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Ask Dr. AdamsAcademia
and Media
Conditions
FootAchilles Tendon ProblemsBig Toe Problems (Pathology)Bunion DeformityCavus Foot (High-Arched Foot)Flat FeetHaglunds Deformity (“pump bump”)Heel PainToenail Fungus & Athlete’s Foot
AnkleAccessory Muscle SyndromesAcute Ankle SprainAvascular Necrosis of the TalusChronic Ankle InstabilityOsteochondral Lesion of the Talus and TibiaPeroneal Tendon InjuryTarsal Tunnel Syndrome
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MoreBone HealingDiabetic ConditionsHereditary – “Architectural Issues”Nerve Problems (Pathology)Pediatric ConditionsTrauma (Fractures)
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Category: Ankle Replacement

Category: Ankle Replacement

76-female-total-ankle-replacement-chronic-arthritis

76 Female Total Ankle Replacement For Chronic Arthritis

November 27, 2020bywil-adams-dpm
Ankle ReplacementArthritisFoot & Ankle Surgery GalleryFoot & Ankle Surgery Videos

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Service areas include: Greenfield, Hancock County, Knightstown, New Palestine, and Indianapolis, Indiana.

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

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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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adamsfootandanklesurgery

adamsfootandanklesurgery

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Apr 16

Open
Another interesting mistaken identity case;

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)

Another interesting mistaken identity case;

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)
...

adamsfootandanklesurgery

View

Apr 9

Open
Correction of adult acquired flat foot deformity. This healthy 61 yo female had a Gastroc recession (Baumann) , FDL transfer with tenodesis, Evans with BMAC soaked Allograft, and 1st MTP arthrodesis. 

We typically take post-op films at 1, 6, and 10 week intervals following bone surgery. This lady had films at slightly different intervals. 

Always interesting to follow along the consolidation of the allograft wedge(s) to completion.....She is doing contralateral side this coming December. 

Side note; we did not perform any surgery on lesser toes.

Correction of adult acquired flat foot deformity. This healthy 61 yo female had a Gastroc recession (Baumann) , FDL transfer with tenodesis, Evans with BMAC soaked Allograft, and 1st MTP arthrodesis.

We typically take post-op films at 1, 6, and 10 week intervals following bone surgery. This lady had films at slightly different intervals.

Always interesting to follow along the consolidation of the allograft wedge(s) to completion.....She is doing contralateral side this coming December.

Side note; we did not perform any surgery on lesser toes.
...

adamsfootandanklesurgery

View

Apr 2

Open
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.

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.
...

adamsfootandanklesurgery

View

Mar 12

Open
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.

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.
...

adamsfootandanklesurgery

View

Mar 6

Open
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.

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.
...

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