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An Easy Fix for Flat Foot

Those suffering from flat feet know how problematic it can be throughout life.

The key to mitigating a life of problems is early recognition & treatment.

A parent’s suspicion of flat feet often begins when their children begin to walk. However, all children’s feet are pudgy at birth and through the early years of walking. The real sign of flat footedness usually occurs from ages 3-5 when an arch fails to form. In other words, the flatness should go away, if it doesn’t resolve at age 5 you can assume it’s an issue that should be further examined by a medical professional.

-The common misconception that the flatness will resolve is incorrect. Just like any other deformity, it will not autocorrect.-

What’s important to understand is balance. The development of the anatomy under normal circumstances and what happens when circumstances aren’t normal. I’m speaking of course of the foot and how it functions beneath our weight, with every step. Ideally the thousands of steps taken daily by all people, especially children, we want to ensure balance. My belief is, balance encourages normal anatomical development and more likely lifelong normal function.

The bones of a child are soft and constantly changing as they progress toward skeletal maturity. Think of a sack of potatoes. The more you bang the bag around, the more bruised, softened and mashed they become. Imagine the potatoes are the bones of a child. And although even the worst of circumstances doesn’t flatten or bruise the bones like potatoes, they are subject to abuses of walking and imbalance. This leads to the adult flat foot. It’s not to say there aren’t other ailments that can lead to a flatfoot, but this is one very common cause.
So, what happens and where does the imbalance come from. It’s essentially malalignment. The misalignment happens mostly due to flexibility, sure kids are flexible, and some adults too. This is easily found with examination. In my opinion it is balance and a balancing act really. The bones under the ankle interdigitate together through 3 surfaces like 2 inverted tripods against one another. Those surfaces are relatively small and support all the weight of the body. They need to remain in close opposition for the balance act to occur, all the while walking. When the ligaments and soft tissues around them are weak, the interdigitating surfaces of the tripod fall passed one another and collapse the natural space in between them. This collapse as a child is a “Small Problem”. Now imagine thousands of steps per day and years of imbalance resulting in a variety of symptoms and subsequently a “Big Problem”.

So, what is this natural space that we’re so concerned about? It’s shaped like a funnel and is called the sinus tarsi. God created this funnel and it functions like a natural axis of rotation. Like a wheel on your car the feet function to move us along. But unlike a wheel that spins the bones of the feet recreate this effect through rotation of the funnel.

This space needs to remain open for the “balancing act” to occur. This space is precisely where the instability occurs.
Above is an x-ray of a patient whose feet are misaligned. You can clearly see the space between the ankle and heel bone (sinus tarsi) is collapsed.

Imagine an axle with wheels like on your car. To maintain a smooth ride your axle must be true and free of imperfection. The flat functioning foot has a weak axis of rotation and is overly flexible.

So how to fortify the axis of rotation? A simple and minimally invasive procedure that’s been around for a long time and addresses the imbalance. Introducing Gramedica’s HyProCure Stent. A small fix for a small problem. Technically the term to describe the procedure is called Subtalar arthroeresis. Consider it a blocker of abnormal motion. It’s a small titanium device that looks like a dowel. Note in picture below, how the HyProCure stent pictured right is anatomically correct as compared to the older device on the left. The stent is inserted down the funnel of the axis of rotation in the foot. It strengthens and preserves the space like the axle of rotation on your automobile.
Although it’s not perfect and cannot give you the foot of a gazelle, it’s very powerful and result are immediate as observed in the image below.

We know if the flat foot doesn’t resolve fairly young, it’s not going away. As time wears on the child becomes the adult and the deformity will continue worsening. It’s likely to be related to many other deformities and a continued worsening flat foot. At this point, it’s likely to be related to more complex problems in adulthood requiring invasive corrective surgical procedures. “Big Problem requiring a big fix” as pictured below.’

Reconstructive Surgery While This can be effective, it destroys the integrity of the foot, and required a long painful recovery process.
Reconstructive Surgery
While This can be effective, it destroys the integrity of the foot, and required a long painful recovery process.

Or the less invasive and clearly effective minimally invasive technique to restore balance as pictured:

HyProCure Easy insertion. Typicaly done in about 15 minutes.  No permanent damage to the bone of joins.
HyProCure
Easy insertion. Typicaly done in about 15 minutes.
No permanent damage to the bone of joins.

Big fixes are sometimes necessary, but most of the time fixes are best when they are done early. Early intervention begins first by realizing the flatfoot deformity is present and not going away. Then by addressing the flexibility in the soft tissues we can provide the successful balancing that’s ideal for long term development.

The insertion of the HyProCure stent is a minimally invasive procedure performed through a 2 cm incision and takes approximately 20 minutes under general anesthesia. The procedure is fairly basic and cost effective. Although best done in the younger patient, I’ve performed the procedure successfully in many adults as well. In the appropriately chosen patient, age is irrelevant.

Post procedure care often involves a walking boot for up to 2 weeks, or longer if necessary. Generally, patients are walking immediately, unlike other reconstructive techniques. This is a hospital-based procedure, at the moment, but for those without insurance we’ve developed reasonably priced options that can be done in the office. Complication rate is very low and the outcome is very effective. Moreover, if the implant if not well tolerated by the patient it can be removed just as easily as it was inserted. So, before you accept that your child will outgrow a flatfoot deformity, think again. Small problem – small fix, the HyProCure Stent. Contact our office for more information.

Gabriel F.Delgado
DPM FACFAS

Lakeland Office
203 Kerneywood St.
Lakeland, FL 33803

Bartow Office
510 West Main St
Bartow, FL 33830

midflfootanklevein.com

863-686-1641

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