Several members of the OFAC team were recently at the Annual Scientific Conference for the American College of Foot and Ankle Surgeons in Ft. Lauderdale, Florida.  This prestigious conference hosts approximately 2000 foot and ankle surgeons from around the world to learn the latest techniques and information.

OFAC research was well represented at the conference with 18 scientific research posters and 2 research projects presented at the podium. Last year’s fellow, Dr J.George DeVries presented a groundbreaking study on predictive factors for below knee amputations in patients with Charcot ankle deformity. In fact, this research earned a 3^rd place award in the manuscript competition. Dr Bussewitz also presented his work on Structures at Risk with the Evan’s Osteotomy which generated a lot of interest from the audience.  In addition, a 2^nd place poster award was gained for important research using MRI to measure success of OCD drilling and microfracture.

Dr. Hyer was quite active at the meeting as a faculty member. He was faculty for the pre-conference cadaver workshop, training other surgeons on TTC fusion using retrograde nailing technique. On the main stage, he also gave presentations on ORIF of Lisfranc joint injuries, Salvage techniques for chronic Achilles disorders and also Autograft harvest techniques in Foot and Ankle Surgeries.

One of the highlights of the meeting for OFAC was getting together fellows from the past, present and future.  Overall, this conference was an exciting opportunity for OFAC to showcase some of our fantastic research on an international stage.

As was mentioned in Dr Decarbo’s earlier link, the physicians of OFAC were awarded an “Honorable Mention” in the Manuscript Competition at the 68th Annual Scientific Conference of the American College of Foot and Ankle Surgeons in Las Vegas, Nevada. Congratulations to Dr Decarbo, lead author of the winning manuscript!

OFAC also presented 2 other manuscripts and 12 scientific poster presentations. The physicians of OFAC continue to lead the charge in education and research in the field of foot and ankle surgery. This was the single largest presence of any group or institution in the entire country.

Our other manuscripts were:

1. Evaluation of Two Types of Fixation for a 1st Tarsometatarsal Arthrodesis: A Retrospective Comparative Cohort. Authors: Drs. DeVries, Granata and Hyer

2. Age Stratification of Outcomes for Osteochondral Lesions of the Talus. Authors: Drs Deol, Berlet, Hyer, Philbin, Lee

Our scientific posters were:

1. A Retrospective Review of First Metatarsophalangeal Joint Arthrodesis Using a Locked Plate and Compression Screw Technique. Authors: Drs Ringus, Swiatek, Hyer

2. A Retrospective Comparative Analysis of Charcot Ankle Stabilization using an Intramedullary Rod with and without Application of Circular External Fixator. Authors: Drs DeVries, Hyer

3. Xenograft Soft Tissue Scaffold for Tissue Augmentation in Foot & Ankle Surgeries. Authors: Drs Hyer, Berlet, Lee

4. Conversion of Failed Total Ankle Arthroplasty to Tibial Stemmed Prosthesis: Techniques for Anterior and Posterior Approaches. Authors: Drs DeVries, Hyer, Berlet, Lee

5. A Retrospective Comparison of Four Plate Constructs for First Metatarsophalangeal Joint Fusion: Static Plate, Static Plate with Lag Screw, Locked Plate, Locked Plate with Lag Screw. Authors: Drs Swiatek, Ringus, Hyer

6. Surgical Technique: Retrograde Drilling of Medial Osteochondral Lesions of the Talus. Authors: Drs Hyer, Berlet, Lee, Granata.

7. Autogenous Bone Graft Harvest Using Reamer Irrigator Aspirator (RIA) Technique for Tibiotalocalcaneal Arthrodesis. Authors: Drs Cuttica, DeVries,Hyer

8. Porcine Dermal Matrix for Tendon Augmentation; A Prospective, Multi-center Series. Authors: Drs. Hyer, Liden

9. Cannulated Screw Fixation of Jones’ 5th Metatarsal Fracture: A Comparison of Titanium and Stainless Steel Screw Fixation. Authors: Drs Hyer, Cuttica, DeVries

10. Interpositional Arthroplasty of the First MTP Joint Using a Regenerative Tissue Matrix for the Treatment of Advanced Hallux Rigidus: 5-year Case Series Follow-up. Authors: Drs Hyer, Granata, Berlet, Lee

11. Wound Complications in Operative Treatment of Calcaneal Fractures. Authors: Drs DeCarbo, A. Granata, Hyer

If you have any questions or interest in these posters or manuscripts, please don’t hesitate to contact OFAC for more information.

