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FAI July 2025 Podcast: Radiographic Results of Percutaneous Reduction of Calcaneal Fractures and Posterior Arthroscopic Subtalar Arthrodesis (C-PASTA)
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- [00:01]
A
Foreign. This is Mark Easley, and I have the distinct honor of talking with Dr. Kevin Martin, the senior author of July's lead paper in fai. The paper is titled Radiographic Results of Percutaneous Reduction of Calcaneal Fractures and Posterior arthroscopic Subtalar Arthrodesis or C postA. Dr. Kevin Martin is an associate professor and the current chief of the Division of Foot and Ankle Surgery at the Ohio State University WEC Wexner Medical center in Columbus, Ohio. Dr. Martin served 26 years in the United States army and continues to serve as a team surgeon in research and development for the Joint Special Operations Command Joint Medical Augmentation Unit of the Austere surgical team. Dr. Martin completed his orthopedic training at William Beaumont Army Medical center in El Paso, Texas in a foot and Ankle fellowship under the direction of Ned am Andola at the University of Iowa. Following his fellowship, Dr. Martin was the Chief of Foot and Ankle Division at the Evans Army Community hospital in Carson, Colorado. Dr. Martin is a distinguished arthroscopic leader in the Arthroscopic association of North America, an Orthopedic Learning center master instructor, and a master instructor in military advanced surgical training for the Society of military orthopedic surgeons. Dr. Martin is active in the AOFAS leadership, serving on the Postgraduate Education Committee and as a reviewer for Foot and ankle International. In 2023, he was selected as a traveling fellow in the American Orthopaedic Foot and Ankle Society European Foot and Ank Ankle Society exchange program. Dr. Martin is recognized as a thought leader and pioneer in applying minimally invasive techniques in the management of foot and ankle trauma. Dr. Saltzman and I selected this article highlight this investigation describing the results of the combined percutaneous calcaneus reduction in posterior arthroscopic arthrodesis or C Posta for acute Sanders 3 and 4 displaced intra articular calcaneus fractures. Welcome to the program, Kevin.
- [01:57]
B
Yeah, Mark, I wanted to start by saying thanks for inviting me tonight and send my best to Dr. Salt as well. It's a real honor and a real privilege to be here with you tonight.
- [02:07]
A
I tell you, the the honor is all ours, so we'll get started. As a senior author, would you please give the listeners a brief summary of your paper and its major findings?
- [02:17]
B
Yeah. So as you described, the calcaneus fractures, especially Sanders threes and fours, are very difficult fractures to manage. We know that complication rates can hit 33% with the open technique, and we actually know there's a couple randomized control studies out there with Buckley and the UK paper that show should we even be fixing them at all? And then what I tried to do is combine some of my techniques of doing these percutaneous and then also my experience with doing these subtalar fusions in the chronic setting and try to combine all these techniques into one standardized technique that can give us kind of the all in one to reduce our complication rates by using arthroscopy and then going straight to arthrodesis to reduce that reoccurrence or that repeat trip to the operating room and trying to really wrap it all into one and see if we can get these patients to heal and go on to have good function.
- [03:05]
A
Yeah, it's great. It's. I've really enjoyed the paper and learning and there's a lot more I have to learn. So we'll try to hit on some of those points as well. So you were a co author in the 2016 JBJS article on Posterior Arthroscopic Subtalar Arthrodesis with Drs. Rung, Preniscule, Famino, Saltzman and Amendola. For our listeners, would you review this approach and technique for subtalar arthrodesis and how they apply to this current investigation?
