Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 10 , ISSUE 2 ( April-June, 2023 ) > List of Articles


Use of HyProCure in Correcting Flatfoot in Adolescent and Adult Asians: A Radiographic Study Using a New Method of Measuring Hindfoot Alignment

Zhi Hao Tang, Keen Wai Chong

Keywords : Arthroereisis, Deformity correction, Flexible flatfoot, Hindfoot, Pes planus

Citation Information : Tang ZH, Chong KW. Use of HyProCure in Correcting Flatfoot in Adolescent and Adult Asians: A Radiographic Study Using a New Method of Measuring Hindfoot Alignment. J Foot Ankle Surg Asia-Pacific 2023; 10 (2):56-60.

DOI: 10.5005/jp-journals-10040-1238

License: CC BY-NC 4.0

Published Online: 11-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: Extraosseous talotarsal stabilization (EOTTS) is increasingly popular as a surgical treatment for adult symptomatic flexible pes planus. This can be performed alone or combined with medializing calcaneal osteotomies with or without medial column stabilization. The aim of our radiographic study is to evaluate the changes in various radiographic parameters of a pes planus deformity including hindfoot alignment after EOTTS. We hypothesize that EOTTS can demonstrate improvement in radiographic parameters, including hindfoot alignment. Materials and methods: A total of 12 feet from nine patients who had undergone EOTTS using the HyProCure implant were analyzed. Weight-bearing radiographs were used to measure the pre- and postoperative talar-second metatarsal, lateral Meary's, calcaneal inclination, talar declination angles. Hindfoot alignment was measured using fibular axis calcaneal offset (FACO) method. Results: Our results showed significant improvement in all the radiographic parameters including hindfoot alignment. Conclusion: There is a radiographic improvement in a flexible pes planus deformity after an EOTTS procedure, including hindfoot alignment. Clinical significance: Hindfoot alignment can be corrected with EOTTS procedure with or without associated procedures.

  1. Noll KH. The use of orthotic devices in adult acquired flatfoot deformity. Foot Ankle Clin North Am 2001;6(1):25–36. DOI: 10.1016/s1083-7515(03)00077-9
  2. Needleman RL. Current topic review: subtalar arthroereisis for correction of flexible flatfoot. Foot Ankle Int 2005;26(4):336–346. DOI: 10.1177/107110070502600411
  3. Lelievre J. The valgus foot: current concepts and correction. Clin Orthop 1970;70:43–55. DOI: 10.1097/00003086-197005000-00005
  4. Grice DS. An extra-articular arthrodesis of the subastragalar joint for correction of paralytic flat feet in children. J Bone Joint Surg Am 1952;34 A(4):927–940. DOI: 10.2106/00004623-195234040-00020
  5. Subotnick S. The subtalar joint lateral extra-articular arthroereisis: a follow-up report. J Am Podiatry Assoc 1977;67(3):157–171. DOI: 10.7547/87507315-67-3-157
  6. Saxena A, Via AG, Maffulli N, et al. Subtalar arthroereisis implant removal in adults: a prospective study of 100 patients. J Foot Ankle Surg 2016;55(3):500–503. DOI: 10.1053/j.jfas.2015.12.005
  7. Usuelli FG, Montrasio UA. The calcaneo-stop procedure. Foot Ankle Clin N Am 2012;17(2):183–194. DOI: 10.1016/j.fcl.2012.03.001
  8. Vogler HW. STJ blocking operation for pathologic pronation syndrome. In: McGlamry ED, editor. Comprehensive Textbook of Foot Surgery. Baltimore, MD: Williams & Wilkins; 1987. p. 466–482.
  9. Thomas J, Kunkel M, Lopez R, et al. Radiographic values of the adult foot in a standardized population. J Foot Ankle Surg 2006;45(1):3–12. DOI: 10.1053/j.jfas.2005.10.014
  10. Gentili A, Masih S, Yao L, et al. Pictorial review: foot axes and angles. Br J Radiol 1996;69(826):968–974. DOI: 10.1259/0007-1285-69-826-968
  11. Graham ME, Chikka A, Jones PC. Validation of the talar second metatarsal angle as a standard measurement for radiographic evaluation. J Am Podiatr Med Assoc 2011;101(6):475–483. DOI: 10.7547/1010475
  12. Ryuji N, Keita M, Hiromasa M, et al. Medial torsion of the tibia in Japanese patients with osteoarthritis of the knee. Clin Orthop Relat Res 2003;(408):218–224. DOI: 10.1097/00003086-200303000-00028
  13. Neri T, Barthelemy R, Tourne Y. Radiographic analysis of hindfoot alignment: comparison of Meary, long axial, and hindfoot alignment views. Orthop Traumatol Surg Res 2017;103(8):1211–1216. DOI: 10.1016/j.otsr.2017.08.014
  14. Saltzman CL, el-Khoury GY. The hindfoot alignment view. Foot Ankle Int 1995;16(9):572–576. DOI: 10.1177/107110079501600911
  15. Haraguchi N, Ota K, Tsunoda N, et al. Weight-bearing-line analysis in supramalleolar osteotomy for varus-type osteoarthritis of the ankle. J Bone Joint Surg Am 2015;97(4):333–339. DOI: 10.2106/JBJS.M.01327
  16. Graham ME, Jawrani NT, Chikka A, et al. Surgical treatment of hyperpronation using an extraosseous talotarsal stabilization device: radiographic outcomes in 70 adult patients. J Foot Ankle Surg 2012;51(5):548–555. DOI: 10.1053/j.jfas.2012.05.027
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