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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 appears that you did not do anything wrong. Every sinus tarsi has a variable alignment from one foot to the other and from one patient to the other. Some feet have an extremely oblique sinus tarsi while others are more lateral to medial. Just as long as the HyProCure stent is centered under the talus and correction is maintained, there is nothing to be concerned about.

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.

A. I would not be too concerned as HyProCure is simply pushed into the sinus tarsi and we are at the mercy of the soft tissues and osseous structures to hold it in place until the tissues adhere to the device. After placing HyProCure in the foot and upon weightbearing it is possible for the stent to “seek its own level”. We need to remember that this is not a screw anchored into a bone so slight displacement can and will occur. Just as long as the correction is maintained and the patient isn’t experiencing pain out of proportion then I would just leave it alone. However, if there is loss of correction or the patient feels the stent is clicking or popping then a revision may be required.

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.