2025 AOFAS Annual Meeting-Symposium 6B, Symposium 7B, Symposium 8B

Video Transcription

Video Summary

The symposium featured complex cases and discussions on advanced foot and ankle pathologies and treatments, particularly focusing on hindfoot deformities, talus avascular necrosis (AVN), and midfoot reconstruction.<br /><br />Alexandre dos Santos presented a challenging case of a young ex-MotoGP rider with severe deformities encompassing hindfoot valgus, alux valgus, and varus knee deformity. His surgical strategy involved a one-stage multilevel correction, including high tibial osteotomy and ACL reconstruction for the knee, along with lateral column lengthening and soft tissue procedures in the foot. The approach achieved good realignment and bone healing, though concerns about overcorrection and timing were debated.<br /><br />Joseph Park discussed a severe flatfoot deformity with valgus hindfoot and midfoot collapse in a heavy laborer, outlining complications of triple arthrodesis, nonunions, and ankle arthritis progression. He emphasized challenges with reduction, fixation reliability, and staged versus single-stage surgeries, underscoring the complexity of correcting rigid deformities with multiple joint involvement.<br /><br />Mark Meyerson shared insights on calcaneovalgus deformities primarily associated with neuromuscular conditions, describing surgical principles of tendon transfers, osteotomies, and in severe bilateral cases, TTC arthrodesis with tendon transfers enabling ambulation.<br /><br />Howard Donner delivered a compelling wilderness medicine presentation highlighting expedition medical planning, challenges of remote care, unique therapies (e.g., Penthrox inhaler, Iloprost for frostbite), and advances such as satellite communication and point-of-care ultrasound that have transformed remote medical management.<br /><br />The presidential address by David Thurardison summarized AOFAS initiatives including resident education, research funding, and advocacy highlighting the distinction between orthopedic surgeons and podiatrists. Sheldon Lin was introduced as the incoming president with a vision emphasizing resident education, research, international collaboration, and advancing foot and ankle orthopedics.<br /><br />A separate symposium focused on talus AVN management debated the roles of total ankle arthroplasty (TAA), total talus replacement, and arthrodesis options. Ray Walsh shared that TAA can be considered in select focal dome AVN cases with careful workup. Rishan Kadakia advocated for total talus replacements combined with subtalar fusion in advanced cases to preserve motion. Glen Maloney reviewed fusion techniques (isolated ankle, subtalar, TTC) emphasizing high complication rates but necessary trade-offs.<br /><br />A panel discussion addressed technical nuances like implant choice (cobalt chrome vs PEEK), size selection, subtalar fusion necessity, and graft options (allograft vs femoral head) highlighting individualized surgical decision-making.<br /><br />The midfoot symposium presented complex trauma and arthritis cases illustrating the challenges of deformity location identification, staging, appropriate joint fusions vs osteotomies, and soft tissue management. The speakers emphasized understanding deformity apex, correcting supination or adduction deformities, and balancing fusion extent with motion preservation.<br /><br />Cases included catastrophic crush injuries with vascular compromise, flatfoot with cavus/adduction post-TTC fusion requiring distal corrections, and naviculocuneiform arthritis necessitating medial column fusions with structural grafting.<br /><br />Minimally invasive strategies and recent innovations in fixation and biologics were discussed, but the speakers agreed that complex foot deformities demand case-by-case tailored plans involving multidisciplinary collaboration and patient-specific goals.<br /><br />Overall, the sessions highlighted the intricacies of managing severe hindfoot and midfoot deformities, emerging technologies in implant design and remote care, and the critical role of education and research to improve outcomes in foot and ankle orthopedic surgery.

Asset Caption

"Symposium 6B: Techniques of the Masters: Hindfoot
Howard J. Donner, MD; Extremes and In-Betweens: A Journey Through Expedition Medicine
Symposium 7B: The Talus Is So Frustrating II: Talus AVN
Symposium 8B: Techniques of the Masters: Midfoot"

Keywords

hindfoot deformities

talus avascular necrosis

midfoot reconstruction

multilevel correction

high tibial osteotomy

ACL reconstruction

lateral column lengthening

triple arthrodesis complications

calcaneovalgus deformities

tendon transfers

TTC arthrodesis

wilderness medicine

total ankle arthroplasty

total talus replacement

midfoot arthritis