Upon completion of this course, learners should be able to:

• Describe the evaluation, treatment, and outcomes of cavus deformity
• Describe the evaluation, treatment, and outcomes of flatfoot deformity
• Understand the basics of evaluating patients with deformity
• Understand the basics of orthotics for use in deformity correction

A need for this educational activity has been determined based on previous course evaluations and the AOFAS educational curriculum. The content of this course was based on current issues and topics provided by AOFAS membership and leadership. For more information on the AOFAS CME mission, visit aofas.org/education.

AOFAS requires all instructors, planners, and other individuals in a position to control or influence the content of an educational activity to disclose all relevant financial relationships or affiliations during the past 12 months with any commercial interest (any entity producing, marketing, re-selling, or distributing healthcare goods and services consumed by, or used on patients). All identified conflicts of interest must be resolved and the education content vetted by AOFAS for fair balance, scientific objectivity, and appropriateness. AOFAS also requires faculty to disclose when off-label/unapproved uses of a product are discussed in a CME activity. AOFAS attests that the persons responsible for the development of this educational activity did so independently and were not influenced by commercial supporters. All financial disclosures will be provided to meeting attendees in the final program materials.

The material presented in this continuing medical education activity has been made available by the American Orthopaedic Foot & Ankle Society (AOFAS) for educational purposes only. This material is not intended to represent the only, nor necessarily the best, methods or procedures appropriate for the medical situation discussed, but rather is intended to present an approach, view, statement, or opinion of the authors or presenters, which may be helpful or of interest to other practitioners. Methods, techniques, and procedures demonstrated and views and opinions expressed by speakers, presenters, and faculty are their own, and do not necessarily represent those of AOFAS, nor does presentation on the program represent or constitute endorsement or promotion by AOFAS. AOFAS expressly disclaims any warranties or guarantees, expressed or implied, and shall not be liable for damages of any kind in connection with the material, methods, information, techniques, opinions, or procedures expressed, presented, or demonstrated.

FDA Statement
Some drugs or medical devices demonstrated at this meeting have not been cleared by the FDA or have been cleared by the FDA for specific purposes only. The FDA has stated that it is the responsibility of the physician to determine the FDA clearance status of each drug or medical devices he or she wishes to use in clinical practice. AOFAS policy provides that “off label” uses of a drug or medical device may be described in its CME activities so long as the “off label” use of the drug or medical device is also specifically disclosed (i.e., it must be disclosed that the FDA has not cleared the drug or device for the described purpose). Any drug or medical device is being used “off label” if the described use is not set forth on the products approval label.

Faculty/Planner Disclosure Declaration
As an Accreditation Council for Continuing Medical Education (ACCME) provider, AOFAS has the obligation to ensure the delivery of education that is balanced and free of commercial bias. To achieve this, it is the policy of the AOFAS that all CME-related board members, committee members (“planners”), faculty, and appropriate staff disclose in writing to the learners’ all financial relationships that you have had in the past 24 months with ineligible companies. An “ineligible company” are those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

In addition to faculty members, commentators from the floor are charged with verbally disclosing any interests immediately prior to speaking. All disclosures are provided in this final program distributed at the meeting to all program participants.

In accordance with AOFAS policy:
Faculty participation in this educational activity will be predicated upon timely submission and review of AOFAS disclosure. An individual who refuses to disclose all financial relationships will be disqualified from being a planning committee member, a teacher, or an author of CME, and cannot have control of, or responsibility for, the development, management, presentation, or evaluation of the CME activity. Non-compliance will result in a faculty member being stricken from the program.

An indication of the participant’s disclosure appears after his or her name as well as the ineligible company that provided the support. AOFAS does not view the existence of these disclosed interests or commitments as necessarily implying bias or decreasing the value of the author’s participation in this activity. In addition to ensuring that presentations be free of bias, faculty members are required to ensure that all material presented and discussed will be based on best- available evidence.

All of the relevant financial relationships listed for these individuals have been mitigated. 

Richard Zell, MD (Moderator)
Dr. Zell completed his Orthopedic Residency at the University of Connecticut.  He then proceeded with a Sports Medicine Fellowship at Hahnemann University in Philadelphia followed by a Foot & Ankle fellowship at the Hospital for Joint Diseases in New York City.  He is a past Assistant Clinical Professor of Orthpoedic Surgery at the Yale School of Medicine.  Dr. Zell recently moved to Bel Air, Maryland to join the Orthopaedic department at the University of Maryland Upper Chesapeake Medical Center.  Dr. Zell has served as the membership director for the American Orthopedic Foot & Ankle Society.  He is currently a proud member of the AOFAS Education Committee.

