Treatment for ‘Untreatable’ Foot and Ankle Deformities

Published in Orthopaedic Surgery - Winter 2018

Foot and ankle care for medically frail, diabetic or transplant patients can be daunting, but not for Casey Humbyrd, chief of the Foot and Ankle Division in the Johns Hopkins Department of Orthopaedic Surgery. She says, “I like to take on complex problems that haven’t been solved elsewhere.”

Humbyrd says that treating a patient who hasn’t healed after a severe calcaneus or talus fracture can be challenging. She credits her success with such patients to her partnership with the Johns Hopkins Metabolic Bone and Osteoporosis Center. Working with Suzanne Marie Jan De Beur, associate director of the Johns Hopkins Bayview Clinical Research Unit, Humbyrd evaluates patients quickly and obtains targeted DEXA scans. She can then plan surgery for when patients are at peak healing potential.

“For patients who haven’t healed before,” says Humbyrd, “we have been much more successful at getting them to heal because we have a comprehensive approach to metabolic bone health. The multidisciplinary care is what makes Johns Hopkins unique,” she says.

For example, patients with uncontrolled diabetes see a geriatrician when they are admitted and then meet with that geriatrician daily. An infectious disease physician spearheads a diabetic management service to optimize their health. Then, a focus on preoperative physical therapy builds patients’ strength before surgery to help shorten the hospital stay and get them moving sooner postoperatively. Such an approach to patient care is key to successful treatment of complex orthopaedic foot and ankle problems.

In close partnership with the Johns Hopkins Comprehensive Transplant Center, Humbyrd is able to treat post-renal and post-liver transplant patients as well. She says she often operates on patients who have been told, “you can’t have surgery—you had a kidney transplant.” Many of these patients have bone deficiencies induced by long-term steroid therapy, but the multidisciplinary team can successfully perform surgery because of the support network behind them, says Humbyrd.

Barbara Hope was treated by Humbyrd for a torn peroneal tendon in her ankle. “I’m a transplant patient, and I experience a lot of issues just because of that,” says Hope. “For surgery, one of my concerns is always the ‘germ factor.’ And Dr. Humbyrd was so aware of that in terms of the operating room and everything that needed to be done.”

Since surgery, Hope has taken two trips overseas and several domestic trips. “My husband and I really love to travel,” she says “Thanks to Dr. Humbyrd, we are still able to do that, which is really, really nice. We will continue to travel for as long as we can.”