One of the most frequently asked questions is how to know if a patient is a potential candidate for EOTTS-HyProCure. Dr. Graham will enlighten viewers on how to identify ideal, less-than-ideal, and non-candidates. This information is extremely important to reduce removal rates and potential complications.
First, it is very important to inject long-acting anesthesia combined with ¾ cc of short- to mid-acting steroid. The reason for pain is from the inflammatory reaction, so it is important to put the medication right where it needs to go. The injection of local anesthesia and steroid should be given prior to making the skin incision.
It is better to perform uni-lateral correction, but that foot will continue to have soreness until the contra-lateral limb is internally corrected with HyProCure.
Patients should be prescribed a post-op anti-inflammatory and should ice.
If pain out-of-proportion is affecting the patient, and both feet have been internally corrected with HyProCure:
The “standard of care” is to diagnose the true deformity and to provide treatment solutions/options to the parents/guardian/child. Recurrent talotarsal joint displacement (RTTJD) is not a life-threatening condition, but it is a disaster waiting to happen. It is not if the second pathology will happen - it is when that secondary pathology will happen. The sooner any treatment is provided, the less tissue damage will occur. There are risks with any surgical procedure, and there are benefits with every procedure. So it is up to the patient to decide if the benefits outweigh the risks.
What is below the standard of care is to spread misinformation that their child will outgrow this condition and that no treatment will ever be required. Or that the use of a shoe insert will “fix” the hindfoot misalignment as the child grows. Those statements are not backed by any published evidence.
It really depends on the first ray deformity. Many times, patients with a mild/moderate deformity will only require EOTTS, which could actually reduce the size of the bunion because the primary etiology is reduced. Other times, due to the severity of the first ray deformity, the combination of EOTTS with first ray corrective surgery is mandated. Ideally, it is better to first perform EOTTS and stage the 1st ray correction. “Fixing” both at the same time results in guarded supination of the hindfoot and forefoot during the recovery process. Performing both at the same time can compromise the success of the EOTTS procedure.
It really depends on the flexibility and stability of the first ray. See the question, "Do you often perform an EOTTS with a bunionectomy?" If both have to be performed at the same surgical setting, always perform EOTTS first and then evaluate the first ray.
Yes, absolutely. This can be easily measured on a pre- and post-EOTTS procedure. The reduction of the anteriorly deviated cyma will lead to a shortening on the medial column. That is the reason for the formation of a “short” lateral column.
There are no studies to show that or anticipate any difference or effect trisomy 21 would have. The EOTTS procedure is not an osseous procedure, so the only reason for non-weight-bearing is to allow the tissues to respond to the inflammatory reaction from cutting the tissues. The patients with trisomy 21 would have the same recovery regardless of that finding.
There is no particular preferred sport after HyProCure – it is what the child prefers there are no limitations to sports after the patient is fully recovered.
We suggest that there should not be any strenuous activity as far as running, jumping, etc. until a minimum of 6 to 8, that’s because the chance of stent displacement after 6 weeks is < 1%.