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Talotarsal displacement treatment alternative

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Talotarsal Displacement leads to many different problems to our feet, knees, hips and back. This presentation presents a brief discussion of various treatment measures and provides a benefit risk analysis.

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Talotarsal displacement treatment alternative

  1. 1. Talotarsal DisplacementAlternative Treatment Options
  2. 2. Treatment Goal• Not to just cover-up/mask the pain with pills.• Identify what caused the pain in the first placeand to eliminate the cause (cure it).• If we only address the symptom(s) and not thecause, the symptom(s) will continue until theyreach their breaking point.
  3. 3. Treatment dependson the severity of the displacement.• Observation – nothing?• Shoe inserts/arch supports/orthotics?• Reconstructive hindfoot surgery?• Extra-Osseous TaloTarsal Stabilization?
  4. 4. Treatment Option- ObservationDid you know average person takes• 7,000 steps/day• 49,000 steps/week• 196,000 steps/month• 2,352,000 steps 1 year• 11,760,000 steps 5 years• 22,520,000 steps 10 years• 47,040,000 steps in 20 years• 116,600,000 steps in 50 years
  5. 5. Treatment Option- Observation• These feet don’tautomatically fixthemselves.• They don’t get better,they get worse.
  6. 6. Treatment Option- Observation• Symptom(s) will occur at theweakest link.• Most likely there will not beany pain at the primarydeforming site (TTM)• Unfortunately, attention isfocused on symptom reliefand the underlying etiology isusually ignored or under-treated.
  7. 7. Benefit – Risk AnalysisObservation• Benefits:– Non-surgical option– Relatively inexpensive– Does not rely oncompliance– No anesthesia/surgicalrisks– Cheap and easy• Risks:– Progression of the diseaseprocess– Every step is inefficient– Excessive abnormal strainon supporting soft tissuestructures while standing,walking or running– Mal-alignment to otherstructures within the foot& ankle and also up themusculoskeletal chain– Leads to the many possiblelong-term complications
  8. 8. Shoe insert-• Maybe some patients willbenefit with relief, but whatif it doesn’t?• There are pitfalls with thesedevices such as expense,compliance, replacementcosts and so on.• Where is the proof that theyactually “fix” or reduce theexcessive hindfoot motion?
  9. 9. Treatment Option- orthoses/shoesDo arch supports really stabilize the ankle bone?BarefootOrthosis
  10. 10. This is the results of 20 years of shoesinserts. Now there is only 1 option.
  11. 11. Benefit – Risk AnalysisArch supports/Orthotics/Shoes• Benefits– Non-surgical option– Relatively inexpensive(compared to surgicaloptions)– No potentialanesthesia/surgicalcomplications• Risks– Not proven to decreasetissue strain– Not proven to improveradiographicmeasurements– Can lead to otherproblems- increased pain– Patient compliance issues– Need new devices maderegularly– Have to be worn in shoes
  12. 12. Treatment Option- Rearfoot Surgery
  13. 13. Benefit – Risk AnalysisRearfoot Reconstructive Surgery• Benefits:– Radiographic correction– Internal correction– Does not rely on patientcompliance (once healed)– May be covered by insurancecompanies.• Risks:– Surgical risks• Non-union• Infection• Need for revision• Need to remove internalhardware– Can lead to arthritis in adjacentjoints– Anesthesia risk (low)– Very expensive– Long recovery• Cast• Cannot walk on foot• Edema, pain, stiffness• Physical therapy
  14. 14. What can EOTTS Achieve?
  15. 15. What can EOTTS Achieve?
  16. 16. Benefit – Risk AnalysisEOTTS• Benefits:– Internal solution– Minimally invasive, “fast”– Extra-osseous (soft tissue)– Reversible– Proven to decrease strainon supporting tissues– Radiographic evidence– Does not rely on patientcompliance (once healed)• Risks:– Device displacement– Over/Under-correction– Need for revision orpermanent removal– Soft tissue adaptations– General surgical risks

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