In addition to our large research presence at ACFAS, the physicians of OFAC also led educational lab and lecture sessions on the following:

1. Advanced Techniques in Diabetic Reconstruction Workshop: Dr Hyer

2. The Evolution of Surgery: Dr Hyer

3. Surgery in the Advanced Aged Flatfoot: Dr Hyer

4. Curbside Consult Forum: Dr DeCarbo

5. Traumatic Complications-Malunited Ankle Fractures: Dr Hyer

6. Cavus Foot Reconstruction Workshop: Dr Hyer

As you can see, the physicians of OFAC are the leading experts in all aspects of foot and ankle care. If you need the highest level of expert care, don’t hesitate to contact us.

The OFAC Fitness Challenge has become an annual tradition and the time is here again!

The holidays can be a tough time to stay active and healthy. So, now is the time to finish off the last of your cravings and desserts and buckle down for the OFAC Fitness Challenge.

A Final Dessert

Each year we put together a competition to encourage health and fitness in a fun, lively atmosphere with a little competitive spirit thrown in as well. This contest has grown in number every year and each year is a bit different. It has been my pleasure to organize this year’s challenge with help from our friends at Baseline Fitness.

This year we are going to use social media and our OFAC Facebook site to help coordinate and update everyone on the contest over its 3 months. Sorry, you will need a facebook account to view the postings I believe.

Here are some details:

• Contest open to all ‘friends of OFAC’- everyone is welcome to participate. The more the merrier.
• Contest runs from Jan 4 to March 31. Yeah, I know—IT’S 3 MONTHS LONG! Only the strong survive.
• RSVP to Katie Allen @ OFAC to confirm you’re joining  allenkm@orthofootankle.com
• Coordinate with Eve Ann @ Baseline Fitness to complete your BOD POD which is a body analysis of lean muscle and body fat content. We’ll do this as a ‘weigh-in’ at the beginning of the contest and another at the end as a ‘weigh-out’. ‘Weigh in’ has to be done by Jan 1.
• You’ll need a pedometer. You can use your own or get one from Eve Ann @ Baseline. One that measures steps for a week is preferable and easier on you.

We will have a Weigh Out Party in early April to celebrate everyone’s improvement and announce the winner!

• This party will feature all the fried food, carbs and sugar laden treats you’ll be skipping on during the contest. This is a nice reward for a job well done.

Here’s how the competition will work:

Points will be calculated by-

• 20% BOD POD- you’re raw numbers won’t be published or identified. We’re looking at who can make the greatest improvement in loss of % body fat- % body fat is changed by losing fat and/or gaining lean muscle–either way, you make positive change to this number.
• 20% Pedometer steps- steps need to be recorded and reported on a weekly basis via email to Katie Allen allenkm@orthofootankle.com First email report to Katie will be Sunday, Jan 10 and every Sunday night after that. If you don’t report, you don’t get credit.
• 20% January Weekly Fitness Events- Each week will have a new ‘Fitness Event’ to perform. It can be done anytime during that week. These events are designed to promote health, wellness and camaraderie amongst contestants. Everyone of all activity levels will be able to perform.  Each Sunday night, starting January 3rd, the event and description will be posted on to the OFAC Columbus Facebook Site . Most events will require you to upload photo evidence to the Facebook site that you completed the event. If you don’t prove you did it, you can’t get credit for that week’s event.
• 20% February Weekly Fitness Events- same rules as January
• 20% March Weekly Fitness Events- same as Feb.

I hope everyone will consider joining this year’s contest! I think with the addition of a new event each week, we should have more fun than ever before!

