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Flat Feet

Flat Feet

There is a treatment that is minimally invasive and affordable, so you no longer have to feel like your entire life is being controlled by flat feet.

Flat Feet

What is Flat Foot?

Flat Foot is a partial or total loss of the arch on the inside of your foot.  Some people may be born with flat foot, and some may develop flat foot over time. Most people have no symptoms or only minor symptoms associated with flat feet, others may experience heel pain or arch pain or even knee/ hip pain. This can be in one foot or both feet and generally becomes progressively worse.

Flat Foot may cause your foot/feet to roll inwards when standing, walking, or running. This can result in further issues like pain developing in your ankles, knees, or hips.

Causes

Genetics: parents can pass this onto their children.

Injury or Overuse: soft tissues such as tibialis posterior tendon or spring ligaments are damaged.

Obesity: additional weight puts added stress on arches and tendons to cause the arch to flatten.

Arthritis or Rheumatoid Arthritis: can irritate the tendon which may lead to flat foot.

Neurological or Muscular Diseases: such as cerebral palsy, muscular dystrophy, or spina bifida.

Treatment

Conservative

Wearing appropriate shoes:

Orthotics: Custom-made or over-the-counter shoe inserts can help to reduce symptoms.

Physiotherapy: Exercises to strengthen muscles and tendons in the feet.

Surgical

There is a revolutionary procedure called HyProCure® (extra-osseous talotarsal joint stabilisation) surgery that has the potential to provide a permanent solution to pain and dysfunction caused by misaligned feet.

Many people’s only option has been to undergo extensive surgery such as fusing of the major joints in the foot and ankle. This creates one solid bone and aims to eliminate pain from the moving joint. This type of treatment/surgery completely stops joint movement in your foot which means that you may not be able to wear those high heels, participate in your favourite sport or dance class and it may cause arthritis in adjacent joints later in your life.

The purpose of the HyProCure® procedure is to reduce any excessive movement in the rearfoot (known as the subtalar joint) so the foot can function optimally without eliminating it altogether. The implant is designed to remain in your foot permanently.

The HyProCure® implant is a small titanium stent that has been designed to be inserted in the subtalar joint, and acts as an internal orthotic for the foot. Abnormal pronation of the foot is now controlled at the source of the problem, and you no longer need to rely on orthotics or orthopaedic shoes.

HyProCure® surgery is minimally invasive and is highly successful and also completely reversible which means that the implant can be removed and does not cause side effects.

Appointment Information

Cost & Item Codes – HyProCure® implant cost is from 1,800.00 with Dr. Kim. Please book an initial consultation with the surgeon to discuss if this is suitable for you.

Scans – We recommend you have weight bearing x-rays prior to your appointment (DP/MO/Lat/Calcaneal Axial views).

Telehealth – We may be able to offer an initial telehealth appointment if you live a distance away. Phone one of our friendly staff to see if this is possible for you. We may ask you to email some photos prior to your appointment. (1. both feet from behind at floor level 2. each foot both inside and outside view [to see arch/flat foot])

Surgery Information

Do I need surgery? – HyProCure® surgery is considered for patients who have not responded with conservative treatment. HyProCure® is usually performed as a stand-alone single procedure but there may be additional surgical procedures required for more complex cases. Although your surgeon may recommend an operation it is your decision if you go ahead with the operation or not.

Duration – The operation usually takes 20-30 minutes.

Anaesthesia – HyProCure® surgery can be performed under general anaesthesia or spinal block, or local anaesthesia with sedation depending on the surgeon’s and the patient’s preferences. Your anaesthetist will discuss with you.

Medications – Your surgeon will discuss all medications with you on your initial consultation.

Smoking – If you are a smoker, you need to stop the habit of smoking 4 weeks before your operation for normal healing and reduce postoperative complications. Nicotine is known to stop bones from healing.

Recovery Process

Patients must follow their surgeon’s instructions carefully during recovery to ensure proper healing and minimize the risk of complications.

The following should be adhered to in order to hasten your recovery from foot surgery.

