ProStop® Arthroereisis

Flatfoot

Flatfoot symptoms:
 Talar head tilt
 Forefoot abduction
 Hindfoot valgus

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Flatfoot

Stabilizes subtalar and

talonavicular joint

Decreases downward
forces on medial column
ProStop®
effects
Decreases stress on the
plantar fascia

Decreases stress on
tibialis posterior tendon

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Surgical Technique

 Insert guidewire  Sizer  Check in fluoro

 It will be above the
neurovascular bundle and
the TP tendon

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Surgical Technique

 Check mobility  Select implant size  Insert implant to the depth

 Oversizing will lead to that was measured with
supination the trial

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Effective and Less Invasive

Subtalar arthroereisis vs. lateral column

lengthening [1]
 Statistically significant improvements in
both groups
 No difference in their outcomes

Arthroereisis  Less- invasive nature

and lower potential morbidity

[1] Chong DY, Macwilliams BA, Hennessey TA, Teske N, Stevens PM. Prospective comparison of subtalar arthroereisis with lateral column lengthening for painful flatfeet.
J Pediatr Orthop B. 2015 Jul;24(4):345-53

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Takes Load Off Plantar Fascia

 Flatfoot increases forces on [1]

‒ Joints of the medial column and first metatarsal
‒ The long plantar ligament and the plantar
aponeurosis
 A 6 mm arthroereisis implant
‒ Shifts the load from the joints of the medial column
back toward the lateral column
‒ Decreases the forces in the medial extensions of
the long plantar ligament and plantar aponeurosis

6 mm subtalar arthroereisis in an adult

flat foot model decreases the load on
the medial arch
[1] Arangio GA, Reinert KL, Salathe EP. A biomechanical model of the effect of subtalar arthroereisis on the adult flexible flat foot. Clin Biomech (Bristol, Avon). 2004 Oct;19(8):847-52

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Supports Severe Flatfoot Correction

In the severe flatfoot model, the talar-first metatarsal

angle, talonavicular angle, and medial cuneiform
height remained significantly undercorrected after
the (MCO) osteotomy and (FDL) tendon transfer.

After the arthroereisis, the talonavicular

angle and medial cuneiform height were …
(similar to)… the values for the intact foot.

[1] Vora AM, MD, Tien TR, MD, Parks BG, MSc, Schon LC, MD, Correction of Moderate and Severe Acquired Flexible Flatfoot with Medializing Calcaneal Osteotomy and Flexor Digitorum Longus Transfer,
JBJS, August 2006; 88:1726-1734

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Removal in Case of Pain is Possible Without Risking
Recurrence
 With the implant in place for 8 months, the foot
adapts to its presence through the stiffening
of the soft tissues that are integral to joint
alignment and motion
 Most patients’ recoveries were faster and less
painful than after other operative procedures

No significant differences could be

detected after the … [implant] … was
removed

Needleman RL, A Surgical Approach for Flexible Flatfeet in Adults Including a Subtalar Arthroereisis with MBA Sinus Tarsi Implant, Foot and Ankle Intl., January 2006; 27(1):9-18.

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Arthroereisis Corrects the Essential Pathology of Flexible
Flatfoot
Essential pathology of the flexible flatfoot:
 Excessive subtalar eversion with associated
hindfoot valgus,
 Plantar flexion of the talus, and
 Lateral peritalar subluxation

Arthroereisis is a core procedure that

corrects these pathologies

Needleman RL, A Surgical Approach for Flexible Flatfeet in Adults Including a Subtalar Arthroereisis with MBA Sinus Tarsi Implant, Foot and Ankle Intl., January 2006; 27(1):9-18.

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Combination with Gastrocnemius Recession Appears to
Provide Powerful Correction
28 feet in 20 pediatric patients in 3 groups
 Subtalar arthroereisis,
 Arthroereisis + gastrocnemius recession,
 Arthroereisis + gastrocnemius recession
+ medial column reconstruction

Arthroereisis with gastrocnemius

recession showed the greatest
correction of this angle

Cicchinelli LD, DPM1, Huerta JP, DP2, Garcia Carmona FJ, DP3, Fernandez Morato D, DP4, Analysis of Gastocnemius Recession and Medial Column Procedures as Adjuncts in Arthroereisis for the the
Correction of Pediatric Pes Planovalgus: A Radiographic Retrospective Study, Foot & Ankle Surg., Sep-Oct 2008; 47(5):385-91.

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Reduces Non-Weight-Bearing Time by Avoiding Calcaneal
Osteotomies
Uniportal endoscopic gastrocnemius
recession, subtalar arthroereisis and
complete transfer of the FDL to the tarsal
navicular

Postoperative non-weight-bearing time

was reduced to approximately 3.5 weeks
as compared with the 6 to 8 weeks of
non-weight-bearing typically required
following calcaneal osteotomies

Adelman VR, DPM, AACFAS1, Szczepanski JA, DPM, FACFAS2, Adelman RP, DPM, AACFAS3, Radiographic Evaluation of Endoscopic Gastrocnemius Recession, Subtalar Joint Arthroereisis, and Flexor
Tendon Transfer for Surgical Correction of Stage II Posterior Tibial Tendon Dysfunction: A Pilot Study, J Foot & Ankle Surg., Sep-Oct 2008; 47(5):400-8.

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AOFAS Subtalar Arthroereisis Survey

 Survey among AOFAS members on the use of

arthroereisis
 In the United States, 52% of the respondents
performing arthroereisis use Arthrex ProStop®
 Outside of the United States, 27% of the
respondents performing arthroereisis use Arthrex
ProStop®

Arthrex is the most commonly used

implant among AOFAS survey
respondents
Shah NS, Needleman RL, Bokhari O, Buzas D. 2013 Subtalar Arthroereisis Survey: The Current Practice Patterns of Members of the AOFAS. Foot Ankle Spec. 2015 Jun;8(3):180-5

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ProStop® Advantages

Contour of the implants supports the

Better fit
anatomy of the tarsal canal

Safer Soft threads are easier on soft tissue

Concave back Allows easy guide pin access

Straightforward One-piece, color-coded trial implants

instrumentation support easy and accurate placement

Soft tissue
Preserves interosseus structures
screw

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Thank you very much for your attention.

PPT2-80005-EN_A