Mark Yakavonis, MD

Mark Yakavonis, MD, MMS, FAAOS, is an orthopedic surgeon who specializes in foot and ankle conditions. He is an Assistant Professor of Orthopaedic Surgery at Boston University Medical Center. His expertise includes sports injuries, fractures, syndesmotic injuries, cartilage injuries, Achilles tendon injuries and tendonitis, post traumatic arthritis, foot and ankle arthritis, minimally invasive and arthroscopic surgery, osteochondral lesions of the Talus, foot deformity, bunions, hammer toes, ankle joint replacement surgery and neuromuscular disease. Dr. Yakavonis earned his doctorate at New York Medical College. He completed his residency at BMC, where he served as Chief resident and received the Resident Research Award for his research on a novel operative technique for reducing the ankle syndesmosis. He completed fellowship in foot and ankle surgery at Massachusetts General Hospital where he was awarded a national research grant for his research on the ankle syndesmosis. Dr. Yakavonis has published several peer reviewed scientific papers and co-authored a book chapter on foot and ankle conditions.

Amanda Keefer, APRN

Amanda Keefer APRN, CNP, RNFA, BSN I live in Reno, Nevada. I have been an NP for 5 years and have worked at Reno Orthopedic Clinic for my entire career. Prior to that I worked as a nurse in the apperating room at a local hospital. I obtained my bachelorette from the University of Nevada, Reno and my masters from University of Cincinnatti. I currently work with Dr. Scott Whitlow and work closely with him during clinic and assist in surgery.

Christopher G.. Neville, PT PhD

Dr Christopher Neville is a Professor in the Department of Physical Therapy Education at Upstate Medical University. He is director of the Motion Analysis Laboratory where he completes research with the Department of Orthopedic Surgery, Department of Neuroscience, and the Upstate Concussion Center. Dr. Neville teaches in the area of biomechanics, kinesiology, and research methods for the physical therapy program as well as supervising graduate and medical students from across the campus. Dr. Neville is past-president of the Foot and Ankle Special Interest Group (FASIG) in the Academy of Orthopedic Physical Therapy.

Robert S.. Lin, MEd,CPO,FAAOP

Robert S Lin MEd,CPO,FAAOP Lives in: Rocky Hill, Connecticut Education: University of CT, 1978/ New York University, 1980/ Western Governors University 2010 For nearly 2 decades, Robert Lin served as the Chief Orthotist at Connecticut Children’s Medical Center while simultaneously holding the positions of national residency director and director of academic programs for Hanger Clinic. After completing his undergraduate degree at the University of Connecticut, Bob went on to complete his orthotic/prosthetic training at New York University’s (NYU) Post Graduate Medical School and received his Masters Degree in Clinical Education from WGU. He completed both his orthotic and prosthetic residencies at the then Newington Children’s Hospital and became board certified in orthotics and prosthetics by the American Board for Certification for Orthotics/Prosthetics and Pedorthics (ABC) in 1984. In 2001, he completed the fellowship program with the American Academy of Orthotics and Prosthetics. In 1993, Lin founded the Newington Certificate Program in Orthotics and Prosthetics (the precursor to the University of Hartford’s MSPO Program), growing the program from an initial cohort of six students to its current level of 24 graduates per year. Known nationally and internationally for his work in pediatric orthotics, spinal orthotics, and O&P academia, Lin has authored numerous journal articles and textbook chapters and lectured extensively in his areas of clinical expertise. In addition, he has served on the board of the National Commission on Orthotic Prosthetic Education, culminating in his year as chairman of the board in 1995. He also served as president of ABC in 2009 and holds joint adjunct faculty appointments at the University of Connecticut and University of Hartford. He is a member of the O&P New Editorial Board and the O&P News 175, as well as the New England and American Academy of Orthotists and Prosthetists.

