The correct question with TARs (and many other things podiatry) is not "can?" but "why?"
A lot of things look cool on Xray, rep ads, theory, conference booth, maybe reimbursement, youtube animation video, etc. This applies to TAR, other implants, fancy fixation, amnio/BAT stuff, expensive DME, etc etc. The question should really be how the results are (long term), how cost effective it is, if it will substantially help the patient or just the surgeon ego, and if you'd actually consider them for your own mom/dad should they had ever have pathology. Follow-up is the enemy of "good" ideas (look at the powe-diatry graveyard of silastics, absorbable pins/screws, regranex, sclerosing injects, Oasis, etc etc etc). The anatomy doesn't change. You need to use good diagnostic and surgical techniques over simply fancy new technologies.
We can read, so we know the real answers (non-sponsored literature). In the end, each doc can do what they like. The TAR literature will say they are at best equal to fusions (which cost less, have lower skill curve, wider candidate activity/health/age/etc criteria, and fewer resultant amps and revisions). Sure, the TAR proponents (and rep cronies) try to make up higher function scores for the TARs in their pubs and lectures by saying patients like them even if they have more revisions and amps, but that's not objective.... and read the study financing for 95% of those. Personally, and correct me if I'm wrong, I haven't seen any literature on TARs helping the surgeon's anterior underwear size to grow, but I have seen plenty of TARs get infected and go BKA or get revised many times. I know many skilled and cert surgeons (both ortho and pod) who have done TARs and chose to quit or greatly narrowed their indications for them. It's a personal decision. Many times, the decision for ankle arthrosis is actually to do an Arizona brace and call it a day since they aren't a decent surgical candidate at all... but surely somebody would do a TAR on that same patient if you searched far and wide. Sure, I would make a lot more RVUs if I did more first MPJ implants and revisions on them... and less Valente or fusions as I actually do, but I don't tend to enjoy creating potential apropulsive gait or short first MPJ with lesser met problems that's hard for me or anyone to revise, so I might stick to just following the the literature and aiming for good long term foot stability. I dunno.
In the end, TARs will be a very small of the practice for 99% of DPMs... often zero percent. The majority of F&A orthos do not perform them either (philosophy, training, or both). Even for those surgeons who like them, the indications are pretty narrow (neuropathy, BMI, smoker, active, etc contra) and revisions will be frequent and very sad and complicated. As in anything surgery, the research shows that you need volume for best TAR results, and even then, they are at *best* equal to fusions (in short/med term... in the biased results that are sponsored or surgeon self-eval and self-pub). TAR is a fine thing to know about and to be aware of for boards or for patients who have gobbled up the marketing pitch on TV or internet, but you don't need to make it a big focus. I always offer patients who ask about TAR or who fit the indications to go to a center/doc that does many (since I am philosophically against them), but if any took me up on that, I would fear the worst and half expect them to come limping back years later with a loose implant and a 9cm bone defect for me to try to fuse. Ankle fusion should be in the toolbox of any RRA surgeon (esp TAR surgeons!), and it is much more frequently indicated and reasonably considered. You can get by without that fusion too, though (and 85% of DPMs probably do?)... simply do scope/recon if indicated early, PT, Ariz braces and injects, and refer to a skilled RRA guy in your area for fusion consult if the pt is a fair surgical candidate and that stuff doesn't work to their satisfaction.