Good luck—see you at the Weigh Out Celebration Party

Christopher Hyer, DPM, FACFAS

Orthopedic Foot&Ankle Center

The OFAC team has three recent publications in scholarly, peer-review medical journals. I’ve posted the title, reference and abstract of each below. In addition to our many lectures at local, regional, national and international medical meetings, our focus on scholarly research and publication of our results continues to forge us ahead of any other foot and ankle practice in the country.

Complications associated with autogenous bone marrow aspirate harvest from the lower extremity: an observational cohort study

J Foot Ankle Surg. 2009 Nov-Dec;48(6):668-71.

Roukis TS, Hyer CF, Philbin TM, Berlet GC, Lee TH

The purpose of this article is to report the complications associated with autogenous bone marrow aspirate harvested from the lower extremity (ie, tibia and/or calcaneus) for soft tissue and/or osseous healing augmentation. This is a multisite, multisurgeon, observational cohort study involving retrospective review of prospectively collected data of 548 autogenous bone marrow aspirate harvests from the lower extremity of 530 consecutive patients between August 2000 and March 2009. Each patient underwent autogenous bone marrow aspirate harvest from the proximal medial tibial metaphysis, distal medial tibial metaphysis, medial malleolus, lateral calcaneus, medial calcaneus, or a combination of both the proximal tibial metaphysis and lateral calcaneus for application to split-thickness skin graft application sites or for mixture with allogeneic bone graft material for osseous defects or arthrodesis. Patients were kept non-weight bearing based on the index procedure and followed until clinical healing occurred or failure was declared. There were 324 female and 206 male patients with a mean age of 54.7 +/- 14.1 years (range: 14 to 84 years). There were 276 left feet/ankles and 272 right feet/ankles undergoing operative interventions with 18 harvests occurring from the proximal medial tibial metaphysis, 183 from the distal medial tibial metaphysis, 11 from the medial malleolus, 325 from the lateral calcaneus, 3 from the medial calcaneus, and 8 from both the proximal tibial metaphysis and lateral calcaneus. All procedures were deemed successful with no nerve-related injury, infection, wound-healing complications, or iatrogenic fracture occurring. When properly performed, autogenous bone marrow aspirate harvest from various locations about the lower extremity as described here represent safe and minimally invasive techniques useful for soft tissue and osseous healing augmentation. Level of Evidence: 4 (Case Series; Therapeutic Study).

Transosseous fixation of the distal tibiofibular syndesmosis: comparison of an interosseous suture and endobutton to traditional screw fixation in 50 cases.

J Foot Ankle Surg. 2009 Nov-Dec;48(6):620-30.

Cottom JM, Hyer CF, Philbin TM, Berlet GC

In this prospective cohort study, we compared screw fixation to interosseous suture with endobutton repair of the syndesmosis. Outcomes of interest included preoperative and postoperative modified American Orthopedic Foot and Ankle Society (AOFAS) hindfoot and ankle scores, and Short Form-12 health status scores, as well as radiographic measurements and the time to full weight bearing. Mean averages and ranges were calculated for numeric variables, and outcomes for each fixation group were compared statistically with Student t test. The cohort consisted of 50 patients; 25 in the screw fixation group and 25 in the interosseous wire with endobuttons group. The mean patient age was 34.68 (15 to 55) years in the interosseous suture endobutton group and 36.68 (17 to 74) years in the screw group, and the mean follow-up was 10.78 (range 6 to 12) months in the interosseous suture endobutton group, and 8.20 (range 4 to 24) months in the screw group. No statistically significant differences (P < or = .05) were noted in regard to age, follow-up duration, time to postoperative weight bearing, or subjective outcome scores between the fixation groups; although statistically significant improvements were noted in the subjective scores for each fixation group between the preoperative and postoperative measurements. The results of this study indicate that the interosseous suture with endobuttons is a reasonable option for repair of ankle syndesmotic injuries, and may be as effective as traditional internal screw fixation. Level of Clinical Evidence: 2.

