Disclosure Subtalar Arthroereisis Survey: The Current Practice Patterns of Members of the AOFAS. Presenter: Neil S. Shah, M.D.

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2 Disclosure 2013 Subtalar Arthroereisis Survey: The Current Practice Patterns of Members of the AOFAS Presenter: Neil S. Shah, M.D. My disclosure is in the Final AOFAS Mobile App I have no potential conflicts with this presentation

Historical Background Subtalar arthroereisis (SA) has been a procedure used for correction of painful flexible flatfoot deformity in adults & children Modification of

3 Historical Background Subtalar arthroereisis (SA) has been a procedure used for correction of painful flexible flatfoot deformity in adults & children Modification of the Grice procedure, first reported by Haraldson in 1962, using allograft cortical bone wedges Different implants used over past 50 years, varied by design & composition

4 Introduction SA is a surgical procedure of the foot used for the treatment of flexible flatfoot deformity Advantages: small incision, less surgical pain, less trauma, more rapid recovery Clinical studies are sparse, with mixed results & variable indications Purpose of study: Determine current practice patterns among orthopaedic foot & ankle specialists regarding SA

5 Methods Web-based questionnaires were ed to all members of the American Orthopaedic Foot & Ankle Society (AOFAS) in November 2013 Follow up was sent December 2013 for those who had not yet completed the survey Requested information included demographics & practice patterns in regards to performing SA surgery 572 respondents completed the survey (32% response rate)

6 Results N = 572 respondents Respondents Have performed subtalar arthroereisis Still perform subtalar arthroereisis Total 100% 48% 33% U.S. 70% 40% 24% Non-U.S. 30% 66% 53%

9 Results Most common indications for subtalar arthroereisis

10 Results 83% of responders who still perform the procedure have at some point had to remove the implant after the initial surgery 80% of the U.S. group & 27% of non-u.s. group have experienced problems with payment from health insurance companies

11 Conclusion Many have performed SA & a significant number no longer perform this procedure for various reasons Greater percentage of non-us practitioners performed & continue to perform SA than their U.S. counterparts There is a common list of surgical indications Most who still perform this procedure have removed the implants, most common reason is for pain Subtalar arthroereisis is still being performed in the United States & throughout the world

12 References 1. Needleman, Richard L. A Surgical Approach for Flexible Flatfeet in Adults Including a Subtalar Arthroereisis with the MBA Sinus Tarsi Implant. Foot & Ankle International, 27(1): pp. 9-18, Needleman, Richard L. Current Topic Review. Subtalar Arthroereisis for the Correction of Flatfoot, Foot & Ankle International, 26(4): pp , Schon, Lew C. "Subtalar arthroereisis: a new exploration of an old concept." Foot and ankle clinics 12.2 (2007): Mosca, Vincent S. "Flexible flatfoot in children and adolescents." Journal of children's orthopaedics 4.2 (2010): Garras, David, et al. "Outcome of Modified Kidner Procedure with Subtalar Arthroereisis for Painful Accessory Navicular Associated with Planovalgus Deformity." Foot Ankle Int, Metcalfe, SA, et al. "Subtalar joint arthroereisis in the management of pediatric flexible flatfoot: a critical review of the literature." Foot Ankle Int Dec;32(12): Viladot, Ramón, et al. "Subtalar arthroereisis for posterior tibial tendon dysfunction: a preliminary report." Foot & ankle international 24.8 (2003): Martinelli, N et al. "Effect of subtalar arthroereisis on the tibiotalar contact characteristics in a cadaveric flatfoot model." J Biomech Jun 1;45(9): Arangio, George A., Kristy L. Reinert, and Eric P. Salathe. "A biomechanical model of the effect of subtalar arthroereisis on the adult flexible flat foot." Clinical Biomechanics 19.8 (2004): Vedantam, Ravishankar, Ann Marie Capelli, and Perry L. Schoenecker. "Subtalar arthroereisis for the correction of planovalgus foot in children with neuromuscular disorders." Journal of Pediatric Orthopaedics 18.3 (1998): Oloff, L. M., B. L. Naylor, and A. M. Jacobs. "Complications of subtalar arthroereisis." The Journal of foot surgery 26.2 (1986): Saxena, Amol, and Aidan Nguyen. "Preliminary radiographic findings and sizing implications on patients undergoing bioabsorbable subtalar arthroereisis." The Journal of Foot and Ankle Surgery 46.3 (2007): Chang, Thomas J., and Jake Lee. "Subtalar joint arthroereisis in adult-acquired flatfoot and posterior tibial tendon dysfunction." Clinics in podiatric medicine and surgery 24.4 (2007): Maxwell, Jerry R., Armando Carro, and Claire Sun. "Use of the Maxwell-Brancheau arthroereisis implant for the correction of posterior tibial tendon dysfunction." Clinics in podiatric medicine and surgery 16.3 (1999): Zaret, David I., and Mark S. Myerson. "Arthroereisis of the subtalar joint." Foot and ankle clinics 8.3 (2003):

Evaluating midcalcaneal length after Evans calcaneal osteotomy: a comparison of the locking plate and tricortical allograft wedge

IFFAS AOFAS Chicago, 2014 Evaluating midcalcaneal length after Evans calcaneal osteotomy: a comparison of the locking plate and tricortical allograft wedge Garrett M. Wobst, DPM, AACFAS, Nicole M. Protzman,