Over one-fifth of AAHKS members promoted the DAA on the internet. Member websites claimed DAA benefits such as faster recovery and decreased pain approximately 9 times more frequently than any potential risk of the procedure (P < .001). While AAHKS policy does not regulate member marketing, it is the responsibility of all orthopedic surgeons to disseminate accurate, validated information concerning the procedures we perform.

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: There has been a growing interest in the utility of minimally invasive surgery (MIS) to correct foot and ankle deformities. MIS is performed using small, targeted incisions rather than large incisions required of open procedures. Proposed benefits of MIS include preservation of blood supply, limited injury to adjacent soft tissue, and fewer wound complications amongst many others. (Neufeld et al, Lu et al). To date, a large number of minimally invasive techniques have been developed to treat common deformities such as hallux valgus, hammertoe, and bunionette. However, there is no brief review that summarizes the literature comparing open surgery with its minimally invasive counterpart. Additionally the options available for MIS treatment of Flexible Adult Acquired Flat Foot/Progressive Collapsing Foot Deformity have failed to keep pace. Methods: We will begin by synthesizing data on MIS in the foot and ankle through analysis of those three aforementioned deformities, summarizing both technique and associated research. Then, we will introduce a novel technique for stage II (flexible) flat foot correction, the Mini-BEAR (bone extra articular reconstruction). Historically treated with the now largely insufficient FDL transfer, we believe this new technique will not only prove biomechanically efficacious but also lead to improved patient safety and lower complication rates. The rapid pace at which novel MIS procedures are developed requires surgeons to be disciplined in conducting and analyzing studies; this synopsis will aim to aid in that process. Results: A novel surgical technique that involves a minimally invasive, all bone extra-articular reconstruction (Mini-BEAR) system. We believe that this technique can potentially replace the multiple long surgical incisions that accompany the traditional medial displacement calcaneal osteotomy, lateral column lengthening, and Cotton procedures with minimal ones, reduce post-operative recovery time, reduce operating room procedure time, and produce a better cosmetic result. Additionally, we believe it will reduce narcotic use secondary to less pain by virtue of less surgical work on the patient. We have also performed a cadaveric anatomic study that qualitatively and quantitatively observed the tendinous and neurovascular structures at risk with the Mini- BEAR procedure. Conclusion: The majority of the publications on the use of MIS to address deformities in the foot and ankle are small cohort studies or retrospective case reviews; many of which lack a control group. Due to this, data showing improvements in MIS vs open techniques is rare. However this is to be expected in a newer, developing field and as larger studies are performed there is optimism that this trend may change. (attached file is example of chart, we have similar format for all 4 deformities discussed in this paper)

The purpose of this study was to determine the relationship of the sural nerve to the Arthrex Percutaneous Achilles Repair System (PARS) jig and repair sutures. We performed cadaveric dissection on 10 unpaired above-knee amputation specimens (6 were right legs and 4 were left legs). In all but 1 cadaver, all of the sutures either punctured the nerve or passed anterior to it. Only 1 cadaver had sutures that were posterior to the sural nerve. In all cases, removal of the jig pulled the sutures through the nerve and the nerve was completely free after locking the sutures, and the sural nerve was within 1 cm of the lateral aspect of the transverse incision made for insertion of the jig. This cadaveric study revealed a high rate of sural nerve puncture when passing needles across the Achilles tendon using a commercially available minimally invasive repair device. This finding should caution users of Arthrex PARS jig to be attentive to postoperative symptoms of nerve injury.Level of Evidence: Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

No abstract

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: The lapidus procedure is a longstanding operation performed for the treatment of hallux valgus deformity with a concomitant hypermobile first ray. Orthopaedic surgeons have a myriad of options to choose from in performing the lapidus procedure. The implantation of orthopaedic implants comes with the risk of iatrogenic injury to surrounding anatomy. Several cadaveric studies in the humerus and femur have described potential neurovascular structures at risk during placement of intramedullary nail systems. The purpose of this study was to determine the proximity of nail insertion and interlocking mechanisms in the Lapidus Phantom Intramedullary Nail System (Paragon 28, Inc.) to neurologic and tendinous structures in the foot. Methods: A titanium intramedullary nail was inserted from the first metatarsal to the medial cuneiform spanning the first tarsometatarsal joint in 10 fresh-frozen cadaver feet. K-wires were inserted in the proximal lateral, proximal medial, and distal medial-to-lateral interlock screw paths. The tibialis anterior tendon, extensor hallucis longus tendon, and superficial peroneal nerve were carefully dissected and exposed, and the distance from each of these anatomic landmarks were then measured and recorded from four different aspects of the nail: Proximal lateral interlocking screw path, proximal medial interlocking screw path, nail insertion, distal interlocking screw path. Distances were averaged, ranges were determined. Results: The tibialis anterior tendon was in closest proximity to the proximal medial interlock K-wire with an average distance of 0.4 mm. The proximal medial interlock bisected the tibialis anterior tendon in three of the specimens. The extensor hallucis longus tendon was in closest proximity to the nail insertion with an average distance of 1.2 mm. A branch of the superficial peroneal nerve was in closest proximity to the distal interlock K-wire with an average distance of 7.5 mm, however, the nerve came in direct contact with the proximal medial interlock K-wire in two of the specimens. Conclusion: The Lapidus intramedullary nail’s proximal medial interlock screw poses the greatest threat to the tibialis anterior tendon, with the distance from the tendon to the interlock K-wire being 3 mm or less in all specimens tested. The extensor hallucis longus tendon is at risk of injury with insertion of the nail. Medial to lateral interlocking poses the greatest danger to a branch of the superficial peroneal nerve. Blunt dissection should be performed using this system with a path to bone before instrumentation to reduce the risk of nerve and tendon injury in the foot.