2025 AOFAS Annual Meeting-Paper Session 4C

Video Transcription

Video Summary

This session presented several studies on foot deformity corrections focusing on first tarsometatarsal (TMT) joint procedures and bunion surgeries, highlighting outcomes, complications, and novel techniques.<br /><br />Dr. Bopa Kriya reported on first TMT bone block arthrodesis using a precontoured allograft wedge with a two-year follow-up of 52 feet. Significant improvements in pain and function were noted; however, there was a high nonunion rate (42%) and a 27% revision surgery rate. Complications included contractures, wound issues, and implant failures. Notably, increased plantar first metatarsal overload and potential acceleration of hallux rigidus were observed. Dynamic plantar pressure assessment suggested altered load distribution post-surgery.<br /><br />Dr. Johnson discussed correction of dorsal bunion deformity via a double bone block arthrodesis at the naviculocuneiform and intercuneiform joints, targeting the apex of deformity. Radiographic analysis of nine feet showed significant restoration of first ray alignment with no nonunions or infections. Successful adjunctive tendon transfers and soft tissue releases were critical due to the complexity of the deformity.<br /><br />Comparative research on modified Lapidus fusion versus minimally invasive Chevron-Akin (MICA) bunionectomy in patients with asymptomatic flatfoot found both procedures improved PROMIS and radiographic outcomes. Lapidus had better correction in certain angles linked to sagittal collapse, suggesting it may be preferable for patients with more severe medial column collapse.<br /><br />Further, a study using weight-bearing CT coverage maps demonstrated that after MIS bunionectomy, first TMT joint congruency significantly changed with regional decreases and increases in coverage, suggesting pronation rotation of the proximal metatarsal fragment and potential clinical implications like recurrence or arthritis.<br /><br />Another bone block Lapidus series showed restoration of foot alignment but with an 11.9% clinical nonunion rate and 33% tomographic nonunion, emphasizing cautious patient selection and fixation techniques.<br /><br />Lastly, inclusion of an intercuneiform screw in modified Lapidus procedures reduced intercuneiform gapping and hallux valgus recurrence compared to traditional fixation, enhancing midfoot stability.<br /><br />Discussion emphasized the importance of technique precision, patient selection, adequate fixation, and longer-term follow-up to understand fusion success and recurrence risks, with current data suggesting careful counseling regarding complication rates and reoperation likelihood.

Keywords

first tarsometatarsal joint

bone block arthrodesis

bunion surgery

Lapidus fusion

minimally invasive Chevron-Akin (MICA)

foot deformity correction

nonunion rate

plantar pressure assessment

intercuneiform screw fixation

hallux valgus recurrence

weight-bearing CT coverage