Podcast Summary: Meet the 2025 Roger Mann Award Winner – Enhancing the Progressive Collapsing Foot Deformity Classification System

Podcast: The AOFAS Orthopod-Cast
Episode Date: December 10, 2025
Host/Moderator: Dr. Scott (AOFAS Podcast Committee)
Guests: Dr. Rebecca Blonde (HSS, lead researcher), Dr. De Cesar Netto (Contributing researcher)

Episode Overview

This episode highlights the cutting-edge advancements in the classification and treatment of Progressive Collapsing Foot Deformity (PCFD), featuring Dr. Rebecca Blonde and Dr. De Cesar Netto, winners of the 2025 Roger Mann Award. The discussion centers on improving the PCFD classification system by introducing objective, imaging-based measures, and explores the clinical and research impact of these refinements. Listeners gain insights into the practical consequences for both diagnosis and surgical intervention.

Key Discussion Points & Insights

1. Motivation and Background for the Project

• Development of PCFD Classification Improvement ([01:01]):

  • Dr. Blonde describes how the work builds upon a consensus meeting at HSS in 2020, with the aim to give objective, measurable parameters to PCFD’s broad classification classes.
  • “Basically, it's to further characterize the classification system by giving it objective measures for each class…that would help tailor what our treatment options would be.”
    — Dr. Rebecca Blonde, [01:25]

• Need for Standardization ([02:33]):

  • Dr. Scott notes the clinical difficulty posed by flatfoot deformity and the variability in both assessment and surgical decisions.
  • “First of all, I think we got to be speaking the same language...that's step one because we can't speak the same language, we don't know if we're getting the same outcomes on the same patients.”
    — Dr. Scott, [03:09]

2. Imaging Requirements and Clinical Application

• Reliance on Weight Bearing CT ([03:09]–[04:45]):

  • The new objective measures for PCFD are based on parameters derived from weight bearing CT scans, which offer superior accuracy compared to weight bearing x-rays.
  • Dr. Blonde clarifies: “To objectively classify it in this way, you need a weight bearing CT, but I think you can use weight bearing radiographs...CT is more accurate.”
    — Dr. Blonde, [03:40]
  • Dr. De Cesar Netto emphasizes that while the study uses CT, many parameters do correlate to those on plain x-ray; certain features (like Class C’s forefoot arch angle) truly require CT.

• Discussion on Imaging Quality and Accessibility ([05:07]–[06:08]):

  • Dr. Scott raises practical concerns about image quality and radiologist acceptance.
  • De Cesar Netto responds: “The resolution is probably a little bit less, but it's gotten way better as we get different iterations...you can actually make an x-ray from it.”
    — Dr. De Cesar Netto, [05:42], [06:07]
  • Future direction: Potential to digitally reconstruct x-rays from CT data for better comparison and broader accessibility.

3. Research & Clinical Impact

• Linking Classification to Surgical Decision-Making ([06:46]):

  • The authors see the revised classification as a way to guide treatment planning and post-operative assessment.
  • “Each class usually drives with it a certain surgical treatment…so we can use the classification then to drive the specific surgical treatments, the amount of each of those osteotomies that you might do.”
    — Dr. De Cesar Netto, [07:08]

• Opportunities for Algorithmic and AI Integration ([07:37]):

  • Dr. Scott envisions integrating AI for imaging interpretation, classification, and even surgical recommendations.

  • “Maybe there's help from AI here—basically, I put my X ray, my weight bearing CT scan into AI, it does a whole classification, and then...develop what is the algorithm, steps do I need to do.”
    — Dr. Scott, [07:37]

  • Dr. De Cesar Netto highlights ongoing work on a “smart flat foot” tool for patient-specific, algorithm-driven surgical planning ([09:05]).

  • “If you plug in a CT scan for a patient and it can tell you using these thresholds how much you need to correct…all the options for that particular person.”
    — Dr. Blonde, [09:15]

• Personalization and Correction Accuracy ([09:30]):

  • There is a clinical need to move from subjective to objective intraoperative decisions.

  • “I'd like to know, oh, you need to put in an eight and a half millimeter wedge. Okay, can do. Right...”
    — Dr. Scott, [09:30]

  • Dr. Scott lauds the significance: “Step one is we have to all agree on what we're talking about, and I think this is going to help that.”
    — Dr. Scott, [09:45]

Memorable Quotes

• On the challenge of flatfoot:
  “I think every foot and ankle surgeon sees people with flat feet, both symptomatic and asymptomatic, which is also fascinating...It's like going to the heart doctor and telling them you have chest pain. And they're like, yeah, we have really no idea what caused this...”
  — Dr. Scott, [02:33]

• On imaging advances:
  “You can actually make an x-ray from [weight bearing CT data]...It's gotten way better.”
  — Dr. De Cesar Netto, [06:07]

• On future directions:
  “We're developing a smart... patient specific...the smart flat foot.”
  — Dr. De Cesar Netto, [09:05]

Timestamps of Key Segments

• [01:01] – Project background and motivation (Dr. Blonde)
• [02:33] – The frustration and ubiquity of flatfoot problems (Dr. Scott)
• [03:09] – Importance of a shared language in classification; specificity of new system
• [03:30] – Discussion about imaging requirements: weight bearing CT vs. x-ray
• [04:08] – Crosswalk between measurement parameters on x-ray and CT (Dr. De Cesar Netto)
• [05:07] – Practical imaging limitations and advancements (all)
• [06:46] – Application of classification to surgical outcomes (Dr. Blonde, Dr. De Cesar Netto)
• [07:37] – Dr. Scott’s vision for algorithmic/AI-assisted decision-making
• [09:05] – AI and smart flatfoot tools (Dr. De Cesar Netto, Dr. Blonde)
• [09:30] – Objective targets for surgical correction (Dr. Scott)

Conclusion

The episode delivers a detailed exploration of how precise, imaging-driven categorization of PCFD can enable improved patient outcomes and advances in surgical planning. The conversation covered the technical and practical aspects of implementing the new classification, the promise of AI assistance, and the next research steps in personalizing flatfoot treatment. The guests were celebrated for their important work that lays the foundation for clearer communication, better research, and ultimately higher quality care for patients with complex foot deformities.

Final Thanks:
“Congrats on a major award and thanks for spending some time talking with us about it. Really appreciate it.”
— Dr. Scott, [10:00]