Overview of the Subtalar Arthroereisis procedure; what is does, the evidence for it and alternative treatments. Learn more at www.GraMedica.com.

1. What is
Subtalar
Arthroereisis?

2. Subtalar Arthroereisis
A surgical procedure
where something is placed
below the talus (ankle bone)
with the intended function
to block or limit excessive talar motion.

3. Sub-talar Arthro - ereisis
(below the talus/ankle bone) (joint) (blocking/ear-re-sis)

4. Specifically,
there is a blocking/limiting of motion
of the lateral process of the talus.

5. The device acts at the lateral/superficial outer half
of the naturally occurring space
below the talus – the sinus portion of the sinus tarsi.

6. A subtalar arthroereisis device is:
placed into a drilled-out hole in the calcaneus
or simply inserted into the sinus tarsi
space until the leading edge of the
device reaches the half-way point of
the neck of the talus.

7. Either way,
subtalar arthroereisis
blocks or limits motion
of the lateral process of the talus.

8. This limiting/blocking stops the forward/inward
rotation of the lateral process of the talus which in
turn limits or reduces the amount of pronation of
the talotarsal/subtalar joint complex.

9. Subtalar Arthroereisis
is not a new idea.
The procedure originated in the 1940s.

10. Subtalar Arthroereisis Devices
have undergone many decades of
design changes to try to decrease the
removal rate.

11. Unfortunately,
even with all the device design changes, the
subtalar arthroereisis devices have a higher
than accepted removal rate
which makes this procedure questionable in the
minds of most foot surgeons.

12. Why?

13. Scientific evidence is available,
but not
compelling enough to take this
procedure to the next level.

14. What does the scientific
evidence tell us?

15. Subtalar arthroereisis should be
used in conjunction with other
surgical procedures.

16. 38% to 100% of subtalar
arthroereisis procedures results in
the removal of the stabilization
device.

17. 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

18. What is the primary underlying
cause that has led to the failure of
what could be “the most powerful
orthopedic surgery” performed on
the human body?

19. It stems from -
the biomechanical principals
of the talotarsal joint complex.

20. So, where the implement/device is
placed
and
how the implement/device acts
to prevent the abnormal
talotarsal motion.

21. Biomechanical principals of the
talotarsal joint complex.

22. 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.

23. Talotarsal Joint
Dislocation/Displacement
Leads to a longer period of pronation. This equals instability of the foot
bones when they should be stable and getting ready to propel the foot.

24. Talotarsal Joint
Dislocation/Displacement

25. This is a pathologic condition where
the talus is partially dislocating on
the tarsal mechanism
(calcaneus/navicular).

26. 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.

27. Talotarsal dislocation/displacement
not only destroys the structures
within the foot and ankle,

28. talotarsal dislocation/displacement
leads to the damage of the knees,
hips, back and neck.

29. Excessive abnormal forces are acting
on the structures within the foot,
knees, hips, pelvis, back and neck
while standing, walking or running.

30. The average person has taken over
120,000,000 steps
by 50 years of age.

31. Eventually, a critical threshold
point is reached where the
tissues simply cannot
compensate for these excessive,
abnormal forces.

32. Pain is a warning signal from our
body that something is wrong.

33. Unfortunately, we ignore or just
cover-up the symptoms,
meanwhile more and more damage
is continuously being inflicted
every single day.

34. The underlying etiology is the excessive
talotarsal joint dislocation/displacement.

35. A subtalar arthroereisis device
attempts to fix this problem.

36. However, subtalar arthroereisis devices
FUNCTION AGAINST
the natural biomechanical motions of the
talotarsal complex.

37. The lateral process of the talus
smashes into the upper back portion
of the implant/device
and pushes it forward…

38. …until the front/lower end of the
device hits the portion of the
calcaneal floor that forms the
anterior chamber of the sinus tarsi.

39. This motion occurs, on average,
7,000 times a day.
Day after day.
Week after week.
Month after month.

40. Subtalar arthroereisis devices are like
placing an octagonal tire on your car.

41. It kind of works,
it just doesn’t work efficiently
and therefore
doesn’t last long.

42. Ready for the
Paradigm Shift
in the
extra-osseous
stabilization of
talotarsal joint displacement?

43. Scientifically proven

44. time tested

47. “The most powerful minimal incision
foot and ankle procedure.”

48. Introducing
the
non-arthroereisis
procedure…

49. Extra-osseous
Talotarsal Internal Fixation Device

50. functions like a round tire on a car.

51. works
WITH
the normal biomechanics of the talotarsal complex

52. simply acts as an internal stent to
maintain the opening of the sinus tarsi.

53. Just like an arterial stent keeps
an artery open.

54. does not limit or block motion!

55. simply restores the normal amount of
talotarsal joint motion.

56. has been scientifically proven to:

57. 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

58. Refuse to
ignore
or cover-up the
symptoms of
talotarsal joint
displacement!

59. Let’s fix the problem at its root.

60. To learn more please visit:
www.HyProCure.com