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This is one of my favorite cases of the year, not just because of the outcome, but also because the patient personally was great to work with. He is a 24 yo male with CMT but otherwise unremarkable history. He presented with complaints of unsteady gait, repeat sprains, and pain.
After thorough examination we determined his eversion and dorsiflexion strength were approximately 70% of normal. Because of this we elected not to consider PT through IO transfer.

To provide a more planus, and durable foot long term we performed:

▫️TAL
▫️PL to PB
▫️1st IP arthrodesis
▫️DFWO of 1st
▫️PT tendon lengthening
▫️Triple Arthrodesis with everting wedges taken from posterior facet, and CC joint

Post op X-rays and clinical images were taken at 4 months from date of surgery. Pt still very swollen, but minimally tender. Pt starting to ambulate in a sneaker with no bracing. Vitamin D was 47.9 at the time of surgery so no supplementation required. Pt did complete multiple weeks of PT following surgery to work on strength and gait training.

90% of CMT (Charcot-Marie-Tooth) patients have 1 of 4 subtypes. It is a progressive inherited peripheral nervous system disease. 3+ million people worldwide suffer from the disease. It is named after 2 deceased Frenchmen, and a British bloke. ...

Although not common, Sural nerve entrapment can cause debilitating posterior calf pain.
In a healthy 37 year old female whom suffered from this we performed neurolysis after failure of conservative care. We tried US guided steroid injections, gabapentin, topical creams, NSAIDs, oral steroids, and seated positional changes, yet she continued to have pain...The injection did allow total pain relief for less than 2 months. Because of the significant relief with the injection provided when performed at the level of the gastroc heads, this was site of neurolysis. At times pain did radiate along lateral ankle, and into 5th toe. She had history of 5th met fracture within a year, that was treated conservatively with walking boot for 8-10 wks. It is in our opinion that boot may have caused entrapment....No other remarkable findings in history.

At 2 weeks out from surgery she was 100% pain free. ...

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) ...

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. ...

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. ...