Results of lapidus arthrodesis and locking plating with early weight bearing.

Foot Ankle Spec. 2009 Oct;2(5):227-33

Sorensen MD, Hyer CF, Berlet GC

In the endeavor toward Lapidus fusion, the authors have studied a new application of locked plating for the first tarsometatarsal joint. The goal was to assess the time to fusion, time to ambulation, rate of delayed union/nonunion, rate of revision, and need for hardware removal following the use of locked-plate technology in the fusion of the first tarsometatarsal joint. The findings denoted an average of 6.95 weeks to radiographic fusion, an average of 2 weeks to ambulation, a 9.52% rate of asymptomatic mal-union, a 0% rate of delayed union or nonunion, and a 0% rate of revision. The rate of need for hardware removal was 4.76%.

Check back often for more updates on our mission on improving foot and ankle education
and outcomes.

Christopher F. Hyer, DPM, FACFAS

  One of the many challenging and complex problems our diabetic patients face is Charcot foot or neuroarthropathy. This condition creates destruction and collapse of the bones in the foot and can lead to amputations.

"Normal" foot on xray

“Charcot Foot” with joint dislocations

The physicians at OFAC  are skilled at this complex reconstructive surgery and are constantly developing and using new techniques to improve patient outcomes. Recently, Dr. Hyer is one of the first physicians in the world to utilize this innovative, new intramedullary compression device within the bones of the foot as part of this reconstruction. This new implant (called TarsX) provides a much stronger form of fixation compared to typical screws and plates that are used and should allow for better bone healing. 

Here is a video of technique on cadaver specimen (you’re warned!)

Case Presentation

This case has a typical pattern of midfoot joint destruction with severe foot deformity as a result.

Severe Charcot Midfoot deformity with planned correction

Reconstruction in process. Half of implants in.

Reconstruction and realignment finished. Complete implants in.

Implants in. Realigned foot and arch achieved.

  Please check back often for updates and new techniques such as this for these challenging cases.

Dr. Hyer

The physicians of OFAC recently had their research published in the peer-reviewed journal, Foot and Ankle Specialist. The article demonstrates a new method to correcting severe bunion deformities while safely allowing patients to ambulate much sooner. The procedure, called a Lapidus arthrodesis or fusion, typically required patients to be in a non-weight-bearing cast for at least 6 -8 weeks. New techniques and evidence documented in this study by OFAC has shown a higher healing rate than other published studies and with patients weight-bearing at 2 weeks after the surgery!

Severe Bunion Deformity

Severe Bunion Corrected with Modified Lapidus Technique

With this new technique, patients often can begin protected weight-bearing in a bunion boot walker around 10-12 days. This is an important advance as early weight bearing minimizes time lost from work, eases burdens onto family and friends and is overall much healthier for our patients. 

'Bunion Boot'- protects foot during early weight-bearing.

Not all bunions need to be fixed, but when they do, the physicians of OFAC have the expertise and experience to insure the solution is the right one for you.  I encourage everyone to ask questions, discuss with your doctor and understand what is being recommended and why.

One of our main tenets in practice is to continually educate and strive to improve. I am proud of the research and education efforts our team provides and am confident it is unmatched anywhere. Our new website allows us to quickly broadcast this new information as it becomes available, often before it is even in print.

Check back often as more and more of our work moves toward publication in leading medical journals.

Christopher F. Hyer, DPM, FACFAS

Co-Director, Foot and Ankle Fellowship, Orthopedic Foot & Ankle Center, Westerville, Ohio

Trauma Section Editor, The Journal of Foot and Ankle Surgery

Editorial Board, Foot and Ankle Specialist

OFAC takes pride in leading the way in foot and ankle education and training. We are currently preparing for the American Orthopaedic Foot and Ankle Society’s summer academic meeting. In addition to giving lectures and moderating panels of experts, we will be presenting several abstracts and academic posters on various foot and ankle problems. This is a focus of our team all year long and allows us to raise the bar of what the foot and ankle specialty can provide. Check back often as we will continue to post updates on our latest research and publications.