2025 AOFAS Annual Meeting-Symposium 11A

Video Transcription

Video Summary

This symposium highlighted key aspects of pediatric foot and ankle pathology, emphasizing multidisciplinary collaboration to improve long-term outcomes. Dr. Einow discussed managing pediatric clubfoot, a common congenital deformity characterized by cavus, adductus, varus, and equinus components. The gold standard treatment is the Ponseti method—serial casting and Achilles tenotomy—with a high success rate, but adherence to bracing is critical to prevent recurrence. For resistant or recurrent cases, surgical options range from tendon transfers to more invasive releases and bony procedures, always striving to preserve function and avoid fusions that complicate adult care.<br /><br />Dr. Zeid addressed painful pediatric flexible and rigid pes planus, stressing tailored surgical approaches including gastrocnemius recession, lateral column lengthening, and selective coalition excision. Identifying symptom generators and understanding the anatomy are key to surgical planning. CT imaging aids deciding between coalition excision versus arthrodesis, with flatfoot correction combined as needed.<br /><br />Dr. Pfeffer focused on Charcot-Marie-Tooth disease-related cavovarus deformities. He emphasized early surgical intervention in symptomatic children to avoid lifelong bracing and irreversible deformity. CMT surgery involves tendon transfers, osteotomies, and careful management of Achilles contractures, favoring HIBs tendon transfers over posterior tibial transfer in children due to functional considerations.<br /><br />Dr. Norell reviewed rare pediatric deformities including congenital vertical talus, skewfoot, neuromuscular flatfoot, and adolescent bunions. Treatment ranges from manipulation and casting with percutaneous pinning to salvage procedures like naviculectomy and talectomy in severe or syndromic cases. Recognizing associated neuromuscular disorders and performing appropriate soft tissue and bony corrections tailored to the pathology and growth potential is essential.<br /><br />The session concluded with adult cases highlighting the sequelae of pediatric deformities and complexities in salvage surgery, underscoring the importance of early, multidisciplinary pediatric management to optimize lifelong foot and ankle health.

Keywords

pediatric foot pathology

clubfoot

Ponseti method

pes planus

Charcot-Marie-Tooth disease

cavovarus deformity

tendon transfers

congenital vertical talus

neuromuscular flatfoot

salvage surgery