Challenges in Foot and Ankle Reconstructive Surgery

Harry John Visser, DPM, FACFASDirector of Residency Training SSM DePaul Foot and Ankle Reconstructive Surgery St. Louis, Missouri

Part I. Forefoot Maladies.- Revision of Lapidus, antibiotic spacer 2nd MTPJ.- Revision of Lapidus, interposition biofoam wedge, CC arthodiastatic via TN fusion.- Revision of Lapidus with interpositional fresh femoral head allograft and akin, gastroc recession.- Revision of trauma after Austin bunionectomy, locking plates x2 applied.- Revision of bunionectomy with 1st MT head resection, interpositional fresh femoral head allograft/bone marrow aspirate, locking bridge plate.- Removal of Laporta implant, allomatrix in canals, interposition 1st MTPJ.- Congenital brachymetapody.- Part II. Varus Foot and Ankle.- Cuboid reconstructed with fibula, reattachment.- STJ arthrodesis, arthrodesis of 5th MT shaft to 4th MT base.- Talectomy via transfibular approach, locking plate.- TA tendon tranfer to lateral cuneiform.- AVN of talus secondary to Charcot. Talectomy via transfibular approach, interposition of allograft in reamed tibial and calcaneal sites, application of internal bone stimulator.- Talar AVN. Transfibular approach, resection of tibia and calcaneus, back filling with bone chips. Rigid construct to allow for back filling of gap.- Intrinsic talar tilt in varus. Evans, PB tenodesis, lateral ankle stabilization, deltoid peel, tibialis posterior intratendinous lengthening.- Part III. Valgus Foot and Ankle.- Mueller-Weiss disease reconstruction.- Revision of flatfoot recon. Removal of subtalar screws, revision of STJ arthrodesis. Repeat gastroc recession, derotation osteotomy of TN malunion, removal non-union allograft medial cuneiform arthrodesis of 1st TMT.- Revision of failed triple arthrodesis. Re-alignment of ankle by resection of medial malleolus, femoral head allograft, lateral stabilization plate.- Severe fibular-calcaneal impingement secondary to valgus rearfoot position. Performed talectomy, tibiocalcaneal arthrodesis with IM nail, arthrodesis of 1st MTPJ and hammertoe repair.- Semi-rigid flatfoot in 15 yo M. Treated with sub-capital talar head wedge, Z-plasty tendo achilles lengthening, Koutsigiannis osteotomy.- PT tear. Baumann gastroc recession, double calcaneal osteotomy, Koutsigiannis calc osteotomy, PB to PL transmer inframalleolar, Evans, spring ligament repair, FDL transfer.- Subtalar arthrosis with valgus deformity. Repaired by revision of STJ via Achilles tendon split tendon approach to expose posterior facet. Joint backfilled with BMA and DBM and cancellous chips with 2 parallel fully threaded screws.- Part IV. Charcot Neuropathy.- Biplane transpedal wedge, gastroc recession, posterior calcaneal osteotomy.- Beaming screws to medial and lateral columns, locking plate medially.- Schon type II/III treated with triple arthrodesis with beams, medial column naviculectomy with grafting using beaming technique, protected with Ex-fix.- Bimalleolar fracture. ORIF 5 weeks post injury. Multiple tetrasystesmotic screw fixation, percutaneous screw fixation of medial malleolus.- Ankle fx with IM nail, no joint preparation.- Part V. Tendinopathies.- Hunter rod peroneal reconstruction.- Dwyer osteotomy, excision of peroneal tendons, insertion of peroneal tendon allograft.- Lateral calcaneal osteotomy, FDL transfer to PB stump.- D.P.- Infection secondary to graft jacket. Treated by open Z-plasty and FHL tendon transfer.- Revision of Achilles tendon repair. Treated by resection of Achilles and transfer FHL an FDL.- Repair of insertion of TA tendon.- Part VI. Ankle Joint Revisions.- Tibial calcaneal arthrodesis with IM nail.- Removal of ankle implant, ankle arthrodesis with interpositional bone graft.- Revision of INBONE TAR. 50% talar surface replaced with iliac crest bone graft strut.