Pediatric Flatfeet – a Disaster in the Making

February 26, 2020

One of the greatest and most expensive diseases of humankind begins with the partial dislocation of the talus on the posterior facet of the calcaneus. This orthopedic pathology is present at birth and continues to get worse over time. There is no radiographic evidence that a child with a “flexible” flatfoot outgrows this condition. You and I know it, but unfortunately, the rest of the world is told to ignore this condition as it is a normal variant. The scientific evidence that has been accumulating over the past many decades refutes this myth. This webinar will explore the myths of pediatric flatfeet, the evidence of auto-correction will be analyzed, and most importantly when and why early intervention should be recommended over a watch-and-wait. We look forward to your participation.

Questions & Answers

Have there been many cases where TTJD might be a cause of recurrent metatarsal stress fractures?

I am not aware of any stress fractures as a result of EOTTS-HyProCure. There is a normalization of plantar forces to the metatarsal heads, so I would not foresee this to be an issue.

How long do you wait before correcting the contralateral foot with HyProCure in Pediatric vs. Adult patients?

The answer is the same for both – as soon as the recipient can bear full weight on the foot with HyProCure, then the contra-lateral limb can undergo HyProCure placement. This is typically performed 7 days to 3 to 4 weeks apart. Waiting longer periods of time is ok, but that foot with HyProCure will continue to be sore until the contra-lateral limb is stabilized.

Why you don’t prefer Prostop vs. HyProCure?

Prostop is an joint blocker, the lateral process of the talus smashed into the device, the talus glides over HyProCure. The function between the arthroereisis device (type 1 EOTTS), is inferior HyProCure (type 2 EOTTS). You can view more information on: HyProCureDoctors.com
http://www.hyprocuredoctors.com/comparison-of-the-eotts-hyprocure-sinus-tarsi-stent-to-other-forms-of-treatment/

What is the ideal time for surgery? As soon as possible or for example 12 years old?

Generally speaking, 8 to 10 years but there are exception when it can be recommended younger – as young as 3 years of age.

What is the role of physical therapy?

Generally, this is not necessary – unless the patient is taking longer than normal to recover.

What are your age recommendations for the HyProCure? How young would you do it? Is there an upper limit that is too old?

The age range is 3 years to 94 years old. They just need to have a flexible/reducible talotarsal joint displacement deformity.

Is it better to use a larger implant in a child vs adult?

You should use the size that you determine at the time of surgery, do not try to over-size because their foot is smaller. This could put the foot into a varus.

What is your thoughts on taking an implant out and upsizing to improve heel valgus post op?

You would need to make sure that the size is correct by measuring the talar second metatarsal angle and talar declination angle. It is possible you need to perform a combination of surgery, maybe even staged procedure. First HyProCure and then see if any other procedures are needed.

How do you deal with sever forefoot varus deformities?

This is where the combination of EOTTS-HyProCure and the use of a foot orthotic is recommended. Sometimes a plantar flexory first metatarsal osteotomy is needed or cotton, etc.

What makes the HyProCure different from the other implants on the market?
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