- [03:32]
B
Yeah, this paper really is the premise for the whole CPOs technique. And actually it was first called the arthroscopic subtalar arthrodesis. And then it went on to gain the P for the prone, which I actually thought that Ned named because it was pasta for, you know, his background. So that's what I thought. He actually had named this. Interesting enough. And so. But why prone so prone to me allows us to have a better access to that subtalar joint and get that nice view and come right in on top of that posterior facet and be able to prep the joint in these chronic cases, mainly that had been performed open. So when we started doing these arthroscopically, it really reduced our complication rate from the sinus tarsi approach or even the lateral approach. And just being able to do this arthroscopically and then place our bone graft arthroscopically as well to fill some of these voids for these chronic post traumatic cases. And then also little things we kind of developed along the way was that we could use the mini C arm, we could minimize our radiation exposure to us and our staff. And then a valuable lesson that I actually applied to the CPASTA paper is that we were using these six, five partially threaded headed screws. And one of our most common Complications was the hardware removal and chronic heel pain. So when I began to do this, I was trying to take some of the lessons learned from that paper and go to the headless screws. And then we actually really based some of this off of your work, Dr. Eastleigh, with that double divergent screw pattern that we took from that paper as well. And then on the CPASTA just added one more divergent screw. So it really was the background of the basebone, this whole technique of the c pasta.
- [05:02]
A
Great. Well, it's hard to believe I actually made a contribution somewhere, but not anywhere. It pales in comparison to what you guys have done here. So great work. I recognize that the listeners may just refer to your excellent description of the CPASA technique in your 2022 JBGs Essential surgical techniques article. However, you are an expert in percutaneous management of displaced calcaneus fractures and many of us are not. Would you briefly teach our listeners the key steps to successfully reducing displaced calcaneal fractures percutaneously and provide some tips and tricks when performing the percutaneous reduction and fixation with the patient in the prone position? And really specifically, number one, what do you consider the most challenging step? And number two, what is the most critical step in the percutaneous reduction of calcaneus fractures?
- [05:53]
B
Yeah, what a difficult question to answer because anybody that tackles Sanders threes and fours knows that there is no true expert. And they humble us every single case. So every single case I am humbled when I approach these and I think that's we have to go into on these difficult cases is knowing we will face some humility, but going in with the right steps in order. So I would say the most challenging step for me is the order of operations. So on this, what I constantly get asked on my Instagram and when I speak about this is what do we do first? So for first on this case, we have to prep the joint first. When that posterior facet is is down and collapsed, that actually allows you to get your scope deep inside that joint and actually prepare the joint surfaces and remove all of that articular cartilage and really get good space in there to work before it's actually reduced. And then I place a shant in that posterior lateral tuber and begin to first pull plantarly. Then to correct the varus alignment and try to swing that up. And then I still do establish a small portal size sinus tarsi incision laterally and then insert either a small elevator, I like a little key elevator and try to push that posterior facet up and then what I think is really important is taking that lateral wall and then reducing it either manually or with a large clamp and actually try to narrow that heel and make sure that you do not have any of that sub fibular impingement that we know long term can really impinge on those peroneals and cause a lot of pain with our operative and non operative Sanders threes and fours. So I think getting the joint prepped first and then putting the bone graft in and then working around with that Shantz pin in the elevator and kind of going back and forth with multiple radiographic views, that's really the challenge on these cases.
- [07:33]
A
Great. Yeah, that's really helpful. I also have a question and I, I wonder about this at times type of screw. And you, you mentioned different options and what you learned from the the posterior prone subtalar arthrodesis. But in your surgical technique for this paper, you describe using fully threaded variable pitch compression screws. So in my experience, I wish to compress across the subtalar arthrodesis, but then I would favor positional fully threaded screws to maintain the anatomic reduction of the calcaneus fracture. Would you please share with the listeners how you balance these two seemingly opposing goals in your combined fracture reduction an arthrodesis procedure? Also, do you know if the screws used in your investigation feature more compression in one particular segment of the screw or is the compression uniformly distributed throughout the entire length of the screw? And really, probably more importantly, is compression really important in this operation or are fully threaded screws, even without variable pitch, acceptable for your technique?
