A. The stent is made of titanium and this is the best material used in the body. People do not form allergic reactions to it. It is possible for a patient to have a synoviitis, which is the chronic inflammation in the sinus tarsi due to the repeated injury to the joint complex, but this is NOT an allergic reaction to HyProCure. Furthermore, sometimes patients will have a clear drainage coming from the incision, this is because the skin is not completely healed and fluid will "leak-out" until the skin edges are healed.

A. Generally no, but it can depend on the patient and the structure of their foot. First, if the only problem is due to the over-pronation of their subtalar joint and the rest of the foot is structurally repaired by reposition of the talus on the calcaneus than I would say no. The HyProCure will make the work of an orthotic for the most part. However, there are cases where an orthotic can do things that the HyProCure can’t. Also, we do cast patients in the “neutral” or “ideal” position and so if we get their foot back to the ideal position then the orthotic wouldn’t need to be changed. My experience is that most patients are very happy not to need their orthotics anymore and that their feet actually feel a lot better without them. But, again, I want to reiterate that there are some cases that would greatly benefit from orthotics after the HyProCure procedure. The simple thing to do is have the patient wear their orthotics after the procedure and see if they help at all or if they can be discarded.

A. HyProCure is placed within the orientation of the sinus tarsi, which is anterior lateral distal to posterior medial proximal, not lateral to medial. Therefore, the HyProCure stent prevents the slipping of the talus off the posterior facet and the talus can perform its heliocoidal motion to transfer the weight of the body to the calcaneus and navicular bones. Devices placed lateral to medial act by blocking the lateral process of the talus leading to potential bone deformation. The true talar stabilization occurs right at the cruciate pivot point of Farabeuf. The tapered portion of HyProCure, the middle of the device, is placed right at this cruciate pivot point, providing stability to the STJ complex, whereas in competitive devices only the leading edge is placed at this essential location.

A. Yes, there really is a difference, it may seem like they are all the same but this is absolutely not the case. There are several unique characteristics of HyProCure. It’s evident that the overall shape of HyProCure is different from any other device currently on the market. The other devices are either cylinders or cones, they are laterally anchored, the tip of the device is placed at the “50 yard line” or at the bisection of the talus, and finally the other devices are placed from lateral to medial. HyProCure is the combination of cylinder-cone-cylinder to really provide a complete anatomic fit to the whole sinus tarsi. These core differences in implant design are what make HyProCure's success rate and patient candidacy so dramatically superior to anything else on the market.

A. Absolutely not! Would you wait until you had 20,000 miles on your car tires to balance them? The sooner the subtalar joint is stabilized, the better. The average person takes nearly 10,000 steps a day and with every step there is excessive wear and tear. Even if symptoms are not present the pathological condition is still present and it requires a physical correction. I think we need to be a lot more proactive. Do we need to wait for someone to end up in a diabetic coma to begin insulin treatment? Eventually, a cumulative trauma disorder will occur resulting in a symptom. We need to eliminate the root-cause and not just ameliorate the symptoms.

A. By the time a child is 3 to 4 years old the sinus tarsi is formed by the osseous structures from the talus and calcaneus. It is my belief that the sinus tarsi does not change in its dimensions (yet to be proven). This is based on the fact the most common HyProCure size is 7 then 6 in adult patients. So, if a child already has a size 6 or 7, then they already have the most common adult size stent. However, I have found that in my hands, the most common pediatric sizes are 7 and 8. I will always advise parents that it may be that once the child has reached skeletal maturity that the stent may need to be either up-sized or down-size.

A. Yes, it is a quick, simple procedure so why shouldn’t we fix both feet at the same time thus saving insurance costs and time? Well, I used to always perform both feet at the same time, when it was indicated that both feet needed to be fixed. I found that there was a significantly prolonged recovery when compared to one foot at a time, with a much greater chance of stent displacement. The patient doesn’t have one “good” foot to walk on and will end up compensating by supinating both feet when they walk. The excessive supinatory force at the subtalar joint could end up laterally displacing one of the stents and require a trip back to the operating room to reposition the stent. I found that by performing one foot at time not only did it improve patient outcomes; patients had a faster, easier recovery when compared to both feet at the same time. I feel that we should only perform this procedure one foot at a time. However, there are always exceptions to the rules and individual case judgment should be used.

A. I feel it is in the patient’s benefit to have not only a local anesthetic but also the addition of a long lasting steroid injected into the sinus tarsi prior to the procedure. First, it will significant decrease the post-op pain as I use a long lasting local (marcaine) and therefore the patient should have a better recovery. Also the steroid will have to minimize the major inflammatory reaction that is going to occur with the procedure. I will use two syringes the first with just the local only (3 to 5 cc syringe of 1:1 mix of 0.05% marcaine with and without epi) then the second syringe (also 3 to 5 ccs of the 1:1 mix) containing both the short and longer acting steroids. This has significantly decreased the amount of post-op pain pills that my patients require. Finally, if it isn’t contra-indicated, I will also give an IV anti-inflammatory prior to the surgery to also help decrease the inflammation from any angle.