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Flat feet stents

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Simon Spooner, Oct 8, 2008.


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    All,

    An article in the Daily Mail UK yesterday by Angela Brooks- doesn't appear on their website as yet, so I've copied part of it here.

    "Tube in your heel that ends agony of flat feet:

    A tiny metal tube implanted into the foot could help thousands of Britons with flat feet. The tube - or 'stent' - works by supporting the fallen foot arch, so relieving pain and helping ease many of the complaints associated with this problem.

    As many as 18 million people in the UK have flat feet. [Spooner- UK population: 60,776,238 (July 2007 est.) so about 1/3 of the population- does this seem about right??] While the majority have no problems, some suffer not only very painful feet but a host of ligament, tendon and joint injuries, which in turn can affect the hips, back and neck.

    This chain of events is driven by faulty foot mechanics. When we walk, the full weight from the body is carried from the heel through to the front of the foot, which works as a lever propelling the foot forward.

    It is normal for the foot arch to relax downward slightly in this motion but for those with flat feet it totally collapses so the foot rolls inwards when it bears weight.

    The continual collapsing of the arch- known as over-pronation - can damage surrounding soft tissue, stretching the foot ligaments and tendons designed to keep the foot stable.

    [Spooner- this is where it caught my attention]
    Over time, these stretched ligaments and tendons are pushed into the sinus tarsi - the small gap between the heel and ankle bone which contains fluid and works to support the arch.

    When the sinus tarsi becomes closed in this way, the arch of the foot collapses even further, causing problems further up the body.

    The first line of treatment is usually insoles to prop up the arch and stop the over-pronation. Insoles don't improve foot mechanics, however - they can also be worn only in flat, sensible shoes."

    The article continues to discusses the use of stents wedged into the sinus tarsi and takes quotes from Stuart Metcalfe a podiatric surgeon from the UK who allegedly introduced the stent to the UK from America, I'll post a link to the full article when it appears on their websit, although I shall be away for a few days so if anyone else spots it- feel free.

    So there you have it, "insoles don't improve foot mechanics."
     
  2. Graham

    Graham RIP

    Simon,

    Sounds like the 'Stay Peg" procedure in the US.
     
  3. Paul Bowles

    Paul Bowles Well-Known Member

    Hi Grahem do you mean a STA-PEG?
     
  4. Graham

    Graham RIP

    QUOTE]Hi Grahem do you mean a STA-PEG?[/QUOTE]

    Very probably!
     
  5. Paul Bowles

    Paul Bowles Well-Known Member

    Ok Grahem, no problems - I thought that's what you may have meant.

    Simon, surely you already knew that insoles don't improve foot mechanics and isn't it obvious that a small implantable piece of something will with as little complications as a piece of plastic!!!

    ;)

    Oh the irony of it all!!!
     
  6. simonf

    simonf Active Member

  7. Sammo

    Sammo Active Member

    If it works, seems like it might be a good alternative surgical intervention for PTTD than calcaneal resection (or whatever it is called). But for use in kids?? Seems a little extreme no? Does it not impinge on all the soft tissues in the Sinus Tarsi? Is there any cases of iatrogenic sinus tarsi syndrome from it's use?

    S
     
  8. neilmalc

    neilmalc Member

    Our local orthopod seems to be favouring the Kalix implant for children.
    I presume it's a very similar system to the one outlined in the Daily Mail article.

    Cheers,

    Neil.
     
  9. simonf

    simonf Active Member

    Yes and heres another one: http://www.hyperpronation.com/

    Its certainly less trauma than extensive rearfoot surgery, and you can always take it out if it causes any problems

    s
     
    Last edited: Oct 9, 2008
  10. Subtalar arthroeresis procedures have been performed here in the US for the past 30 years and are most commonly used for correction of children's flatfoot deformity and for augmentation of surgical correction of adult flatfoot deformity. The idea is based on the concept that if the sinus tarsi is filled with a non-deformable material, then the rotational motion of the subtalar joint will be limited in the pronation direction due to preventing the lateral process of the talus from reaching the floor of the sinus tarsi when the subtalar joint is maximally pronated. Most common problems with the procedure are migration of the implant and chronic sinus tarsi pain post surgically. Compared to other surgeries for flatfoot correction, the subtalar arthroeresis procedure has relatively few complications and sequellae.

    Hope this helps.
     
  11. g c mann

    g c mann Member

    As the podiatric surgeon who actually introduced the Hyprocure sinus tarsi implant into the Uk the impression that it is a primary Tx for PTTD or AAFF is erroneous,It is very effective in controlling those patients who have failed to respond to orthotic therapy either due to hypermobility or an inability to cope with footwear complications.The algorythm provided by the ACFAO on the treatment of AAFF is still extant.All non-invasive TX should be offered and/or trialed before use of the stent,including Richie type braces.The sta-peg is an early predessor to the hyprocure system,currently there are various arthroereisis implants available and new systems become available yearly.
     
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