Dealing with First Ray, Flatfoot

July 21, 2017

Track 4: Foot and Ankle Surgery
Thursday, July 27
10–11:30 a.m.
Tennessee A

Two surgery presentations in Thursday’s Foot and Ankle track will look at managing infections and non-union of the first ray and osteotomy options for repairing flatfoot deformities.

First Ray Infection, Non-Union

Jacob Wynes, DPM, MS, will present “Management of Infection and Non-Union of the First Ray,” focusing on biologic considerations for infection and non-union, and ways to recognize them. He also will provide practical treatment options.

Dr. Wynes, an assistant professor of orthopedics at the University of Maryland School of Medicine, Baltimore, will use case studies and explain the development of novel management approaches.

“Infection and non-union are mutually exclusive events, but they can overlap,” he said.

Approaches Dr. Wynes will discuss include out-of-the-box thinking based on literature for hip and knee infections.

“There will be a mixture of established as well as novel procedures. It will provide a good understanding of what available options there are in managing these two entities,” he said. “There are guidelines that have been developed from other areas extrapolated to the management of the first ray. There is substantial evidence to support a lot of these modalities.”

Surgery for Flatfoot Deformities

Michelle L. Butterworth, DPM, will explore “Medial Calcaneal Displacement Osteotomy,” in which she will discuss indications for using the procedure and how it is performed.

“This is a highly effective procedure when it is properly indicated. You get adequate correction, it has high success rates, and with the proper technique you can minimize complications,” said Dr. Butterworth, chief of the medical staff at Williamsburg Regional Hospital, Kingstree, SC.

The procedure is best used to deal with stage 2 posterior tibial tendon dysfunction. In a physical exam, if the patient has any tibial posterior dysfunction, the strength of the tendon should be assessed, she said.

“If it is a flexible deformity where I can still do a flatfoot reconstruction, then this osteotomy is one of the procedures I use to correct the deformity,” Dr. Butterworth said.

In her presentation, Dr. Butterworth will explain the techniques she uses, surgical tips, fixation options, and dealing with complications.

 

 


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