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Have a 48 y/o patient who underwent surgery 2 years ago (USA) for correction of his flatfeet. Had bilateral subtalar titanium implants inserted through the sinus tarsi to "prevent his foot from collapsing" and has had significant post operative discomfort since - with localised oedema and erythema. He wears no orthoses and was advised that with this type of surgery, orthoses would not be indicated.

Anyone much experience with these impants - particularly if there is history of rejection? Any comments appreciated.

Mark Russell

If the patient is asympromatic then leave well enough alone. These have to be done in VERY well screened patients. There have been many instances when they dislodge particularly if the patient was poorly screened, or if too small or large of a size was used.

Once again, in properly selected patients, particularly those of younger age, they work pretty well, are minimally invasive, and removeable should it be necessary.

Articles from Podiatry Today:
A Guide To Indications For Subtalar Implants
IS THE SUBTALAR IMPLANT THE ANSWER FOR JUVENILE FLATFOOT?

and from Podiatry Management:
A new generation of subtalar implants: these devices make procedures safer and more user-friendly

Cheers for this Craig - much appreciated. I have this away for x-ray today to see if there's any fracture as he came down heavily on the foot after descending a ladder three weeks ago.

Is this surgery commonplace in correction of paediatric or flexible adult flatfoot?

Mark Russell

Sounds like bad advice. The surgery is generally only performed on those who are severe enough so as they do not respond to foot orthoses. The surgery will NEVER, generally, get the foot back to a 'perfect' position (not even close), so foot othoses would be essential long term.... ie the surgery will usually improve the foot enough so that foot orthoses can now work .... IMHO

I am not a doctor, therefore my posting in this thread may be highly inappropriate, but I am seeking help for my son. At the age of 12 he suffers chronic foot and ankle pain. He cries almost every day now as the afternoon wears on. If he participates in physical activites for too long, his knees, hips, and lower back also begin to ache.

I recently took him to a podiatrist that came highly receommneded. He diagnosed my son with sublexing subtalar joints and valgus deformity of foot. His recomendation was subtalar implants.

My insurance company has just informed that they won't cover this procedure. They said I need to look for alternatives.

So..... what, if anything, is "wrong" with this procedure?..... what alternatives are there? (we've already tried shoe inserts)..... is it just my insurance company or is it across the board that this is not covered?

Please help. I can't bear to watch my son continue to cry every day. Thank you.

I would have you son checked for calcaneal apophysitis. This is a rather painful condition which often times can mimic the symptoms which you describe. Generally the treatment for this is ice massage, as well as rest and nonsteroidal's such as Motrin. Orthotics have been shown to be of some benefit in this condition as well.

Additionally there is a particular strapping which although difficult for a parent to do, it has been shown to be effective as well.

The good thing, is that if calcaneal apophysitis is the problem, although painful, it will improve as he matures. Basically, for lack of a better term it is inflammation of the growth center of the calcaneus (heel bone). If there is pain with compression of the posterior aspect of the heel (using your fingers from side to side roughly where the Achilles tendon inserts) this could be his problem. I would bring this up at your next visit.

Summer

Carolyn:

Even though it is very difficult to diagnose your son's condition with the limited information you have presented, he probably has pain in his foot and ankle from his overly pronated foot. No surgery should be done on your son unless custom foot orthoses are first made for him with special modifications to control the excessive pronation in his feet.

In my twenty years of practice, I have seen literally hundreds of children in this age group with flat feet and the exact same symptoms. Once they receive foot orthoses, and are in appropriate shoes, about 85-90% become asymptomatic or have only slight pain with very aggressive physical activities. I would only reserve subtalar implants for those children that showed only partial improvement with foot orthoses.

If your podiatrist has not already suggested foot orthoses for your son, then I would suggest finding another podiatrist. Please tell me where you are located and I'll try to help you find a good podiatrist that knows how to make effective custom foot orthoses so that your son can be more comfortable and resume his normal activities without pain.

__________________
Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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