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A. Yes, it is a quick, simple procedure so why shouldn’t we fix both feet at the same time thus saving insurance costs and time? Well, I used to always perform both feet at the same time, when it was indicated that both feet needed to be fixed. I found that there was a significantly prolonged recovery when compared to one foot at a time, with a much greater chance of stent displacement. The patient doesn’t have one “good” foot to walk on and will end up compensating by supinating both feet when they walk. The excessive supinatory force at the subtalar joint could end up laterally displacing one of the stents and require a trip back to the operating room to reposition the stent. I found that by performing one foot at time not only did it improve patient outcomes; patients had a faster, easier recovery when compared to both feet at the same time. I feel that we should only perform this procedure one foot at a time. However, there are always exceptions to the rules and individual case judgment should be used.

A. I feel it is in the patient’s benefit to have not only a local anesthetic but also the addition of a long lasting steroid injected into the sinus tarsi prior to the procedure. First, it will significant decrease the post-op pain as I use a long lasting local (marcaine) and therefore the patient should have a better recovery. Also the steroid will have to minimize the major inflammatory reaction that is going to occur with the procedure. I will use two syringes the first with just the local only (3 to 5 cc syringe of 1:1 mix of 0.05% marcaine with and without epi) then the second syringe (also 3 to 5 ccs of the 1:1 mix) containing both the short and longer acting steroids. This has significantly decreased the amount of post-op pain pills that my patients require. Finally, if it isn’t contra-indicated, I will also give an IV anti-inflammatory prior to the surgery to also help decrease the inflammation from any angle.

A. The anesthesia and incision are the same as the original procedure. After light dissection with the curved tenotomy scissors the lateral end of the HyProCure will be found. I like using a strong needle driver to remove the existing HyProCure stent. Place one jaw into the driver portion of the stent and the other jaw on the lateral end of the stent, clamp the HyProCure and you will need to twist the HyProCure 360 degrees, this breaks the tissue adhesion to the stent. You should then be able to just pull out the HyProCure, kind of like a dentist pulling a tooth. After that, I would flush the sinus with more local to make sure the deeper fibers have been anesthetized. Then you will need to make sure the deeper fibers of the soft tissues medial in the sinus tarsi are cut, re-trial size, and insert the HyProCure making sure to place the threads of HyProCure deep into the canalis portion of the sinus tarsi. Close the incision per your choice.