Subtalar Arthroereisis Explained

Subtalar Arthroereisis Explained



Overview of the Subtalar Arthroereisis procedure; what is does, the evidence for it and alternative treatments.

Overview of the Subtalar Arthroereisis procedure; what is does, the evidence for it and alternative treatments.

Learn more at



Total Views
Views on SlideShare
Embed Views



4 Embeds 429 300 120 8 1


Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
Post Comment
Edit your comment

Subtalar Arthroereisis Explained Subtalar Arthroereisis Explained Presentation Transcript

  • What is SubtalarArthroereisis?
  • Subtalar Arthroereisis A surgical procedure where something is placed below the talus (ankle bone) with the intended functionto block or limit excessive talar motion.
  • Sub-talar Arthro - ereisis(below the talus/ankle bone) (joint) (blocking/ear-re-sis)
  • Specifically,there is a blocking/limiting of motion of the lateral process of the talus.
  • The device acts at the lateral/superficial outer half of the naturally occurring spacebelow the talus – the sinus portion of the sinus tarsi.
  • A subtalar arthroereisis device is: placed into a drilled-out hole in the calcaneusor simply inserted into the sinus tarsi space until the leading edge of thedevice reaches the half-way point of the neck of the talus.
  • Either way, subtalar arthroereisis blocks or limits motionof the lateral process of the talus.
  • This limiting/blocking stops the forward/inwardrotation of the lateral process of the talus which in turn limits or reduces the amount of pronation of the talotarsal/subtalar joint complex.
  • Subtalar Arthroereisis is not a new idea.The procedure originated in the 1940s.
  • Subtalar Arthroereisis Devices have undergone many decades of design changes to try to decrease the removal rate.
  • Unfortunately, even with all the device design changes, the subtalar arthroereisis devices have a higher than accepted removal ratewhich makes this procedure questionable in the minds of most foot surgeons.
  • Why?
  • Scientific evidence is available, but notcompelling enough to take this procedure to the next level.
  • What does the scientific evidence tell us?
  • Subtalar arthroereisis should be used in conjunction with other surgical procedures.
  • 38% to 100% of subtalararthroereisis procedures results in the removal of the stabilization device.
  • This is due to• device displacement• patient intolerance/pain• failure of the device to achieve talar stability• mandate for device removal within 12-18 months after placement
  • What is the primary underlyingcause that has led to the failure ofwhat could be “the most powerfulorthopedic surgery” performed on the human body?
  • It stems from - the biomechanical principalsof the talotarsal joint complex.
  • So, where the implement/device is placed andhow the implement/device acts to prevent the abnormal talotarsal motion.
  • Biomechanical principals of the talotarsal joint complex.
  • Talotarsal Joint Complex has 2 primary complex motions Supination Pronation• Talus externally/laterally • Talus internally/medially rotates on the rotates on the calcaneus/navicular (combined calcaneus/navicular (combined with slight plantarflexion and with slight dorsiflexion and eversion). inversion).• A stable/normal talotarsal • A stabile/normal talotarsal joint should have 2/3 joint should have 1/3 supinatory motion. pronatory motion.• Acts to lock the joints of the • Acts to unlock the foot to foot to create a stable lever- adapt to the weightbearing arm. surface.
  • Talotarsal Joint Dislocation/DisplacementLeads to a longer period of pronation. This equals instability of the footbones when they should be stable and getting ready to propel the foot.
  • Talotarsal JointDislocation/Displacement
  • This is a pathologic condition where the talus is partially dislocating on the tarsal mechanism (calcaneus/navicular).
  • This is a chronic disease process that will lead to a vicious path of destruction. It requires physical intervention, it will not resolve on its own.
  • Talotarsal dislocation/displacement not only destroys the structures within the foot and ankle,
  • talotarsal dislocation/displacement leads to the damage of the knees, hips, back and neck.
  • Excessive abnormal forces are acting on the structures within the foot, knees, hips, pelvis, back and neckwhile standing, walking or running.
  • The average person has taken over 120,000,000 steps by 50 years of age.
  • Eventually, a critical threshold point is reached where the tissues simply cannotcompensate for these excessive, abnormal forces.
  • Pain is a warning signal from our body that something is wrong.
  • Unfortunately, we ignore or just cover-up the symptoms,meanwhile more and more damage is continuously being inflicted every single day.
  • The underlying etiology is the excessivetalotarsal joint dislocation/displacement.
  • A subtalar arthroereisis device attempts to fix this problem.
  • However, subtalar arthroereisis devices FUNCTION AGAINSTthe natural biomechanical motions of the talotarsal complex.
  • The lateral process of the talussmashes into the upper back portion of the implant/device and pushes it forward…
  • …until the front/lower end of the device hits the portion of the calcaneal floor that forms theanterior chamber of the sinus tarsi.
  • This motion occurs, on average, 7,000 times a day. Day after day. Week after week. Month after month.
  • Subtalar arthroereisis devices are likeplacing an octagonal tire on your car.
  • It kind of works,it just doesn’t work efficiently and therefore doesn’t last long.
  • Ready for the Paradigm Shift in the extra-osseous stabilization oftalotarsal joint displacement?
  • Scientifically proven
  • time tested
  • “The most powerful minimal incision foot and ankle procedure.”
  • Introducing thenon-arthroereisis procedure…
  • Extra-osseousTalotarsal Internal Fixation Device
  • functions like a round tire on a car.
  • works WITHthe normal biomechanics of the talotarsal complex
  • simply acts as an internal stent tomaintain the opening of the sinus tarsi.
  • Just like an arterial stent keeps an artery open.
  • does not limit or block motion!
  • simply restores the normal amount of talotarsal joint motion.
  • has been scientifically proven to:
  • Scientific/Evidence Base for - Decrease strain to the posterior tibial tendon Decrease strain to the plantar fascia - Decrease strain to tibial posterior nerve - Decrease pressures within tarsal tunnel/porta pedis - Improve post-procedure functional scores - Normalize abnormal radiographic correction/angles - Lower device removal rate <6% - stabilize the talotarsal joint displacement - decrease forces acting on the medial column - Internally restore navicular height - Improve/normalize plantar pressure/forces
  • Refuse to ignoreor cover-up the symptoms oftalotarsal jointdisplacement!
  • Let’s fix the problem at its root.
  • To learn more please