Abstract
The purpose of this study was to determine radiographic correction achieved in adult
patients treated with an extraosseous talotarsal stabilization (EOTTS) procedure.
Patients diagnosed with flexible/reducible talotarsal joint dislocation (partial)
underwent surgical correction with the HyProCure® EOTTS device. Preoperative and postoperative weightbearing radiographs taken in the
anteroposterior (AP) and lateral views for a total 95 feet (in 70 patients) were analyzed
to determine standardized radiographic angles, and to quantify the correction obtained
after the EOTTS procedure. Postoperative radiographs were taken at an average follow-up
of 17 days from the surgery date. The mean preoperative and postoperative talar second
metatarsal angles (measured from the AP radiographs) were 24.8° ± 1.0° and 5.8° ±
0.9°, respectively, that is, mean decrease by 19°. The mean preoperative and postoperative
talar declination angles (measured from the lateral radiographs) were 25.1° ± 0.7°
and 19.4° ± 0.5°, respectively, that is, mean decrease by 5.7°. The mean preoperative
and postoperative calcaneal inclination angles (measured from the lateral radiographs)
were 21° ± 0.7° and 21.8° ± 0.7°, respectively, that is, mean increase by 0.8°. Postoperatively,
the talar second metatarsal and talar declination angles were reduced to average values
reported in the literature for normal feet. This study shows the efficacy of a minimally
invasive EOTTS procedure in restoring the normal angular relationships between hindfoot
and forefoot osseous structures on weightbearing, in both the transverse and sagittal
planes. This indicates stabilization of the talotarsal joint complex and elimination
of hyperpronation, which may lead to reduced pain, improved foot functional abilities,
and patient satisfaction.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Subtalar joint arthroereisis with SILASTIC silicone sphere: a retrospective study.J Foot Surg. 1992; 31: 47-51
- Pes valgo planus deformity.in: McGlamry E.D. Comprehensive Textbook of Foot Surgery. Williams & Wilkins, Baltimore1987: 403-465
- Flake-Austin modification of the STA-Peg arthroereisis: a retrospective study.J Am Podiatr Med Assoc. 2001; 91: 394-405
- Evaluation of hyperpronation and pes planus in adults.Clin Orthop Relat Res Dec. 1983; : 37-45
- Alternative techniques for the clinical assessment of foot pronation.J Am Podiatr Med Assoc. 1998; 88: 119-129
- Arthroereisis principles and concepts.in: Clark T. Yearbook of Podiatric Medicine and Surgery. Futura, Mount Kisco, NY1981: 448
- The Valenti STJ arthroereisis implant: a ten-year retrospective study.in: Vickers N.S. Miller S.J. Reconstructive Surgery of the Foot and Leg. Podiatry Institute Inc, 1996: 44-53
- Surgical treatment of flexible flatfoot in children a four-year follow-up study.J Bone Joint Surg Am. 2008; 83-A: 73-79
- Johnson Memorial Lecture. Operative treatment of the flatfoot: why and how.Foot Ankle Int. 1998; 19: 52-58
- The flexible flat foot.Foot Ankle Clin. 1998; 3: 573-592
- Effect of feet hyperpronation on pelvic alignment in a standing position.Gait Posture. 2007; 25: 127-134
- The influence of the foot-ankle complex on the proximal skeletal structures.Artif Limbs. 1969; 13: 59-65
- Metrecom measurement of navicular drop in subjects with anterior cruciate ligament injury.J Athl Train. 2000; 35: 403-406
- Foot medial longitudinal-arch deformation during quiet standing and gait in subjects with medial tibial stress syndrome.J Foot Ankle Surg. 2008; 47: 89-95
- Incidence of hyperpronation in the ACL injured knee: a clinical perspective.J Athl Train. 1992; 27: 58-62
- Factors contributing to the development of medial tibial stress syndrome in high school runners.J Orthop Sports Phys Ther. 2001; 31: 504-510
- The relationship between lower extremity alignment characteristics and anterior knee joint laxity.Sports Health. 2009; 1: 54-60
- Hyperpronation and foot pain. Steps towards pain-free feet.Phys Sportsmed. 2004; 32: 19-26
- New concepts in orthotic management of the adult hyperpronated foot: preliminary findings.J Prosthet Ortho. 1997; 9: 77-81
- Orthoses in the treatment of rearfoot problems.J Am Podiatr Med Assoc. 1999; 89: 220-233
- Corrective shoes and inserts as treatment for flexible flatfoot in infants and children.J Bone Joint Surg Am. 1989; 71: 800-810
- Operative management options for symptomatic flexible adult acquired flatfoot deformity: a review.Knee Surg Sports Traumatol Arthrosc. 2010; 18: 135-142
- Subtalar joint arthrodesis.J Am Podiatr Med Assoc. 2005; 95: 34-41