Mark Yakavonis, MD References

• Krause F., Guyton G.  Pes Cavus. In Coughlin, M. J., In Saltzman, C. L., & In Anderson, R. B. Mann's surgery of the foot and ankle (2014). Edition 9. 1361-1382.
• Ledoux, WR; Shofer, JB; Ahroni, JH, et al.: Biomechanical differences among pes cavus, neutrally aligned, and pes planus feet in subjects with diabetes. FAI. 24:845 –50, 2003.
• Manoli A, Graham B.  The subtle Cavus Foot, “the Underpronator,” a Review.  FAI. 26: 256-263, 2005.
• Huber H, Dutoit M.  Dynamic Foot-Pressure Measurement in the Assessment of Operatively Treated Clubfeet.  JBJS. 86:1203-1210, 2004.
• Aminian A, Sangeorzan B.  The Anatomy of Cavus Foot Deformity.  Foot Ankle Clin.  13: 191-198, 2008.
• Scranton, PE; McDermott, JE; Rogers, JV: The relationship between chronic ankle instability and variations in mortise anatomy and impingement spurs. FAI. 21;657 – 664, 2000.
• Ward C, et al.  Long-term Results of Reconstruction for Treatment of a Flexible Cavovarus foot in CMT Disease.  JBJS.  90: 2632-2642, 2008

Amanda Keefer, APRN  References

• M. J. Coughlin, R. A. Mann and C. L. Saltzman, “Surgery of the Foot and Ankle,” 8th Edition, Mosby-Elsevier, Philadelphia, 2007.
• R. M. McMinn, R. T. Hutchings and B. R. Logan, "Color Atlas of Foot and Ankle Anatomy," 2^nd Edition, Mosby-Wolfe, Philadelphia, 2004. 

Christopher Neville, PT, PhD References

• Alvarez RG, Marini A, Schmitt C, Saltzman CL. Stage I and II posterior tibial tendon dysfunction treated by a structured nonoperative management protocol: an orthosis and exercise program. Foot & ankle international. / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. Jan 2006;27(1):2-8. 
•  Augustin JF, Lin SS, Berberian WS, Johnson JE. Nonoperative treatment of adult acquired flat foot with the Arizona brace. Foot and ankle clinics. Sep 2003;8(3):491-502. 
• Bek N, Oznur A, Kavlak Y, Uygur F. The effect of orthotic treatment of posterior tibial tendon insufficiency on pain and disability. The Pain Clinic. 2003;15(3):345-350. 
• Imhauser CW, Abidi NA, Frankel DZ, Gavin K, Siegler S. Biomechanical evaluation of the efficacy of external stabilizers in the conservative treatment of acquired flatfoot deformity. Foot & ankle international. / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. Aug 2002;23(8):727-737. 
• Johnson KA, Strom DE. Tibialis posterior tendon dysfunction. Clin Orthop Relat Res. Feb 1989(239):196-206. 
•  Kitaoka HB, Crevoisier XM, Harbst K, Hansen D, Kotajarvi B, Kaufman K. The effect of custom-made braces for the ankle and hindfoot on ankle and foot kinematics and ground reaction forces. Arch Phys Med Rehabil. Jan 2006;87(1):130-135. 
• Kulig K, Lederhaus ES, Reischl S, Arya S, Bashford G. Effect of eccentric exercise program for early tibialis posterior tendinopathy. Foot & ankle international. / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. Sep 2009;30(9):877-885. 
•  Neptune RR, Kautz SA, Zajac FE. Contributions of the individual ankle plantar flexors to support, forward progression and swing initiation during walking. Journal of biomechanics. Nov 2001;34(11):1387-1398. 
• Neville C, Flemister AS, Houck JR, Neville C, Flemister AS, Houck JR. Effects of the AirLift PTTD brace on foot kinematics in subjects with stage II posterior tibial tendon dysfunction. Journal of Orthopaedic & Sports Physical Therapy. Mar 2009;39(3):201-209. 
• Neville C, Lemley FR. Effect of ankle-foot orthotic devices on foot kinematics in Stage II posterior tibial tendon dysfunction. Foot & ankle international. / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. May 2012;33(5):406-414. 
• Neville CG, Houck JR. Choosing among 3 ankle-foot orthoses for a patient with stage II posterior tibial tendon dysfunction. The Journal of orthopaedic and sports physical therapy. Nov 2009;39(11):816-824. 
• Steb HS, Marzano R. Conservative management of posterior tibial tendon dysfunction, subtalar joint complex, and pes planus deformity. Clinics in Podiatric Medicine & Surgery. Jul 1999;16(3):439-451. 

Robert S. Lin, Med, CPO, FAAOP References

• Orthotics and Prosthetics in Rehabilitation, Lusardi et al. Saunders, 4^th edition Oct 2019
• Management of Common Orthopedic Disorders, Myers et al. Lippincott July 2022
• Atlas of Orthoses and Assistive Devices, Webster et al, 5^th Edition, Feb 2018
• Introduction to Orthotics/A Clinical Reasoning and Problem Solving Approach Coppard et al, 5^th Edition, Mosby May 2019