CME expires March 31, 2028

Go beyond traditional learning with a 360° perspective on orthopedic topics.

Each ICL360 is a cutting-edge CME course designed to provide a holistic learning experience, featuring curated video content sourced from expert-selected Instructional Course Lectures enhanced with insightful commentary and comprehensive assessment questions. This all-encompassing course goes beyond traditional learning by offering a complete 360° perspective on orthopedic topics. Explore additional resources, including full-text readings from the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), technique videos from Orthopaedic Video Theater (OVT), and links to external literature and PubMed. Elevate your clinical decision-making skills and gain a well-rounded understanding of essential orthopedic concepts with ICL360.

This Instructional Course Lecture (ICL) discusses the challenges and techniques associated with the management of complex foot deformities in adolescent patients. The course explores the pathophysiology, preoperative assessment, surgical techniques, and postoperative management for challenging cases, such as neuromuscular cavovarus foot, post-clubfoot sequelae, and deformities requiring external fixation for gradual correction. Patient-specific treatment planning, surgical decision making, and long-term functional outcomes are reviewed.

The principles and case-based approaches discussed in this course offer orthopaedic surgeons a highly valuable framework for effectively managing pediatric and adolescent foot disorders while minimizing complications and maximizing functional recovery.

Editor
Dustin Greenhill, MD, FAAOS 

Learning Objectives

• Analyze the pathophysiology and progression of cavovarus foot deformity in patients with Charcot-Marie-Tooth disease, including the roles of intrinsic muscle imbalance, progressive contractures, and bony malalignment in deformity development.
• Determine the appropriate surgical treatment plan for cavovarus foot correction, including the selection of osteotomies, tendon transfers, and soft-tissue balancing procedures based on deformity severity.
• Understand the indications and contraindications for joint-sparing procedures versus fusion-based correction in patients with progressive neuromuscular foot deformities and their effects on long-term function.
• Recognize the most common residual deformities after clubfoot management in adolescence, including persistent equinovarus, overcorrection into flatfoot or valgus, and anterior ankle impingement, and their respective clinical and radiographic findings.
• Develop a patient-specific surgical approach for recurrent or residual clubfoot deformities, using osteotomies, tendon transfers, and targeted soft-tissue procedures to restore functional alignment while preserving motion if possible.
• Differentiate between patients who require joint-preserving techniques versus those who require limited or extensive fusion procedures, understanding the biomechanical consequences of each approach in the context of adolescent foot deformity.
• Understand the principles of gradual deformity correction using ring fixators, including distraction osteogenesis, hinge placement, and soft-tissue adaptation strategies, to safely correct multiplanar deformities.
• Identify the indications for external fixation versus acute correction, including severe soft-tissue contractures, posttraumatic deformities, and neuromuscular conditions in which gradual correction minimizes neurovascular risk.
• Review postoperative management for patients who undergo external fixation for foot deformities, including pin-site care, neurovascular complication monitoring, and rehabilitation protocol optimization to achieve stable correction and functional mobility.

Earn up to 5 AMA PRA Category 1 CME credits™.