- [08:30]
B
Yeah, thank you for that question. So it's a difficult one because really balancing both of those two components of compression versus holding and preventing long term collapse so simultaneously. So in our pasta paper, like we described a minute ago, they were partially threaded and they had that large head. So we just knew that had to change, that could not continue. So I switched to that fully threaded headless compression screw. These screws are high, they're a variable pitch. And so what happens is they actually, as they begin to turn, it's a progressive compression throughout the screw length. So to answer your second question, it actually goes throughout the entire working length of the screw. So the way it's described to me by the engineers is that each piece, as it hits the screw, it's going to slowly start to compress in between each fragment. So you may say that as a good or bad thing in this case, but it's going to start to pull all these fragments together rather than like a partially threaded screw or a lag technique which just simply compresses point A to point B like a Herbert screw. This actually has sequential compression as it's going. And this was very similar to the Carol Jones paper where he used fully threaded compression screws or even shoe in his paper where he used the partially threaded headless screws. So I think compression is acceptable and I think getting that alignment and getting those screws and just finishing gently on hand and really tapering and sequentially tightening the meatle and lateral screw is really important not to overdo it. I don't drive these in under power and try to get a ton of compression. I think that just going in a slow controlled fashion gives us enough compression, but also to restore that height and then prevent long term collapse. And that's also why we took what your work with those divergent screws and added the work by Jastopher and put a highly divergent kickstand screw up as well, giving us those three screws to balance the construct.
- [10:17]
A
Good. Yeah, that's really helpful. I always wonder and that that's a great explanation. So thanks for taking the time. Let's step away just a little bit from this paper. Would you just take a moment to recount your most meaningful medical experience during your 26 years of military service?
- [10:37]
B
Yeah, it's been a long time. So I started off as a combat medic, but the story that immediately comes to mind was, well, I was deployed in Afghanistan as part of a joint special operations far forward surgical team. We had a patient that we were watching on a drone feed and watched them actually get shot in the abdomen. And then we were airborne and at the site of injury within minutes, which is unheard of even if you were shot in downtown Columbus tonight. To have a surgical team arrive so promptly and to be there and just to be part of that unique, just highly specialized team and working with the best war fighters on earth. And then I caught myself as we were leaving and I was doing some procedures part of a xlap, which I thought to myself and I was laughing internally thinking how many foot and ankle surgeons today are doing an X lab. And I just, I just laugh to myself and I just love our country and serving our finest and it's been a lifelong privilege that I still enjoy today.
- [11:37]
A
Wow. Yeah, just certainly hats off to you and your, your colleagues for all that you do or have done. So thanks for sharing. I just experience I have not had so wonderful that you're there to help the soldiers when they're injured. Let's get back to the paper. You and your co authors mentioned that the C passa technique allows for an earlier time to surgery. So in your experience, what is the optimal time to the surgery after a calcaneus fracture?
- [12:05]
B
Yeah, I think the easy answer is as soon as possible. Often these patients have multiple other injuries, other long bone injuries or spine injuries. So as you know, foot and ankle gets put to the bottom of the priority pole. So sometimes it takes a while to get to these. If I can get to them in the first 48 hours, that is ideal at our trauma center. But oftentimes these do come later to me. So it's really absolutely as soon as I can get to them. The days of waiting, two to three, four weeks, whatever we were doing in the past, wait for the fracture blisters to clear. Of course we do have to mind some soft tissue, but with us only using six small percutaneous portals, you can go sooner. And I think the answer is sooner. But what's the definition of that? It's hard to really say. And as you know, it's very differential with these high energy versus a little bit lower energy fracture pattern. But I think the soft tissue violation is so small that you can hedge on on sooner than later. And that's a very vague answer. Intentionally.
- [12:57]
A
No, it's good, but that's good to know. Just. I guess I'll add one more thing to that. I assume that fracture, if you wait too long, will start to heal and then your manipulation percutaneously becomes more difficult. Would you say that's true?
- [13:10]
B
Absolutely. Getting after three weeks. That's why in the paper we limited it to around that 21 week, 21 day period. Because then once it's getting sticky, it even makes it even more difficult and doing it arthroscopically or percutaneous in fact does become harder.
