47. The forces that should be passing
through the back of the heel are
now passing through the inner-front
of the foot.
48. These excessive forces create a path
of destruction adversely affecting
the bones, ligaments and tendons
to the inner aspect of the foot while
standing, walking and running.
53. That’s due to the potential
pathologic forces that are created
as the supinatory motion reloads
the joint forces that are repeatedly
stressing and straining the tissues.
54. A rigid inflexible talotarsal joint
stays in the locked position and
does not have the same “reloading”
of force.
55. The role of “locking” and
“unlocking” of the talotarsal joint
must also be taken into
consideration.
56. Partial talotarsal dislocation leads to
a pathologic duration of pronation – called
over-pronation/excessive
pronation/hyperpronation.
57. Instead of the bones of the foot in a
stable locked position, they are in
an unstable unlocked position.
58. This leads to increased stress and
strain on the bones, ligaments and
tendons which leads to the majority
of secondary deformities within the
foot and ankle.
59. We now see that a flexible mis-
aligned foot is a very dangerous
deformity that could be responsible
for many of the musculoskeletal
disorders throughout the body.
61. Depends if it’s a recurrent partial
talotarsal dislocation or rigid
deformity and also if there are other
pathologic osseous alignment
issues.
62. There are 2 Treatment Categories
External Internal
63. Problem with External Options
• Cannot stabilize the talus
on the tarsal mechanism.
• Gives a false sense of
correction.
• Not corrective, just
supportive.
• Compliance issues –
patient must wear them
for them to be effective.
65. A Recurrent Talotarsal Dislocation:
Neutral Position Relaxed Stance Position Internal EOTTS
Can possibly be internally stabilized via an
internal, extra-osseous, extra-articular talotarsal
joint stabilizing stent.
66. Extra-osseous Talotarsal Stabilization
(EOTTS)
• Stent is made of
titanium.
• Talus glides over a Type
II EOTTS device.
• Instantly the joint
forces are normalized.
• Talotarsal joint is now
internally stabilized.
67. Many times this procedure alone is
enough to stabilize the deformity.
68. Need to evaluate the whole foot
This image exhibits a talotarsal joint This image shows a talotarsal joint
dislocation with a normal calcaneal dislocation in addition to a lower than
inclination angle. normal calcaneal inclination angle.
69. Lower than normal Calcaneal
Inclination Angle
This patient could benefit
from the EOTTS device
but also requires either a
lengthening of the
Achilles tendon complex
and/or calcaneal
osteotomy.
70. Instability in the Medial Column
• If there is significant
instability to the mid-
foot then additional
surgery will be required
here.
• Many times, this
procedure is not
performed until the
child is older.
74. Where is the evidence that a
recurrent talotarsal joint dislocation
will heal on its own?
There isn’t any, they just get worse!
75. Not only does this deformity lead to
destruction within the foot and
ankle,
76. it leads to a path of destruction
up the body.
77. Benefits of Treatment
• Internal option – does not rely on patient
compliance
• Reversible
• Time tested
• Scientifically based
• Just makes sense
78. Risks of No Treatment
Not only will this lead to problems within the
foot and ankle, it leads to problems in the
knees, hips, pelvis, back and neck.
79. Risks of Treatment
Possible need to remove the stent (EOTTS)
Revision
Resize – under/over-correction
Failure to achieve the desired result
There are no complication free procedures