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A. Generally no, but it can depend on the patient and the structure of their foot. First, if the only problem is due to the over-pronation of their subtalar joint and the rest of the foot is structurally repaired by reposition of the talus on the calcaneus than I would say no. The HyProCure will make the work of an orthotic for the most part. However, there are cases where an orthotic can do things that the HyProCure can’t. Also, we do cast patients in the “neutral” or “ideal” position and so if we get their foot back to the ideal position then the orthotic wouldn’t need to be changed. My experience is that most patients are very happy not to need their orthotics anymore and that their feet actually feel a lot better without them. But, again, I want to reiterate that there are some cases that would greatly benefit from orthotics after the HyProCure procedure. The simple thing to do is have the patient wear their orthotics after the procedure and see if they help at all or if they can be discarded.

A. First, initially after surgery patients will guard their walking and will walk more on the outer part of their foot/slightly supinated. As the inflammation subsides within the sinus tarsi they will walk more on the bottom of the foot. It is also possible that too small a size was inserted. This goes to the art of surgery as we have to try and recreate the function of a foot with full weight, it is impossible to insert a trial sizer into the patient’s foot and have them stand on their foot during the procedure. Make sure to lock the mid-tarsal joint and pronate their foot as much as you can and that it is the best you can do. We cannot predict either clinically or radiographically what size stent the patient will require to give them the best correction. Also, I also recommend that it is better to under-correct than to over-correct. An over-corrected foot will lead to a slightly supinated foot; also remember the 11th commandment- Thou Shalt Not Varus. If there is more than a slight under-correction, then remove that size and replace it with the next best size.

A. Most likely the patient is only feeling the deeper scar tissues as it is still a relatively short time since the procedure. I would have the patient apply a topical scar reducing ointment or topical steroid to help reduce the thickness. Make sure that the would is fully closed before applying these medicines. If for some reason it seems to take longer than usual for this to reduce on its own, you could always give a superficial steroid injection. However, I have never had to resort to steroid injection(s) for that reason.

A. It is possible that there was an oversizing of the stent. However, most likely this is due to the normal post-op inflammation in the peri-HyProCure tissues. These tissues are relatively avascular and are subject to trauma with every step taken. Here’s what to do. Make sure your patient is not wearing a worn out shoe when walking as this will lead to an excessive over-stretching of the already stretched tissues. Prescribe an anti-inflammatory and make sure that the patient feels a difference after taking it. The patient should still be icing the foot a few times in the afternoon, evening and especially at night before she goes to bed.

A. I would recommend a steroid injection into the superficial aspect of the sinus tarsi using a cocktail of 1.5 cc of 0.5% marcaine and ½ cc of depo-medrol and ¼ cc of dexamethasone. The patient may need 2 or 3 injections. If after the 3rd injection there is no improvement then it could be possible that there was an over-sizing or that the patient just doesn’t tolerate that amount of correction. At that point the option is to either downsize or permanently remove the stent.