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This healthy 37 yo male was sent by a colleague that was a childhood friend of the patient. He had been told by a surgeon in his hometown a few hours away, the pain he had in his foot was from a neoplasm, that could be cancerous. Pt was told he needed biopsy right away, and could have cancer.....The pt, a single father, was terrified. He thankfully asked my colleague whom he remained in touch with over the years what to do. Since my colleague lives in another state he was referred to us.
Pt brought all of his advanced imaging with him which is provided. Even patient’s imaging was interpreted/read poorly, at best, in my opinion . (I did have our own MSK rads review as well who disagreed with reads)
After a good discussion with the patient, letting him know he basically had a 0% chance of having foot cancer, I did recommend treating the benign bone cyst surgically because of the pathologic frx he developed at the CC joint margin, and his failure of 8 wks NWB to resolve symptoms (chronic pain with daily activities).
We performed aggressive curettage, and autograft harvest from calcaneus to pack void.
Fixation was not a great option due to location of cyst. We discussed CC joint arthrodesis and pt was consented for it knowing we preferred to avoid if joint looked healthy.
Path report came back as benign cystic tissue....
Note: Side by side oblique x-ray is pre to post-op differences between cyst being present, vs autografted and healed at 12 wks.
Patient sent us the last picture of this post 6 months after surgery.
(He did give us permission to use photo)...
Pediatric flat feet are some of the most gratifying types of cases....
This 9 yo female presented with bad flat feet that hurt her everyday for 2-3 years. She had failed inserts and PT. She was told she would have to wait until she was skeletally mature to have correction.
First thing noticed on exam was the rigidity to her hindfoot. Lateral plain film showed “anteater nose sign”. We ordered MRI to confirm coalition and observe adjacent joints.
We performed coalition resection, Evans, and Cotton in that order. We prefer to soak allograft wedges in BMAC to hasten incorporation. Surprisingly, TAL was not needed.
Small hand plate was used for Evans graft, and small staple for Cotton. This young lady had particularly tiny feet.
Post-op films are at 4 months with total graft incorporation.
Range of motion is now excellent at hindfoot....It was neat to see her Mom’s tears of joy after surgery....
In athletes I think less is more. This 41 yo female gymnastics coach, and rec athlete had painful adult planus deformity. She also had instability from years of “tumbling”. We performed a Modified Bröstrom with Arthrex Fibertaks, and used an allograft soaked in BMAC. These films were taken at 10 weeks post-op.
Her ankle dorsiflexion was excellent so no posterior muscle lengthening. No forefoot supinatus after Evans, so Cotton was overkill. ... Impressive to see what an isolated Evans can do....
This 64 yo, neuropathic, insulin dependent DM, 1 ppd smoker wandered into our office at the end of the day 4.5 months ago. We directly admitted him and performed the TTC next day. He then got admitted to an ECF afterwards so he could stay NWB for 12 weeks, and have a shot at healing (he lives alone).. .He got ill with COVID and almost died. This past week he followed up...in crocs 🤦🏻♂️. Neuropathic patients are always an adventure... Hopefully this gentlemen will listen to us and be compliant moving forward so his ankle will fully heal, and we can avoid bka long term. There is incomplete consolidation in my opinion at medial mortise. He will be in an AFO for lifetime.
(Pt stopped smoking, had vitamin D optimized, and A1C reduced).
Note: We used T2 nail and cadaveric graft over medial mall wound which seemed to do nicely. Never performed a single debridement after graft app....