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Source: The ABC’s of Applying for Fellowship

Moderator: L. Marie Keplinger, DPM, FACFAS
Panelists: Andrew Kapsalis, DPM, AACFAS; William Adams, DPM, AACFAS; Timothy McConn, DPM; Ryan Scott, DPM, FACFAS

Dr. Adams Articles

Patrick A. DeHeer, DPM; William Adams, DPM; Faye-Rose Grebenyuk, DPM; Eric Meshulam, DPM; Kory Miskin, DPM; Tiffany Truong Koch, DPM; Corey Groh, DPM
J Am Podiatr Med Assoc (2016) 106 (6): 387–397.
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Dr. Adams Presentations

Brian Elliott, DPM, FACFAS Major Health Partners – Renovo Orthopedics
Wil Adams, DPM, AACFAS Fellow, American Health Network Hancock Regional Hospital – Orthopedic Department
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William Adams, Chief Resident, DPM, PGY-III Community Health Network – Indianapolis, IN Prospective Fellow at American Health Network – Indianapolis, IN
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William JE Adams, DPM, AACFAS Fellowship Trained Foot and Ankle Surgeon Hancock Foot and Ankle, Orthopedics Department
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William Adams, DPM, AACFAS Hancock Regional Hospital – Orthopedics Dept.
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William Adams, DPM, AACFAS Fellow – American Health Network
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Wil Adams, PGY-III, CHN – American Health Network Monthly Meeting
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Disclaimer: Dr. Wil Adams, DPM Greenfield, IN Please remember that medical information provided by Dr. Wil Adams in the absence of a visit with a health care professional, must be considered as an educational service only. The information sent through e-mail should not be relied upon as a medical consultation. This mechanism is not designed to replace a physician’s independent judgement about the appropriateness or risks of a procedure for a given patient. We will do our best to provide you with information that will help you make your own health care decisions. Many external links have been provided on this site as a service and convenience to our patients and other visitors to our website. These external sites are created and maintained by other public and private organizations. We do not control or guarantee the accuracy, relevance, timeliness, or completeness of this outside information. If you require to find out more please email us at info@adamsfootsurgery.com. This website is not intended for viewing or usage by European Union citizens.

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Jan 1

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Happy New Year!! Thanks to all our wonderful patients - we had an awesome 2021. Here are a few interesting cases to recap.

Volume up, bass slaps! Please leave us a comment if you enjoyed the video.

Thanks to my NP Kelly Peasley.

Thanks to the Fellows at American Health Network.

Thanks to the residents at Community Health Network.

Thanks to all our vendors.

Hardware used:
Extremity Medical
Arthrex
Flower Orthopedics
Stryker/Wright

Note: permission was obtained prior to using any imaging that could identify a patient. ...

adamsfootandanklesurgery

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Dec 15

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Stage 3 PTTD patient that was referred with MRI already performed….PT tendon ruptured, and spring ligament torn.

Interestingly, the spring ligament damage is evident on lateral plain film with dorsal cortices of TN not matching up. Additionally, profound supination weakness seen on exam provides enough info to confirm PT is insufficient….X-rays and exam give you Stage 3, without necessity for MRI….. At Stage 3, coupled with morbid obesity, patient is guaranteed triple arthrodesis. Painful bunion was also consideration so we chose osteotomy rather than arthrodesis.

Due to severity of deformity and foot type - we felt addition of CC fusion allowed some mild forefoot varus to be addressed without need for opening wedge osteotomy at midtarsal articulation, or plantarflexory TMT arthrodesis.

Post op films were taken at 10 wks from date of surgery with nice unions evident.

Stage 3 patients are stiffer for sure. But seemingly some of the happiest post-operatively, as we’ve found they learned to live with bad deformity and pain longer than necessary. ...

