2025 AOFAS Annual Meeting-Symposium 2A

Video Transcription

Video Summary

This panel discussion covers advanced insights and evolving treatments for complex forefoot issues including big toe arthritis, metatarsalgia, sesamoid pathologies, and lesser toe deformities.<br /><br />Dr. Ken Ellington highlights innovative approaches to big toe problems, exploring partial and total metatarsophalangeal (MTP) joint replacement using improved implant technologies with enhanced bone ingrowth, and the use of amniotic membrane tissue to reduce surgical scar formation. His prospective study revealed better outcomes with amniotic membrane in hallux rigidus surgery, suggesting joint salvage is viable beyond fusion for select patients.<br /><br />Dr. Jose Sanhudo discusses metatarsalgia’s etiology—mainly linked to Achilles/gastrocnemius shortening (functional equinus) and metatarsal length discrepancies (index minus foot). He emphasizes accurate clinical tests like the Silverskiöld test and advocates for gastroc lengthening or metatarsal osteotomies rather than fat injections, stressing tailored surgical interventions based on specific deformities.<br /><br />Dr. Palanca provides a thorough overview of sesamoiditis: anatomy, diagnosis via MRI, and treatment. He stresses conservative management with orthotics, ultrasound-guided corticosteroid injections (limited frequency), and rehab as first-line. Surgical sesamoidectomy yields excellent outcomes if conservative care fails, with plantar approaches preferred to minimize complications.<br /><br />Dr. Neary focuses on lesser toe plantar plate lesions—key stabilizers of MTP joints often overlooked. Early detection through imaging and arthroscopy allows less invasive treatments, while advanced lesions require direct repair or tendon transfers. He warns that despite their importance, plantar plates risk becoming undervalued amid rising minimally invasive surgeries.<br /><br />Rich case discussions underscore challenges in managing recurrent deformities, implant complications, and tailored procedures (fusion, osteotomies, arthroplasty). Speakers advocate for nuanced, patient-specific strategies rooted in anatomical understanding and evolving technology to optimize function and pain relief in forefoot afflictions.

Keywords

forefoot disorders

big toe arthritis

metatarsalgia

sesamoiditis

lesser toe deformities

MTP joint replacement

amniotic membrane tissue

gastroc lengthening

sesamoidectomy

plantar plate lesions