HyProCure Surgery: Understanding the Procedure, Benefits, and Recovery for Flat Feet

What is HyProCure Surgery?

HyProCure surgery is a minimally invasive procedure designed to correct hyperpronation (flat feet) by inserting a small, titanium stent into the sinus tarsi, a naturally occurring space between the talus and calcaneus bones. This stent helps to restore the natural arch of the foot and improve overall foot mechanics.

Understanding Hyperpronation (Flat Feet)

Hyperpronation, commonly known as flat feet, is a condition where the arch of the foot collapses, causing the entire sole to make contact with the ground when standing. While some degree of pronation is a natural and necessary part of the gait cycle, excessive or uncontrolled pronation (hyperpronation) can lead to a cascade of biomechanical issues throughout the kinetic chain.

Key characteristics of hyperpronation include:

• Medial collapse of the arch: The primary identifier.
• Eversion of the calcaneus (heel bone): The heel bone tilts outwards.
• Internal rotation of the tibia and femur: This can lead to knee pain (patellofemoral pain syndrome), hip pain, and even lower back issues.
• Forefoot abduction: The front of the foot drifts outwards.

Untreated hyperpronation can contribute to a variety of musculoskeletal problems, including plantar fasciitis, Achilles tendinopathy, shin splints, bunions, hammer toes, and chronic pain in the feet, ankles, knees, hips, and lower back due to the altered distribution of forces during movement.

What is HyProCure? The Procedure Explained

HyProCure is a specific type of extra-osseous talotarsal stabilization (EOTTS) procedure. Unlike traditional flatfoot surgeries that may involve fusing bones (arthrodesis) or cutting and repositioning bones (osteotomies), HyProCure is designed to be less invasive and reversible. The core of the procedure involves the insertion of a small, medical-grade titanium stent.

Key aspects of the HyProCure stent:

• Material: Made from biocompatible titanium.
• Placement: The stent is precisely placed into the sinus tarsi, which is the natural space located between the talus (ankle bone) and the calcaneus (heel bone).
• Function: It acts as a "spacer" or "block" to limit the excessive inward rotation and displacement of the talus bone, which is characteristic of hyperpronation. It does not fuse bones together but rather helps to stabilize the subtalar joint.

The goal is to restore the natural alignment and function of the foot's joint mechanics, thereby addressing the root cause of the biomechanical imbalance.

How Does HyProCure Work Biomechanically?

To understand HyProCure's mechanism, it's crucial to grasp the role of the subtalar joint and the talus. The subtalar joint, formed by the talus and calcaneus, is primarily responsible for the pronation and supination movements of the foot. In a hyperpronated foot, the talus bone shifts excessively downwards and inwards (medially and inferiorly) relative to the calcaneus, leading to the collapse of the arch.

The HyProCure stent works by:

• Limiting Talus Displacement: By occupying a portion of the sinus tarsi, the stent physically restricts the abnormal downward and medial movement of the talus. This prevents the talus from "collapsing" into the sinus tarsi during weight-bearing.
• Restoring Subtalar Joint Alignment: By controlling talar displacement, the stent helps to realign the subtalar joint, allowing it to function within a more normal range of motion. This, in turn, helps to reform the natural arch of the foot.
• Improving Kinetic Chain Mechanics: With the foot's foundation more stable and aligned, the abnormal rotational forces that travel up the leg to the knee, hip, and spine are reduced. This can alleviate pain and dysfunction in these higher joints. The procedure essentially optimizes the foot's ability to absorb shock and propel the body forward efficiently.

Who is a Candidate for HyProCure Surgery?

HyProCure surgery is typically considered for individuals with a flexible flatfoot deformity who have not found adequate relief from conservative treatments.

Ideal candidates often present with:

• Flexible Flatfoot: This means the arch reappears when the foot is non-weight-bearing (e.g., sitting) but collapses upon standing. This distinguishes it from a rigid flatfoot, which requires different surgical approaches.
• Persistent Pain and Symptoms: Despite trying non-surgical interventions like custom orthotics, physical therapy, supportive footwear, and activity modification.
• Radiographic Evidence: X-rays and other imaging studies confirm the abnormal talar displacement and subtalar joint instability.
• Sufficient Bone Quality: Adequate bone density to support the stent.
• Age Considerations: While often performed on children and adolescents (as young as 3), it is also a viable option for adults. Early intervention in children can prevent more severe deformities as they grow.

It's important to note that a thorough evaluation by an experienced foot and ankle surgeon is essential to determine suitability for the procedure.

The Surgical Procedure

HyProCure surgery is considered a minimally invasive procedure, often performed on an outpatient basis.