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Nov 18

Open

$An isolated CC arthrodesis is not a common procedure. However, in certain instances like large non-united anterior process fractures, it may be the best option. Fixating the CC whether isolated or not, can be a challenge. When performed in addition to a STJ and TN fusion, the fixation is probably less important due to the inherent stability afforded with the fixation of adjacent hindfoot joints. However, in the isolated scenario, fixation is crucial as the non-union rate is much higher. We have utilized a variety of constructs; staples, screws, small plates, headless beam screws from P to A, etc….We have found firsthand the IO Fix device by Extremity Medical not only allows exceptional compression, but also addresses the ever present hardware irritation concern in thinner patients. The intramedullary IO Fix device eliminates the concern for peroneal tendon irritation, and offers superior compression. It has been a great tool for this procedure. Case examples show good union at 8+ wks from date of surgery.$

An isolated CC arthrodesis is not a common procedure. However, in certain instances like large non-united anterior process fractures, it may be the best option. Fixating the CC whether isolated or not, can be a challenge. When performed in addition to a STJ and TN fusion, the fixation is probably less important due to the inherent stability afforded with the fixation of adjacent hindfoot joints. However, in the isolated scenario, fixation is crucial as the non-union rate is much higher. We have utilized a variety of constructs; staples, screws, small plates, headless beam screws from P to A, etc….We have found firsthand the IO Fix device by Extremity Medical not only allows exceptional compression, but also addresses the ever present hardware irritation concern in thinner patients. The intramedullary IO Fix device eliminates the concern for peroneal tendon irritation, and offers superior compression. It has been a great tool for this procedure.

Case examples show good union at 8+ wks from date of surgery. ...

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Nov 3

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$19 yo falls off rope swing 1 year later still in pain…. Advanced imaging to eval quality of lesion ….Original ER plain film shows OLT My rules for favoring open allograft vs scope microfracture are: -Talar shoulder lesions -Full thickness delamination apparent on MR -11-12mm + -Depth is of concern Patient also received direct ATF ligament repair with Fibertak suture anchors. I like BioCartilage as it is half the cost of De Novo, BMAC included. You get the best of both worlds - host cells, and graft. It has been proven to have favorable MOCART scores, and robust thickness as compared to fibrocartilage, when looked at up to 19 months post-op.$

19 yo falls off rope swing

1 year later still in pain….

Advanced imaging to eval quality of lesion

….Original ER plain film shows OLT

My rules for favoring open allograft vs scope microfracture are:

-Talar shoulder lesions
-Full thickness delamination apparent on MR
-11-12mm +
-Depth is of concern

Patient also received direct ATF ligament repair with Fibertak suture anchors.

I like BioCartilage as it is half the cost of De Novo, BMAC included. You get the best of both worlds - host cells, and graft. It has been proven to have favorable MOCART scores, and robust thickness as compared to fibrocartilage, when looked at up to 19 months post-op. ...

adamsfootandanklesurgery

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Oct 16

Open

71 yo nurse falls at home after neck surgery. …. The most heart warming debate out there….ORIF vs Arthrodesis for Lisfranc injuries - both ligamentous, and osseous/ligamentous combined.

In my mind, patients have the last say as long as it’s reasonable.

The most important feature of the TMT complex is stability, not motion. Arthrodesis provides that, especially in patients where demand requires it. Counterintuitively active patients need this the most. Shannon Rush hammers that point. This particular patient hikes with spouse, was about to retire, and wanted the closest thing to a guarantee of 1 procedure allowing success that could be provided.

Trauma to the TMT complex inherently changes the articulation permanently, true. The advantages arthrodesis affords vs ORIF;

-1 procedure assuming union
-Superior stability
-No risk of re-injury to ligament that doesn’t exist
-Decreased risk of complications due to statistically less surgeries required
-Patients have been shown to reach pre injury activity levels up to 30% better in arthrodesis group
-Improved pain scores

Literature defines arthrodesis patients as partial vs total.
Partial = 1-3 TMT fusion
Total = 1-5 TMT fusion

Coetzee’s study is really still the best study because he compares his own patients, fusion vs ORIF, with a 3.5 yr follow up. Of course the limitation to his study is follow up time. If the ORIF group is followed for 20 yrs we would presumably see 100% post traumatic OA in the ORIF group.
Counterpoint would be prevalence of adjacent joint arthritis in arthrodesis group.
My argument to that is - does a joint that does not have exceptional motion to begin with place much burden on an adjacent joint, post fusion?

Yes - ORIF’s are quick, and easy, but do they last?

In our own patients, the arthrodesis patients are happier than the open and perc ORIF patients.

This case was fixated with Extremity Medicals IO Fix device which affords incredible compression with intramedullary fixation.

NOTE: Post-op images demonstrate union at 10th week visit. ...

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DR. ADAMS IS WORTH THE SHORT DRIVE and has many patients from McCordsville, Fortville, Pendleton, Carmel and Fishers Indiana.

adamsfootandanklesurgery