- [13:23]
A
Good. Well, thanks. Yeah, I had one just. This is more of a question where I feel like you really had a really complete paper, but you limited what you first show the reader, which is that your title and abstract for the article focuses only on the radiographic results of the CPASA technique. But for the 19 patients that you were able to study, your investigation and paper also report really well presented functional outcomes, including the foot and ankle disability score or index and the visual analog scale scores at 3, 6 and 12 months. So why did you choose not to feature the functional outcomes in the title and abstract as well?
- [14:01]
B
Yeah, thanks for that question. It's. I'm really kind of holding back because I came out with this paper kind of in a an early timeframe with such a low number. Because I had presented CPASTA around the world on my traveling fellowship to other experts. I was honored to be selected at OTA and AOFAS Specialty Day to talk about this. And I think sometimes I just got labeled as the crazy scope guy that just scopes everything without any results and I do in fact scope everything. But I wanted to get out the results because I think the general learner was just or audience was just thinking that I was just taking these and just jamming screws across and not reducing it. So this paper to me was to get out the results that we were in fact reducing the fracture, restoring height and alignment and then actually getting it to heal with that union rate which was, which was outstanding. And the patient reported outcome measures. I'm really kind of holding back on those because I really want to re reevaluate this and come back to you and Dr. Saltzman with our two year results and give you a full description of the patient reported outcomes with a much larger number and be able to paint the broader brush. But I thought this was an important step to get out there and say that this is a viable option that is safe and then follow it up with a paper that really goes out to a two year range and really talks about shoes and Fadi and really gives us a more of a full picture about this complex fracture pattern.
- [15:17]
A
Well that's great. I just thought it was well presented and was just curious why it couldn't be feature more. But that explanation is great and we'll consider it a teaser. We'll wait for the next this for phase two. So excited. Thanks for doing the extra work. Next, you and your co authors report excellent reconstruction and maintenance of bowler's angle but report that the angle of gissan did not change. In my experience managing calcaneus fractures and I think you mentioned this earlier when you described the reduction I attach importance to reducing the anterior calcaneal process to the lateral articular fragment thereby reestablishing an anatomic or near anatomic angle of gason. How is it that your favorable outcomes do not necessitate re establishing a physiologic angle of gason?
- [16:08]
B
Yeah, there's plenty of papers that show that the anatomical alignment and functional outcomes really don't correlate. And this I think falls right into that because even with our brilliant team of co authors that I had, it is very difficult to assess a Ghassane's ankle angle status post Arthrodesis, that angle that, that focal point is now blurred. And even on the CT scan, it's a little bit more difficult to where to put that measurement. So there's actually some functionality in there that made it difficult. And then we found that Bohr's angle was more consistent and more easily reproduced. And I think that's why we really hung our hat on that and why that was more measurable. And that was also a feature that I really, on this paper, really worked on, is getting posterior height and restoring height. Because we know that's where the function really, I think, comes from, is reducing that subfibular impingement and avoiding that anterior impaction that we can get when that talus falls into that horizontal attitude and can have the anterior impingement. So the short answer is it's just. It was difficult to measure, honestly, and it was just harder. Yeah, got it.
- [17:09]
A
No, well, thanks for sharing that. Yeah, I was just curious. Then let's go to the next question. I believe this, this is personal, that a successful subtalar fusion is enhanced by optimizing the bone contact between the calcaneal posterior facet and then that inferior talar bone surface area with a subtalar arthrodesis simultaneous to calcaneal fracture reduction. How important is it to anatomically reduce the posterior facet?
