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Hyprocure Stent Operation on the NHS

Discussion in 'United Kingdom' started by Carl, Sep 4, 2018.

  1. Carl

    Carl Welcome New Poster

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    Patient came to see me insisting he be referred to the NHS for a hyprocure stent operation to correct his pronated feet.

    I'm reluctant, because I don't know if NHS podiatric surgeons have the expertise to do the procedure correctly.
  2. davidh

    davidh Podiatry Arena Veteran

    Nothing to stop you doing a referral if you think it is appropriate.
  3. Carl

    Carl Welcome New Poster

    Do you know of Dr. Barlow-Kearsley of the Charing Cross hospital? His department seems to be one of the few NHS hopitals in the London area that do the stent operation.

    My patient is unable to work because of his severe Pes Planus and cannot afford to get the op done privately. I really want to help him but I don't want to put him through the lengthy and arduous procedure if it could ultimately make his condition worse
  4. Dieter Fellner

    Dieter Fellner Well-Known Member

    The Hyprocure is a very easy procedure with only a few pearls to know about. I will be impressed if the NHS will cough up for it. In America insurances providers doggedly refuse to do so. Which means it's an out-of-pocket expense, for the patient.

    The Hyprocure is the single best gift a surgeon can offer a patient with 'flat-foot' issues AKA talo-tarsal subluxation and functional instability.

    That aside, do please let the surgeon decide for himself if he is competent.
  5. Carl

    Carl Welcome New Poster

    Thanks for your reply

    The NHS should offer the procedure in my opinion - Pes Planus is a debilitating condition for some people, especilly when orthotics haven't worked - It isn't that expensive compared with many (more questionable) procedures that the NHS routinely coughs up for.

    I agree that Hyprocrure represents a major breakthrough, but I have also read some who have raised rather worrying concerns about its use - see the discussion in this thread for example:

    https:// podiatryarena. com/index.php?threads/biomechanical-treatment-post-op-hyprocure.51697/

    [remove spaces to click on url]

    and the NICE guidelines are somewhat ambivalent about the procedure, but I'm still going to do everything to help my patient get the operation as I believe it's his last hope
    Last edited: Sep 24, 2018
  6. Dieter Fellner

    Dieter Fellner Well-Known Member

    The success, or failure, of a procedure such as Hyprocure is predicated as much (or more) on correct patient selection as technical execution.

    Not every patient will make a good candidate. Some patients may require supplementary, ancillary procedures. Another patient may require supplementary foot orthosis. Another patient may need more traditional surgical remedies.

    A potential problem, with a patient such as this, and I speculate, is the 'Dr. Google' mentality, of some. Spend a half hour on google and oh my, Mr. Patient can bypass training and years of experience and very likely figure out all that ails, all by himself, and what should be done to fix it and how. Wonderful!

    Such a patient should be advised this: maybe you can be a candidate, maybe not. Let's refer you to the specialist to provide an expert opinion.

    How about that, dear patient?

    p.s thanks for the link, but I will give it a miss. I have heard all the discussions before.Most 'opinions 'are from those who do not actively provide the surgery, (or did not master the process and are not very comfortable with it) yet insist on their 'god-given' right to opine.
  7. Lab Guy

    Lab Guy Well-Known Member

    Great advice Dieter.

    Doctors should respectfully listen to their patients but not take orders from the patient with their google degree. The doctor should do a comprehensive biomechanical exam to ascertain underlying causes of the severe flat feet, offer appropriate tests ( ie, MRI) and decide on appropriate treatment choice. Best to refer to a specialist if they do not have experience in assessing the Biomechanics of severe symptomatic flat feet.

    Severe longstanding painful flat feet/PTTD, unresponsive to orthotics/bracing is most often treated surgically with multiple procedures to decrease the high external pronation moment and healing/reinforcement of involved tissues. Proper diagnosis and selection of procedures is paramount to success.

  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    Steven I agree. Hyprocure is a fantastic tool, and in my humble opinion the best of the options, since it probably functions, not as an arthroereisis (which would aim to block or limit motion), but instead to reconfigure the axis of STJ rotation and to guide the joint complex towards better function. This is a measurable effect on x-ray and and this is also clinically demonstrable.

    That being said, there are multiple segments to the foot and while a lot can be achieved, this it is not a 'flat-foot' panacea. Dr. Graham, and his group, are very careful to make this distinction . As a patient, if I have a flat-foot (I use the term loosely) that requires surgical intervention I would likely resist traditional flat-foot reconstruction. I would be quite happy however to try the stent.

    Quite a few patients respond well for a variety of talo-tarsal instability related conditions e.g. plantar fasciitis, posterior tibial tendonitis, hallux limitus and hallux valgus etc can all respond favorably once talo-tarsal complex has been controlled.

    The long honored surgical caveat applies to this procedure as any other: while a favorable response is expected, no guarantees can be offered.

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