• Comments (57)
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  • Dieter - I know of colleagues who perform the procedure bilaterally.
    I don't think it's wise because your moving the foot into a supinatory direction compared to where it was and when doing this bilaterally you could potentially cause the implant to back out.
  • Quote:

    I strive to correct what I think I need to with 1 surgery.  That being said I have had to perform the Cotton staged after the implant.

     

    Don

    MIS for metatarsalgia lends itself well to concurrent surgery with Hyprocure. Some Hyprocure surgeons aim for immediate weight-bearing, i.e. return to sneakers (with ankle strapping) after week 1, while others are more cautious. Is there informed consensus / evidence to know which approach makes for a better outcome?

    A staged surgical approach will make some sense, to evaluate correctly the effect of EOTTS on the foot. The peri-articular connective tissue structures are sometimes observably affected following restoration of TTJ's, this can take a while to settle. Mostly a patient will have Hyprocure staged also, with the second stent implanted around 6 weeks later. Nothing useful can be extrapolated about the position of the structures, and tissue response until the stent is settled and the tissues have adapted and the foot is more settled..  

    Also, does anyone perform bilateral Hyprocure, on the same day?

    Some patients, s/p Hyprocure, will c/o ankle pain - sometimes related to the ATFL, other times the peroneals, or the TCJ. When a patient has radiographic signs of mild / early ankle joint arthritis, would this constitute a C/I, in your collective opinion, or would this be case dependent weighing up the overall objective, with an evaluation of the likely gains & losses.

    About the effect of AT contracture on 1st ray position, is there a reference for this study? 

  • Do you think it matters if you perform these procedures together vs staging. I realize this might be a surgeons preference, however, one can not fully appreciate the hyprocure correction without seeing the patient weight bearing.
  • Thank you, Dr. Peacock, for your time and effort and contributions. It is my observation, and please correct me if I am wrong, that foot-typing dove-tails into your work-up by way of an attempt to simplify the clinical part of a joint assessment. You mention, in passing, the role of radiographic imaging. 

    If that is the sole, stated purpose and foot typing, in this way satisfies your criteria, then that's the end of that.

    If I follow your thought process correctly, you are foot typing to determine flexibility / ROM and position in the STJ and 1st ray, customarily performed by most everyone and distinguished only by a different terminology.

    The concept of foot typing is of course the brain child of the originator, Dr. Scherer. In your version of foot typing, heel position is referenced against the STJ neutral position (by which, I assume you mean talo-navicular congruency, the surrogate marker of STJ neutral); and this is somewhat different to Dr. Shavelson's ideology which has required of him a great amount of time arguing emphatically against the value and significance of the STJ neutral position. However, no attempt is made here, to draw any other conclusion.

    Adopting Dr. Shavelsons' assessment it is stated the great majority of patients will present with RR:FF. Few if any patients, then will require a Hyprocure, following this method of assessment. I posit this is incorrect and the assessment is incorrect. When a patient is evaluated clinically and radiographically the parameters for talo-calcaneal instability are well laid out by Dr. Graham, and this conforms with the larger consensus of our knowledge and understanding of normal and abnormal position and function.  

    For forefoot assessment I am still no wiser to know why the 1st ray, with its' independent axis of motion is referenced to the 5th ray, also with it's own independend axis of motion. Customarily the position of the 1st metatarsal is assessed with reference to the 2nd metatarsal. 

    Others will of course insist that the position of the foot does not create pathology, with moments and torque assuming this responsibility.  

  • Dr. Peacock - thank you for the video, and taking your time to join the discussion here.
    I have some follow up questions if you can indulge.
    1) when addressing the first Ray hypermobility when planning a hyprocure are you doing your first ray procedures like the cotton or plantarflexory osteotomy percutaneously or open?
    2) gastroc recessions is something I brought up before and I didn't get the answer I was looking for. In your experience when performing a gastroc release with a hyprocure what if anything occurs to the first Ray and navicular in particular?
    Do you for example see a correction in navicular fault and a decrease in deformity of first met elevatus?
    3) you said multiple times in your lecture when discussing forefoot serm that most refer to this as hypermobility. That being the case why not stick with the verbiage we are all comfortable with? What's wrong with saying first Ray hypermobility?
    What does the foot typing here add that we all weren't already practicing?
    You look for Equinis, you examine rear foot position then you test for a hypermobile first Ray - all this superfluous lingo of serm and perm makes the discussion confusing at best. All Dr. Shavelson seems to do is create new lingo. Orthotics are foot centrings, limb length is called TIP and the list goes on and on.
    Would you agree or disagree that we are examine range of motion of rear foot when foot in Stj neutral and first Ray hypermobility nothing more nothing less?
  • Quote:

    Hi everyone,

     

    I was not aware of this thread and I will be glad to chime in.  I will read through the post later today and post my thoughts ASAP.  