- [17:36]
B
Yeah, so I think in an arthrodesis case, that is kind of completely changed. You know, you read some of the historic work by Bernirschka and that group at Harborview that was actually taking out the whole posterior facet and they work on the bag table and take these pieces and put them together and put the whole thing back on a. On a shish kebab technique and put it back in and really working on that, that com. You know, that combination, those individual fragments of the posterior facet. But I think with the arthrodesis, I actually use those fragments and take my osteotome and break them up even more. So I take these fragments and I fish scale them in multiple directions and really turn that posterior facet into bone, into bone grafts. So there is no true reduction of those fragments at all. And then with that sinus tarsi portal laterally, I take and elevate that whole piece of bone, that whole posterior facet, and elevate the whole thing up as we're simultaneously bringing the tuber down. And that's what restored our height. Was those two mechanisms working simultaneously and kind of working like you think about a revision case, like you're putting a bone block in there and using that posterior facet as a bone block to kick that up and then hold that up with our screws, and then we backfill with the bone graft kind of simultaneously. So I don't think it's an individual reduction. It's more of a wedge or more of a arthrodesis case than a fracture case. And that was the difference.
- [18:49]
A
Great, wonderful explanation. Thank you. That makes sense. And great work to get it to stay there. And then obviously, with a favorable union rate. That's terrific. Let's step away from the paper for just a moment. So congratulations again on being selected as a 2023 AOFAS traveling fellow as part of the AOFAS and EFAS for the European Society Traveling Fellowship Exchange. This fall, my Duke colleagues and I plan to host the 20 European Foot and Ankle Society Traveling Fellows. Would you please share with me and the listeners your favorite story when you were an AOFAS Traveling Fellow?
- [19:25]
B
Yeah, every nation was just so caring. But the two that stood out in my mind was Manfred Thomas and Martin Jordan in Augsburg, Germany. They just were absolutely outstanding in their hospitality. You know, taking a day off and taking us throughout Bavaria and looking at these different castles. We got to see the castle, or Walt Disney originally sketched the real Disney castle that he went on to build in Florida. And the day we were there, it was pouring rain and cold and just the worst weather ever in November. And we just kind of powered through and they were just outstanding. But even to show their continued caring behavior, I called him up, you know, a year ago and said, hey, my son's an undergrad student. He'd love to study abroad with you. What do you think? And he just went there and they just opened their arms so widely, even to my son, and kind of welcomed him with open arms. And just that caring attitude was just displayed throughout that whole entire time, even taking us into their house. There's a certain characteristic of going to a fancy meal at a fancy restaurant versus having someone in their home and really showing their culture. And they really went above and beyond to make sure we felt welcomed into the German culture.
- [20:27]
A
That's great. That's good to hear. Yeah. Very, very nice people. I agree. Wow. That makes it tough for me, though. Now I've got to really. They've set the bar so high. We'll see if we can be equally good hosts. We'll do the best. Best we. Thanks for sharing.
- [20:42]
B
We got to show them some of that Southern food you guys got down there.
- [20:45]
A
That's right. We'll See what we can do. I don't know if that's so healthy. I don't know if the Bavarian food's that much healthier, but the beer's probably better. Yeah. So, Kevin, you mentioned that your 100% union rate with the arthroscopic technique is better than the 86% reported by Bloomer et al. And they performed a similar simultaneous calcaneal fracture reduction and subtalar arthrodesis, but they did theirs through a sinus tarsi approach. You also reference Rung Pray et al's 2021 FAI article comparing the open and posterior arthroscopic subtalar arthrodesis. Would you please share with the listeners your thoughts on advantages of arthroscopic versus open preparation of the subtalar joint in these procedures?
