Subtalar Arthroereisis Explained


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

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Subtalar Arthroereisis Explained

  1. 1. What is SubtalarArthroereisis?
  2. 2. Subtalar Arthroereisis A surgical procedure where something is placed below the talus (ankle bone) with the intended functionto block or limit excessive talar motion.
  3. 3. Sub-talar Arthro - ereisis(below the talus/ankle bone) (joint) (blocking/ear-re-sis)
  4. 4. Specifically,there is a blocking/limiting of motion of the lateral process of the talus.
  5. 5. The device acts at the lateral/superficial outer half of the naturally occurring spacebelow the talus – the sinus portion of the sinus tarsi.
  6. 6. 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.
  7. 7. Either way, subtalar arthroereisis blocks or limits motionof the lateral process of the talus.
  8. 8. 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.
  9. 9. Subtalar Arthroereisis is not a new idea.The procedure originated in the 1940s.
  10. 10. Subtalar Arthroereisis Devices have undergone many decades of design changes to try to decrease the removal rate.
  11. 11. 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.
  12. 12. Why?
  13. 13. Scientific evidence is available, but notcompelling enough to take this procedure to the next level.
  14. 14. What does the scientific evidence tell us?
  15. 15. Subtalar arthroereisis should be used in conjunction with other surgical procedures.
  16. 16. 38% to 100% of subtalararthroereisis procedures results in the removal of the stabilization device.
  17. 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. 18. What is the primary underlyingcause that has led to the failure ofwhat could be “the most powerfulorthopedic surgery” performed on the human body?
  19. 19. It stems from - the biomechanical principalsof the talotarsal joint complex.
  20. 20. So, where the implement/device is placed andhow the implement/device acts to prevent the abnormal talotarsal motion.
  21. 21. Biomechanical principals of the talotarsal joint complex.
  22. 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. 23. 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.
  24. 24. Talotarsal JointDislocation/Displacement
  25. 25. This is a pathologic condition where the talus is partially dislocating on the tarsal mechanism (calcaneus/navicular).
  26. 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. 27. Talotarsal dislocation/displacement not only destroys the structures within the foot and ankle,
  28. 28. talotarsal dislocation/displacement leads to the damage of the knees, hips, back and neck.
  29. 29. Excessive abnormal forces are acting on the structures within the foot, knees, hips, pelvis, back and neckwhile standing, walking or running.
  30. 30. The average person has taken over 120,000,000 steps by 50 years of age.
  31. 31. Eventually, a critical threshold point is reached where the tissues simply cannotcompensate for these excessive, abnormal forces.
  32. 32. Pain is a warning signal from our body that something is wrong.
  33. 33. Unfortunately, we ignore or just cover-up the symptoms,meanwhile more and more damage is continuously being inflicted every single day.
  34. 34. The underlying etiology is the excessivetalotarsal joint dislocation/displacement.
  35. 35. A subtalar arthroereisis device attempts to fix this problem.
  36. 36. However, subtalar arthroereisis devices FUNCTION AGAINSTthe natural biomechanical motions of the talotarsal complex.
  37. 37. The lateral process of the talussmashes into the upper back portion of the implant/device and pushes it forward…
  38. 38. …until the front/lower end of the device hits the portion of the calcaneal floor that forms theanterior chamber of the sinus tarsi.
  39. 39. This motion occurs, on average, 7,000 times a day. Day after day. Week after week. Month after month.
  40. 40. Subtalar arthroereisis devices are likeplacing an octagonal tire on your car.
  41. 41. It kind of works,it just doesn’t work efficiently and therefore doesn’t last long.
  42. 42. Ready for the Paradigm Shift in the extra-osseous stabilization oftalotarsal joint displacement?
  43. 43. Scientifically proven
  44. 44. time tested
  45. 45. “The most powerful minimal incision foot and ankle procedure.”
  46. 46. Introducing thenon-arthroereisis procedure…
  47. 47. Extra-osseousTalotarsal Internal Fixation Device
  48. 48. functions like a round tire on a car.
  49. 49. works WITHthe normal biomechanics of the talotarsal complex
  50. 50. simply acts as an internal stent tomaintain the opening of the sinus tarsi.
  51. 51. Just like an arterial stent keeps an artery open.
  52. 52. does not limit or block motion!
  53. 53. simply restores the normal amount of talotarsal joint motion.
  54. 54. has been scientifically proven to:
  55. 55. 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
  56. 56. Refuse to ignoreor cover-up the symptoms oftalotarsal jointdisplacement!
  57. 57. Let’s fix the problem at its root.
  58. 58. To learn more please