-malleolar ORIF — he was instructed by the index surgeon he could bear weight in a walking boot as tolerated due to the 6 week x-rays showing good alignment & what they felt was interval healing. Unfortunately, the neuropathic DM went home, & walked on the right ankle without boot on, converting himself to an open Charcot ankle fracture. The patient as stated, presented to us after the fibula plate had been removed, & had been debrided. …. Timing was tricky as I was leaving town the day after patient presented, so I asked my partner Clay Strong, MD to take the patient to the OR, & try to achieve closure prior to what obviously would be definitively treated with a TTC arthrodesis.
Dr. Strong placed the patient in delta frame you see pictured, excised fibula, closed the lateral wound, & placed a wound vac. The patient was directly admitted from our office to hospital. A PICC line was placed, & he was started on antibiotics (although every culture taken from the lateral plate removal, to the TTC arthrodesis was negative).
-After approximately 15 days in the delta frame, lateral incision looked healthy, labs were normal (aside from A1C of 9) (& small wound at tip of ipsilateral great toe was healed), patient was scheduled for TTC with the Dynanail.
-To avoid compromising the lateral tissues given multiple iatrogenic violations we elected to use medial approach — this also gave us access to remaining HW.
-Due to the amount of vascularity provided by the medial mall & surrounding envelope we elected not to excise it, despite the risks associated with index hardware being placed there. The open fracture was treated early, & aggressively by both us, & the index surgeon & yielded neg cultures.
-Fixation of the medial mall certainly may be criticized. We used a screw designed for the nail which only offered decent compression. We wanted something fully threaded due to cancellous nature of the bone, & recent screw holes.
-The CT was performed at closer to 11 wks than 10, & demonstrates uniting bone. Pt is now 12+ wks from DOS, & transitioning to shoes w/ orthosis for mild varus.
This pleasant 69 yo female fell going to feed her horses morning after a substantial snowfall in February.
She presented to the ED at 8am, and due to her coincidental NPO status, we were able to operate on her by ~1pm. That included time for H&P, pre-op imaging, and US guided pop/adductor blocks. Timing worked out well as we had just finished applying a delta frame on another fracture due to same storm.
It is evident on the CT at the lateral aspect of the PM fracture (PMF) there is incarcerated articular surface that would prevent reduction. To address this (after dissection of the most proximal aspect of the fracture only) we used a dental pick to distract the fragment posteriorly, & introduced a pituitary rongeur to snatch the articular fragment out.
Fixing these fractures within that 8-10 hour window prior to profound edema setting in seems to allow smooth reduction, and avoid soft tissue complications.
We elected to use screws and washers, rather than a buttress plate for the PMF.
The included articles were found without a thorough lit review. Regardless, they both demonstrate that not only is reduction better achieved directly, rather than via the lazy man’s “A-P screws”, but also that fixation method may not matter. The 2014 FAI article was a Level II prospective study that showed equivalent results when comparing buttress plating vs lag screws.
We have gone back and forth between plating, versus lag screws, and have anecdotally seen little difference in outcomes. Although, we tend to favor the plate for longer, larger PMF’s.
This patient ultimately healed well - the WB image was taken at 10 weeks from DOS. She does have occasional paresthesias along her post-lateral incision suggesting some mild Sural neuritis. She is in PT working on ROM, and limp elimination. She unfortunately had a retinal detachment surgery 14 weeks after the ORIF which set back her recovery.
Comment below whether you prefer buttress plate, or screws for PMF’s!
FOOT & ANKLE SURGERY
More conditions in the menu above.
Before & After Photos
Before and After correction of painful, arthritic bunion deformity
(Note: Skin color changes due to swelling)
Note: Your results may vary