General steps typically include:

1. Anesthesia: The procedure is usually performed under local anesthesia with sedation, or sometimes general anesthesia, depending on the patient's preference and the surgeon's recommendation.
2. Incision: A small incision (typically less than an inch) is made on the outside of the ankle, directly over the sinus tarsi.
3. Stent Insertion: Guided by fluoroscopy (real-time X-ray imaging), the surgeon gently inserts the appropriately sized HyProCure stent into the sinus tarsi. The stent is self-locking and does not require screws or additional fixation.
4. Closure: The small incision is closed with sutures.

The entire procedure typically takes less than 30 minutes per foot.

Recovery and Rehabilitation

Recovery from HyProCure surgery is generally quicker and less arduous than traditional reconstructive foot surgeries.

Typical recovery phases include:

• Immediate Post-Op (0-2 weeks): Patients are usually able to bear weight immediately or within a few days, often in a walking boot or supportive shoe. Swelling and mild discomfort are common and managed with pain medication.
• Early Rehabilitation (2-6 weeks): Gradual transition from the walking boot to supportive athletic shoes. Light activities are encouraged, and a physical therapy program may begin to focus on gait training, balance, and strengthening of the foot and ankle muscles.
• Progressive Activity (6 weeks - 3 months+): Return to normal daily activities and gradually reintroduce low-impact exercises. High-impact sports may be resumed with surgeon approval, typically after 3-6 months.

Physical therapy plays a crucial role in optimizing outcomes. It focuses on:

• Restoring Range of Motion: Ensuring proper movement of the ankle and foot.
• Strengthening: Targeting intrinsic foot muscles, calf muscles, and other lower limb stabilizers.
• Gait Retraining: Teaching the body to walk with the newly corrected foot alignment.
• Proprioception and Balance: Improving the foot's sensory awareness and stability.

Potential Benefits of HyProCure

For appropriate candidates, HyProCure surgery offers several significant benefits:

• Minimally Invasive: Smaller incision, less tissue disruption compared to traditional surgeries.
• Reversible: The stent can be removed if necessary, though this is rare.
• No Fusion: Preserves the natural motion of the subtalar joint, unlike fusion procedures.
• Reduced Pain: Addresses the underlying biomechanical cause of pain in the foot, ankle, knee, hip, and back.
• Improved Foot Mechanics: Restores the natural arch and improves gait efficiency.
• Quick Recovery: Shorter recovery time and faster return to activity compared to more extensive surgeries.
• Prevention of Progressive Deformity: Especially beneficial in children, as it can prevent the flatfoot from worsening over time and reduce the risk of secondary conditions.

Potential Risks and Considerations

As with any surgical procedure, HyProCure carries potential risks, though they are generally low.

Possible risks include:

• Infection: Standard surgical risk.
• Swelling and Bruising: Common post-operative effects.
• Pain at the Stent Site: While the goal is pain relief, some patients may experience localized discomfort that may necessitate stent removal (in a small percentage of cases).
• Stent Displacement or Migration: Rare, but possible, requiring repositioning or removal.
• Nerve Irritation: Temporary or, rarely, permanent nerve damage.
• Failure to Alleviate Symptoms: While successful for many, some patients may not achieve complete symptom resolution.
• Overcorrection or Undercorrection: The stent size is carefully chosen, but slight over- or under-correction is possible.

It's vital for patients to have a thorough discussion with their surgeon to understand these risks and determine if the potential benefits outweigh them.

HyProCure vs. Other Flatfoot Surgeries

HyProCure stands apart from many traditional flatfoot correction surgeries due to its unique approach:

• Arthrodesis (Fusion): Procedures like subtalar fusion permanently join bones, eliminating motion in the joint. While effective for rigid deformities or severe arthritis, they can alter gait mechanics and increase stress on adjacent joints. HyProCure preserves joint motion.
• Osteotomies (Bone Cuts): These procedures involve cutting and reshaping bones (e.g., calcaneal osteotomy) to realign the foot. While effective, they are more invasive, require longer recovery, and are not reversible.
• Tendon Transfers: Sometimes used to support the arch, these procedures can be part of a larger reconstructive plan but don't directly address the underlying bony alignment issue in the subtalar joint as HyProCure does.

HyProCure is generally considered for flexible flatfoot and offers a less invasive, reversible option that preserves joint motion, making it an attractive alternative for many patients.

Conclusion: A Biomechanical Solution for Foot Health

HyProCure surgery represents an advanced, biomechanically-driven approach to correcting flexible hyperpronation. By addressing the abnormal motion of the talus within the subtalar joint, it aims to restore the foot's natural arch and optimize its function within the entire kinetic chain. For individuals suffering from persistent pain and dysfunction due to flat feet, and who have not responded to conservative measures, HyProCure offers a promising, minimally invasive solution to improve foot health, reduce pain, and enhance overall mobility and quality of life. As with any surgical decision, a comprehensive evaluation and discussion with a qualified foot and ankle specialist are paramount.