Device Offers Unique Solution For Subtalar Joint Instability

Podiatry Today Staff

While there are various options for treating subtalar joint instability, one device reportedly offers unique angulation and placement that facilitate symptomatic relief and earlier weightbearing.

   James Bender, DPM, has performed over 300 procedures with the HyProCure sinus tarsi implant (GraMedica). Dr. Bender has been pleased with the results he has seen in patients of all age groups inclusive of his pediatric population.

   “The results have been outstanding in that these individuals seem to respond to therapy more quickly,” explains Dr. Bender, who notes that the youngest patient he has treated with the HyProCure device is 4 years old. “(Parents have told us) that symptoms have been relieved and the children are quickly up and running with full participation in weightbearing activities that many could not do previously.”

   Philip Bresnahan, DPM, concurs and says the HyProCure implant is “ideally suited for children.”

   “It is a fairly benign procedure with benefits that outweigh the risks when the child has a significant flatfoot deformity that is not amenable to conservative treatment,” notes Dr. Bresnahan, an Assistant Professor who teaches pediatric foot and ankle orthopedics at the Temple University School of Podiatric Medicine.

   Dr. Bresnahan says the angulation of the HyProCure implant facilitates better placement of the device.

   “You can insert the implant further into the sinus tarsi and the canalis portion of the sinus tarsi,” explains Dr. Bresnahan, a Diplomate of the American Board of Podiatric Surgery. “This allows the device to be more centrally located under body weight.”

   In contrast, GraMedica says “over-insertion” has occurred with other subtalar arthroereisis implants when surgeons have inadvertently pushed the implant completely through the sinus tarsi with the implant winding up on the medial side of the foot and completely exiting the sinus tarsi.

   GraMedica notes that the HyProCure stent is a “self-seating stent” in that the tapered portion of the implant abuts the lateral part of the canalis so one cannot “over-insert” the device.

   Dr. Bender points out another key benefit of the HyProCure device over other subtalar arthroereisis implants.

   “(The HyProCure) device also treats the problem of tarsal instability as it relates to hyperpronation at the site of the default (as opposed to) the competitive arthroeresisis procedures that act to block motion in the subtalar joint,” points out Dr. Bender, who is in private practice in Grand Rapids, Mich. “This device maintains the normalized position of the talus on the calcaneus, thus bringing the subtalar joint structures into proper alignment.”

   Drs. Bender and Bresnahan have also had favorable results when using the HyProCure implant to treat adult patients. Dr. Bresnahan has used the implant in patients up to 80 years of age with a flexible deformity. Dr. Bender has likewise treated a 76-year-old patient with the HyProCure implant.

   “Our experience with the adult population has been amazing with patients gaining full relief from clinical symptoms … almost immediately following the talotarsal stabilization procedure with the use of HyProCure stents,” notes Dr. Bender.

   In terms of contraindications for the HyProCure implant, Dr. Bender says the primary ones are: children under 3 years of age; active infection; and a lack of mobility allowing for correction of the talotarsal positioning. Dr. Bresnahan adds that surgeons should not use the device on a rigid flatfoot deformity but otherwise sees no other contraindications that are unique to the device.


I live in Grand Rapids and have observed blatant abuse of this procedure. Far too many implants are being inserted. The indications are also abused. I have seen this used in in place of orthotics, for augmentation of bunion correction and metatarsalgia. All flatoot or subtalar joint instability should always be first treated conservatively.

Flatfoot symptoms are almost always improved or resolved with conservative non-surgical care. Certainly inserting over 300 implants would indicated overuse and/or misuse of this procedure.

Furthermore, statements made in this manuscript are not supported by appropriate evidence-based medicine studies. And most flatfoot corrections require ancillary procedures to augment the arthroereisis. Rarely can a STJ implant be used as a stand alone procedure.

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