    Don Peacock

    Announcement

    Dr. Peacock and I have been engaged in a behind-the-scene think tank opportunity. I am pleased to announce that Dr. Peacock kindly agreed to comment via a filmed video presentation. Once that is complete he will post the link here.

    Thank you, Dr. Peacock, for agreeing to engage in this lively and stimulating debate.

  • Dieter:

    1. From my prospective, ELF Press was invented by Don to improve the ability of more and more foot surgeons to be able to treat metatarsalgia utilizing MIS internationally with fewer transfers, reduced complications and better outcomes.

    2. Unlike you, I do not have the ability to know what others are thinking, rationalizing and speculating and must wait for the next time I think tank with Don to respond to this query as I offered with a civil response to your query the first time.

    Happy Labor Day

    Dennis

    Shame on you --- more gibes


    Dennis,

    I have a better idea. Please shoot him a quick e-mail and invite him to this blog. That should take 10 seconds then we don't have to wait for your think tank session.

     MIS can be a useful tool, internationally, but doesn't require foot typing to succeed. Dr. Peacock is the only MIS surgeon, that we know of, who even mentions it. So, it will be nice if he can return to the forum to explain exactly why he thinks so.

    Thanks

    PS Never mind I'll spare you the trouble and send Dr. Peacock an e-mail myself .....

  • Dr Shavelson - you, not Dr Peacock made the blog.
    The question posed was why did you?
    I presume you enjoyed Dr Peacock mentioning your name and foot typing.
    You state in your response to a Dieter Peacocks System was created to give better outcomes cut down on transfer lesions etc. that is great, but he is doing so without foot typing is the point.
    Foot typing was mentioned but not used in the video.if you feel it was then please explain how it was and how the treatment course changed.
  •  
    Quote:

    Jeff:

    I believe this to be a lecture on the subject of ELF Press, the new acronym that Dr. Peacock coined that includes his Peacock Press.

    I believe that the previous posting you mention is a youtube video and not a powerpoint presentation.

    The "F" in Elf Press if Foot Typing.

    I believe Don is the perfect person to answer your query and not I.

    I will ask Dr Peacock the next time I think tank with him as only he can answer your query or I suggest you do the same.

    Happy Labor Day to all.

    Dennis

    1. Dennis, since you decided to post this item, and not Dr. Peacock, what is the purpose of the blog?

    2. And how is it, as the principal promoter of foot typing, you cannot rationalize or even speculate why Dr. Peacock added foot typing to his pre-operative assessment. Do you not discuss this with him when you brain storm?

    Dieter:

    1. From my prospective, ELF Press was invented by Don to improve the ability of more and more foot surgeons to be able to treat metatarsalgia utilizing MIS internationally with fewer transfers, reduced complications and better outcomes.

    2. Unlike you, I do not have the ability to know what others are thinking, rationalizing and speculating and must wait for the next time I think tank with Don to respond to this query as I offered with a civil response to your query the first time.

    Happy Labor Day

    Dennis



  • Jeff:

    I believe this to be a lecture on the subject of ELF Press, the new acronym that Dr. Peacock coined that includes his Peacock Press.

    I believe that the previous posting you mention is a youtube video and not a powerpoint presentation.

    The "F" in Elf Press if Foot Typing.

    I believe Don is the perfect person to answer your query and not I.

    I will ask Dr Peacock the next time I think tank with him as only he can answer your query or I suggest you do the same.

    Happy Labor Day to all.

    Dennis

    Dennis, since you decided to post this item, and not Dr. Peacock, what is the purpose of the blog?

    And how is it, as the principal promoter of foot typing, you cannot rationalize or even speculate why Dr. Peacock added foot typing to his pre-operative assessment. Do you not discuss this with him when you brain storm? 



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