- Isolated subtalar arthrodesis.J Bone Joint Surg Am. 2000; 82: 613-624
- Subtalar arthrodesis for posterior tibial tendon dysfunction and pes planus.Clin Orthop Relat Res Dec. 1997; : 187-194
- Correction of moderate and severe acquired flexible flatfoot with medializing calcaneal osteotomy and flexor digitorum longus transfer.J Bone Joint Surg Am. 2006; 88: 1726-1734
- Subtalar joint arthroereisis in adult-acquired flatfoot and posterior tibial tendon dysfunction.Clin Podiatr Med Surg. 2007; 24: 687-697
- Use of the Maxwell-Brancheau arthroereisis implant for the correction of posterior tibial tendon dysfunction.Clin Podiatr Med Surg. 1999; 16: 479-489
- A surgical approach for flexible flatfeet in adults including a subtalar arthroereisis with the MBA sinus tarsi implant.Foot Ankle Int. 2006; 27: 9-18
- Current topic review: subtalar arthroereisis for the correction of flexible flatfoot.Foot Ankle Int. 2005; 26: 336-346
- Subtalar arthroereisis: a new exploration of an old concept.Foot Ankle Clin. 2007; 12: 329-339
- Arthrorisis by means of a subtalar polyethylene peg implant for correction of hindfoot pronation in children.Clin Orthop Relat Res Dec. 1983; : 15-23
- Subtalar arthroereisis for posterior tibial tendon dysfunction: a preliminary report.Foot Ankle Int. 2003; 24: 600-606
- Radiographic values of the adult foot in a standardized population.J Foot Ankle Surg. 2006; 45: 3-12
- Radiographic measurements of the normal adult foot.Foot Ankle. 1980; 1: 151-158
- Clinicoradiographic assessment of flexible flatfoot in children.J Am Podiatr Med Assoc. 2010; 100: 463-471
- The Smith STA-peg operation for hypermobile pes planovalgus in children.J Am Podiatr Med Assoc. 1985; 75: 177-183
- Pictorial review: foot axes and angles.Br J Radiol. 1996; 69: 968-974
- Validation of the talar second metatarsal angle as a standard measurement for radiographic evaluation.J Am Podiatr Med Assoc. 2011; 101: 475-483
- Normal biomechanics of the adult rearfoot: a radiographic analysis.J Am Podiatr Med Assoc. 1976; 66: 812-824
- Indications and complications of arthroereisis in hypermobile flatfoot.J Am Podiatry Assoc. 1979; 69: 178-185
- Plantar fasciitis. Mechanics and pathomechanics of treatment.Clin Sports Med. 1988; 7: 119-126
- Biomechanical Examination of the Foot. vol. 1. Clinical Biomechanics Corporation, Los Angeles1971
- Treatment of painful pediatric flatfoot with Maxwell-Brancheau subtalar arthroereisis implant a retrospective radiographic review.Foot Ankle Spec. 2010; 3: 67-72
- Analysis of gastrocnemius recession and medial column procedures as adjuncts in arthroereisis for the correction of pediatric pes planovalgus: a radiographic retrospective study.J Foot Ankle Surg. 2008; 47: 385-391
- Viladot's operation in the treatment of the child’s flatfoot.Foot Ankle Int. 1997; 18: 544-549
- Subtalar arthroereisis for pediatric flexible pes planovalgus: fifteen years experience with the cone-shaped implant.J Am Podiatr Med Assoc. 2009; 99: 447-453
- Giannini prosthesis for flatfoot.Foot Ankle Int. 2005; 26: 918-926
- Flexible flatfoot treatment with arthroereisis: radiographic improvement and child health survey analysis.J Foot Ankle Surg. 2004; 43: 144-155
- Radiographic evaluation of weight-bearing orthotics and their effect on flexible pes planus.J Manipulative Physiol Ther. 1999; 22: 221-226
- Pes planus: radiographic changes with foot orthoses and shoes.Foot Ankle. 1982; 2: 299-303
- Evaluation of the University of California Biomechanics Laboratory shoe insert in “flexible” pes planus.Clin Orthop Relat Res. 1972; 82: 45-58
- Correction of hypermobile flatfoot in children by molded insert.Foot Ankle. 1980; 1: 143-150
- A modified subtalar arthroereisis implant for the correction of flexible flatfoot in children. The STA Peg procedure.Clin Podiatr Med Surg. 1989; 6: 585-590
- Preliminary radiographic findings and sizing implications on patients undergoing bioabsorbable subtalar arthroereisis.J Foot Ankle Surg. 2007; 46: 175-180
- Planal dominance.J Am Podiatry Assoc. 1984; 74: 98-103
- Biomechanics of the tarsal mechanism. A key to the function of the normal human foot.J Am Podiatr Med Assoc. 2000; 90: 12-17
Article info
Publication history
Published online: July 16, 2012
Footnotes
Financial Disclosure: This study was funded by Graham International Implant Institute (Macomb, MI).
Conflict of Interest: Michael E. Graham is the inventor of HyProCure. He is the sole owner of GraMedica, LLC, the company that manufacturers and distributes HyProCure.
Identification
Copyright
© 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
