Journal of Foot and Ankle Surgery (Asia Pacific)

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


Extra-osseous Talotarsal Stabilization (EOTTS) Utilizing Type II Sinus Tarsi Stent: Indications, Technique, and Tips

Abhishek Jain, Michael E Graham

Keywords : Arthroereisis, Extraosseous talotarsal stabilization, Flatfoot, Recurrent talotarsal joint dislocation, Subtalar implants

Citation Information : Jain A, Graham ME. Extra-osseous Talotarsal Stabilization (EOTTS) Utilizing Type II Sinus Tarsi Stent: Indications, Technique, and Tips. J Foot Ankle Surg Asia-Pacific 2023; 10 (2):61-65.

DOI: 10.5005/jp-journals-10040-1285

License: CC BY-NC 4.0

Published Online: 11-04-2023

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


Introduction: One important reason for a flexible flatfoot is the incongruency or partial dislocation of one or more joints within the talotarsal mechanism. This dislocation or subluxation may exist as a recurrent/dynamic/reducible or rigid/static/nonreducible condition. The flexible talotarsal malalignment is termed recurrent talotarsal joint dislocation (RTTJD). Addressing this malalignment to correct the flatfoot using a minimally invasive technique is the call of the present time. Aim: To elucidate, in the simplest of manner, the surgical technique of extra-osseous talotarsal stabilization (EOTTS) using a type II sinus tarsi device for flatfoot patients. Technique: With a 1.5–2.0 cm incision over the dorsolateral aspect of the foot, a type II sinus tarsi device (HyProCure) is inserted into the sinus tarsi after appropriate sizing. Instant and on the table correction of the deformity is achieved. Skin closure can be done with an absorbable subcuticular suture. The entire procedure takes 15 minutes to complete. Discussion: In the past, many orthopedic surgeons have published their work on flatfoot correction using sinus tarsi implants. Appropriate patient selection and sinus tarsi stent design dictate the success of EOTTS. There have been other soft tissue and bony procedures that have their place when appropriately indicated. However, they result in extensive surgical dissection, big and cosmetically challenging scars, long recovery periods with plasters, and nonweight-bearing instruction. The list of possible and known complications of these more aggressive surgical procedures to correct flatfoot is what led to the development of a more conservative option when indicated. Compliance with custom-made orthotic supports, braces, and shoe inserts is relatively poor. Also, there is no proven clinical evidence that externally applied foot orthotics realigns the osseous structure and restores the normal biomechanics of the foot. With EOTTS, all the above problems are bypassed and the most important advantage is its reversibility. Conclusion: Extra-osseous talotarsal stabilization (EOTTS) has resulted in excellent improvement in foot biomechanics, alleviation of symptoms like pain and obvious cosmetic deformity, and restoration of normal foot radiological angles. The procedure is a boon for both surgeon and the patient. It allows the patient for a minimal hospital stay and expense, minimal cosmetic scar, immediate correction of deformity, and a very short rehabilitation period.

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