CME OnDemand: 2025 Advanced Foot and Ankle Course-Symposia 5-8

Video Transcription

Video Summary

The comprehensive symposium covered advanced insights into Charcot neuroarthropathy, complex forefoot and metatarsophalangeal (MTP) deformities, minimally invasive surgery (MIS), arthroscopy in trauma, and progressive collapsing foot deformity (PCFD) with state-of-the-art imaging and surgical strategies.<br /><br />Dr. Einardi discussed evolving management of Charcot, emphasizing early surgical intervention during the inflammatory phase to prevent deformity progression, corroborated by animal studies showing microtrauma’s role. Surgical indications include unstable deformities and infection, with external fixation frames favored, particularly in complex or infected cases. Dr. Reddy detailed utility of external frames and hybrid fixation for enhanced stability, highlighting meticulous pin placement to minimize complications. Dr. Jones presented advances in internal fixation for midfoot Charcot deformities using “beams and bolts” (intramedullary nails and screws), stressing joint preparation and staged procedures with adjunct biologics for infection clearance.<br /><br />Dr. Neary emphasized minimally invasive joint preparation techniques in Charcot surgery to preserve biology and reduce wound complications, advocating axial compression testing to confirm adequate cartilage removal and bone bleeding. Dr. Brodsky reviewed recurrent hallux valgus classification and surgical approaches, advocating precise osseous realignment over soft tissue-only correction, discussing salvage options including fusion for soft tissue laxity or failed prior surgery. Dr. McDonald advocated MIS approaches for metatarsalgia, integrating soft tissue and bony correction tailored to pathology, recognizing limitations in current evidence while underscoring clinical judgment. Dr. Barreto addressed complex MTP salvage surgeries balancing patient goals and bone loss management, highlighting interpositional arthroplasty and arthrodesis options. Dr. Miller covered MIS bunion complications, stressing careful thermal management during osteotomies and delayed union considerations.<br /><br />The trauma segment led by Dr. Dracos championed arthroscopic-assisted ankle ORIF to diagnose and treat cartilage and syndesmotic injuries, improving reduction accuracy and identifying injuries missed by imaging. Dr. Harris highlighted primary fusions as valuable in select midfoot, hindfoot, and ankle trauma, especially in high-energy or non-reconstructible fractures, noting indications evolved based on energy, deformity, and comorbidities. Dr. Clare discussed reconstructive strategies for calcaneal malunions including lateral wall exostectomy, modified Romash osteotomy, and peroneal tendon management tailored to fracture patterns like fracture dislocations. Dr. Oh delineated neuropathic fractures from Charcot neuroarthropathy, advocating early surgical management in unstable fractures, emphasizing augmentation (“double down” fixation), prolonged immobilization, and consideration of TTC fusion for salvage in high-risk patients.<br /><br />In deformity correction, Dr. Smith underscored the importance of “realigning the foot” rather than focusing on perfect joint reduction during triple arthrodesis, clarifying hindfoot kinematics and soft tissue releases for deformity correction without routine wedges or osteotomies. Dr. Ellis debated the ongoing necessity of lateral column lengthening (Evans osteotomy), recommending avoiding overcorrection to prevent lateral overload and highlighting newer techniques like step cuts and ligament reconstructions that may reduce need for large grafts. Dr. McGarvey traced medial column pathophysiology emphasizing multiligamentous contributions beyond posterior tibial tendon insufficiency, advocating comprehensive medial column stabilization in PCFD, including joint fusions as indicated by apex of deformity. Dr. Creech illustrated how weight-bearing CT has revolutionized PCFD assessment by revealing 3D deformities, peritalar subluxation, and sinus tarsi impingement, guiding precise staging and tailored surgical planning, including ligament reconstructions and combined osteotomies. She emphasized early detection and intervention for better outcomes versus progression to arthritis and complex fusions.<br /><br />Panel discussions stressed the individualized nature of deformity correction, recognizing that “perfect” radiographic correction isn’t always essential for good clinical outcomes. Under-correction of abduction with slight overcorrection of heel valgus often yields superior results, while avoidance of eversion stiffness is critical. The emerging interosseous ligament reconstruction shows promise as a motion-sparing strategy in select PCFD patients, potentially reducing reliance on fusion.<br /><br />Overall, these sessions conveyed a multidisciplinary, evidence-informed approach combining advanced imaging, biologics, MIS techniques, and nuanced surgical decision-making to optimize outcomes in complex foot and ankle pathologies. Patient-specific factors and collaborative care remain central to treatment success across Charcot neuroarthropathy, forefoot deformities, trauma, and progressive flatfoot.

Asset Caption

Symposium 5 – Charcot
Moderator: Michael C. Aynardi, MD

Updates to Surgical Indications for Charcot
Michael C. Aynardi, MD

Frames, Hybrid Fixation, and Superconstructs
Veerabhadra K. Reddy, MD

Beams and Bolts
Carroll P. Jones, MD

MIS Joint Prep: How to Know if Your Prep Is Adequate
Kaitlin C. Neary, MD

Cases and Discussion

Symposium 6 – Failures in Forefoot Surgery
Moderator: Jacob R. Zide, MD

Recurrent Hallux Valgus Deformity
James W. Brodsky, MD

MIS Management of Metatarsalgia: Does Anyone Do a Weil Anymore?
Thomas A. McDonald, MD

Salvage Procedures for the 1st MTP Joint
Jason T. Bariteau, MD

Management of the Failed MICA
Christopher P. Miller, MD

Cases and Discussion

Symposium 7 – Trauma
Moderator: Jeremy T. Smith, MD

Scope Assisted Ankle ORIF
Mark C. Drakos, MD

Primary Fusions for Acute Trauma
Thomas G. Harris, MD

Hindfoot Malunions
Michael P. Clare, MD

Neuropathic Fractures
Irvin Oh, MD

Cases and Discussion

Symposium 8 – Flatfoot
Moderator: Jacob R. Zide, MD

Deformity Correcting Triple Arthrodesis
Jacob R. Zide, MD

Is the Evan's Necessary?
Scott J. Ellis, MD

Managing the Medial Column in PCFD
William C. McGarvey, MD

WBCT: Does It Impact Decision Making?
Cesar de Cesar Netto, MD, PhD

Cases and Discussion

Keywords

Charcot neuroarthropathy

forefoot deformities

metatarsophalangeal deformities

minimally invasive surgery

arthroscopy in trauma

progressive collapsing foot deformity

external fixation frames

intramedullary nails

axial compression testing

hallux valgus classification

metatarsalgia

interpositional arthroplasty

arthrodesis

arthroscopic-assisted ankle ORIF

weight-bearing CT