- [21:26]
B
As with any surgery, I think the visualization is key. So I'm using that small nanoscope that's 1.9 millimeters with 120 degree forward view. So it doesn't have a 30 degree view that most scopes have. And that 1.9 millimeter allows you to go into the joint, actually. And I can see the entire posterior facet to allow for meticulous joint preparation, going after the smallest cartilage fragments and to really prep the joint in a whole different light. When I was doing these open, I never felt that I could see all the way across the joint. And I would love for someone to show me how, when they do the sinus tarsi approach, how they look past the perineals, look all the way medial, and still can tell themselves they're getting a great joint preparation. And it's just, for me, it was very difficult in my practice, so I really felt like that is part of it. And then additionally, the scope preserves the entire soft tissue envelope. So we know that a sinus tarsi doesn't probably disrupt too much blood supply. Right? But it really still does disrupt up that, that blood supply in the angiosome. So we know that that's completely restored. One other thing that we did compared to the other groups is we actually used an allograft mixture that was mixed with platelet rich plasma before. And then we evacuated the joint and got it as dry as we could before we injected this mixture with that PRP to get in there. And then we also, like we described earlier, we actually used the three screws so that, so 77% of our patients, we had that, the highly divergent kickstand screw to give us even more compression and hold that anterior part very stable. And what's interesting. And we obtained this with even 60% of our patients using nicotine. So they kind of fell right into that canius fracture patient Clientele with almost 30% of them coming in with illegal drugs in their system as well. So I think the visualization and the soft tissue or the elimination of soft tissue violation is really key on this arthrodesis number.
- [23:13]
A
Great. Yeah, I always think of the sinus tarsi approach to being relatively minimally invasive, but this even more so. So that's great. Thanks for the explanation. Here's something else I want to know and it ties in some of your previous work or maybe ongoing work. But to reduce muscle atrophy with the CPASA technique, you and your colleagues maintain an accelerated rehabilitation and early weight bearing protocol. And at two weeks after surgery, your patients were in a boot, in therapy and even cycling on a recumbent bike. By six to eight weeks, the patients progressively advanced weight bearing and then the boot was discontinued by 10 to 12 weeks. You mentioned the use of a hands free crutch, a device that you have previously studied weight and compared to a knee scooter in your studies. Would you please share with the readers the advantages of using a hands free crutch following the C passa procedure and or other foot and ankle procedures?
- [24:05]
B
Well, it all started with my wife, honestly. She sustained a Weber B ankle fracture when I was in Afghanistan and she was non weight bearing at first. And we had three small kids under the age of, I think at that point 8. So with no father and no family around at a strange army base, I remember seeing the hands free crutch displayed at one of our meetings, you know, walking around the trades room and looking at the shops. So I immediately ordered her one from Afghanistan and had it shipped to her. And I seriously think it may have saved my marriage by my wife being able to take care of our kids and walk around on this device. So I became a believer out of a personal experience. And that really prompted me to establish a series of publications looking at patient preference, what you'd prefer, the energy expectations when you're utilizing it. And then the EMG paper really changed my mind though because when we did this Bluetooth EMG study, we're able to see that we're maintaining contracture of the quads, the hamstrings and even the gastroc. So with this cyclic contracture of these muscles, we're assuming that we're continuing to keep some tension across the muscles and that's got to be good. It's hard to prove Actual muscle mass retention. But we know if they're cycling, that's good. And then truly now taking a different role at Ohio State, taking care of these future first round draft picks and these elite athletes, we've really incorporated it into our. Our accelerated rehab here because taking care of the national championship means you're pulling out all the tricks every step you can. So here at Ohio State now, we're avoiding splints and crutches and blocks as much as possible to get these athletes back on the field. And I think for me, it's an integral part of that recipe. Good.
- [25:40]
A
Well, good lessons learned. Yeah, that's. That's good. I'm glad you're studying this carefully. And now I also know how to save my marriage in case I'm in trouble. So it's good to know, but. But good personal experience. I like it. And then applying it. So, one other question regarding the paper. Just assuming that there's a learning curve with the C pasta, do you suggest that surgeons interested in the procedure start with an isolated posterior arthroscopic subtalar arthrodesis before attempting to combine the two procedures?
- [26:09]
B
Absolutely. This is not a case for a beginner to try. First, I typically would recommend doing a few ostrich trigonums and then a few pastas before stepping up to the C pasta. Absolutely. And people think it looks easy. You know, we post this on Instagram or they see the pictures and like, hey, you just put the camera in and it's just all right there. They're kind of skipping the part, you know, of us going through the bloody hematoma, working our way through the fracture fragments. There's a lot to it that, you know, we don't put online or when we're doing this in a presentation. It is a difficult case. And I'm not here to describe, even in this paper to say, hey, this is easy in a warm up case. I think any calcaneus fracture is challenging, and then the scope adds in our level of complexity to it, for sure. But I think using that small scope and be able to get in there and get deep inside the joint, maintaining low pressure and low volume really allows to be done in a safe manner.
- [26:55]
A
That's great. Good, Good advice. All right, this is your chance. So we mentioned Ned Amendola a few times, and he was your fellowship director. He is my partner at Duke. He's the current president of the aaos, and he's also a good friend. So I need this from you. You shared a lot of good information. But. But would you please share with me and the listeners your favorite and funniest fellowship story, ideally with at least some humor at Ned's expense.
- [27:25]
B
Well, he is the president, so I gotta go lightly because I like my career. So I had met Ned. I knew he was coming to the a SOMOS meeting, so I actually found him online, said, hey, can I meet you? And he said, yeah. So as a second year med student, I met him, we had coffee and we talked for quite a while in San Diego. And I said, I want to apply for your fellowship. And he's like, well, you got to stay in touch. And I said, what's your number? So he actually gave me his number in his email and I said, sir, I'm going to stay in touch. And he's like, okay, do it. So I literally called Ned or emailed or both. Sometimes once a month for the next probably 18 months, random calls. How's it doing? How's the weather? I have this difficult case and harassed him. So I show up for the interview and there's 16 of us in suits and me and my uniform. He's walking down, down, introducing each other, and he sees me, he just grabs me, says, kevin, come with me. Pulls me out of the lineup. We talk for an hour, he will, we then transfer, you know, interview style. And he comes in and grabs, I think John famino and says, hey, we're taking Kevin. Send the rest of these guys home. And I don't think had anything to do with my application. I think he literally wanted me to stop calling him and leave him alone. But he has just been such a great mentor. The next funny ed's no Ned story is I then completed special operations, sears crew school. And I said, hey, Ned, I'm down your area down at Fort Bragg. Can I come up and have dinner with you? And he said, yeah, let's do it. So we had dinner and when I met him, I had a black eye and I was looking emaciated. And he's like, wow, what happened to you? And I kind of went through that. I'd been locked in a box for a couple weeks and slapped around and he immediately waved the waiter over and said, stop what you're doing. Get this man another meal. And I'm like, no, no, I don't need another meal. And ordered me a whole second round meal and two desserts. So I think I cost net a few hundred dollars that night night in food, but I ate every scrap. And it just shows his love for the country and just what a great dude he is.
- [29:10]
A
That is great. Well, thank you. Yeah, I needed something like that. So it's good. I like it. He knows the Pope well. Used to, you know, the Pope unfortunately passed away, but he actually met the Pope, which I thought was pretty impressive. Anyway, thanks for sharing the story. Kevin, to finish up this excellent work. And as our podcast comes to its conclusion, is there anything else you would like to share with the listeners?
- [29:35]
B
Yeah, I just think that more further awareness of doing some of this arthroscopic is great. I would love to come down to Duke and do a visiting professor or seek some more of these opportunities and get out there and really talk about this. And I think conversations like this are so important to have as we shift the paradigm to a new technique. And I just really wanted to thank you and FAI and all the readers for just listening tonight and just I really appreciate the opportunity to be here. So thanks a lot, Mark.
- [29:59]
A
It's been terrific. And thanks for sharing all, all the information. Really terrific. So I'd like to thank Dr. Martin for sharing his insights and his and his co authors FAI publication. Radiographic Results a Percutaneous Reduction of Calcaneus Fractures and Posterior Arthroscopic Subtalar Arthrodesis or cpasta. And I'd like to thank everyone participating in this month's FAI podcast. And as you already alluded to, I look forward to your next research with the functional outcomes too. So thanks for giving us a little preview into what's. What's next. And so this is Mark Easley and I look forward to next month's podcast.