While the amount of discomfort and swelling will vary from patient to patient, for your best personal results, please follow these instructions:

  1. Sit sideways in the back seat of the car with the surgical foot elevated, while returning home from surgery.
  2. Remain off your feet as much as possible for the first 3-5 days. Place a pillow under your calf so the surgical foot is elevated. It is important to walk as little as possible during this time.
  3. Place an ice bag (a bag of frozen peas works best, as the bag is easy to contour over your ankle) over the surgical area 15 minutes out of every hour. This should be continued, as needed, for several weeks following surgery. Ice will significantly decrease inflammation and post-op pain.
  4. Wear new and supportive shoes. A “worn out” shoe will hinder your recovery and cause pain. Make sure the shoe you are wearing does not rub against the incision area.  Please note that you are required to wear a post-op sandal for the first 2-3 weeks then transit into runners or tennis shoes.
  5. DO NOT apply any ointments/gels/creams to the incision area. Do not apply hot water bags or electric heating pads to your foot; this will increase your pain.
  6. Keep the operative area completely dry. While it may seem ideal to bathe right after surgery, a wet bandage can cause bacteria to grow and puts you at risk of infection. If the bandage should accidentally get wet, dry immediately with an absorbent towel and call your doctor’s office.
  7. A soiled bandage is normal. Do not be alarmed if you see a moderate amount of blood on your bandage after the procedure.
  8. Make sure to eat prior to taking any pain medication. Failure to do so may result in nausea, vomiting and/or light-headedness. If this happens, stop taking the pain pills.
  9. Follow a light diet and abstain from the use of alcoholic beverages while taking medications. Eating salty foods and/or drinking lots of fluids will increase your swelling.

Call your doctor’s office immediately if you experience any of the following:

  • Active and persistent bleeding at the incision site.
  • Prescribed anti-inflammatory medication/pain medications are not decreasing your inflammation or pain.
  • Nausea, vomiting and/or light-headedness due to medication(s).
  • You experience a temperature over 38.5 degrees..
  • Should you incur any other problems not discussed in these instructions.

Stay off your foot as much as possible. Every step you take leads to increased trauma of the surgical site. The highest level of post-procedure inflammation is in the first three to five days. Rest and elevate your surgical foot as much as possible during this time.

However, you do need to use your foot. If you “baby” your foot too much it will take longer for the soft tissues to adapt to their new functions. “Listen” to your foot; it will let you know when you are doing too much. When your foot really gets sore, take a break, and let it rest. After a short time, you should be able to do more. Be sensible.

Take an oral anti-inflammatory (if prescribed). The primary reason for post-procedure pain is inflammation. A pain pill masks the pain but does not treat the underlying reason the pain is still present – inflammation. Make sure the oral anti-inflammatory is working. There are many different brands; one could be effective for one person while not having any effect for someone else. You should feel at least some relief within a half-hour after taking the medication.

Ice is your best friend. Ice helps to decrease inflammation and swelling. Also ensure that you elevate your foot at least 10 to 15 minutes an hour. Ice should be used hourly the first 3 to 5 days, and then slowly decreased. However, ice should be used at least once or twice in the evening for several weeks following surgery. We suggest using a moist dish towel and a bag of frozen peas. Application for approximately 15 minutes is usually sufficient.

Bandages must be applied to keep the site of incision clean and dry. However, make sure your bandages are not contributing to post-procedure pain. Your foot may develop some swelling and the bandage can act as a tourniquet. If your bandage feels extremely tight and your toes are swelling, have the bandage replaced.

New shoes will aid in a quicker recovery. After your procedure, it is extremely important not to wear your old shoes. Discard your worn-out shoes, as they will lead to increased strain on your tissues. The wear pattern on these shoes will counter-act the correction. You may notice a slight increase in soreness several months after your procedure, most-likely due to the wearing of a worn-out heel on your shoe.

In general, the following timeline can be expected:

Immediately after surgery: Go home and rest. Elevate your foot as often and as much as possible to reduce swelling. Take pain medication as instructed and avoid smoking. Wear post-operative shoe all the time, even at bed for the first 2 weeks. Place a plastic bag over your foot when showering.

You should be able to gently step on your foot immediately following the procedure, but it’s important to use extreme caution. Patients are recommended to restrict activities to home only for 1-2 weeks following surgery.

The first few days: Restrict your activity to going to the toilet only for the first 3 days. You will be able to stand and take weight on your heel. Bend your knee and ankle regularly to stimulate circulation. Most people can stop taking their painkillers after 48 hours. Do not leave the house, drive, or get the foot wet.

3-7 days: You should aim to be moving around for 15 minutes in each hour (not in one go) resting with your foot elevated for the remaining 45 minutes. Still do not go out of the house, drive, or get your foot wet.

1-2 weeks: Your foot will be checked in the clinic and your dressing will be changed. You should still stay in your house, do not drive, and keep your foot dry. Keep wearing your post-operative shoe. Your stitches are removed 2 weeks post-op.

2-4 weeks: You will be advised to gradually increase your activity and exercise your foot as tolerated. You may wash and bathe normally and apply moisturising cream to improve your skin condition. You should continue applying ice compresses to your foot several times each day to reduce swelling. You may now stop wearing the post-operative shoe and change to wearing wide comfortable shoes such as trainers. Start to bear weight through the foot with it flat on the ground with the aid of crutches. An x-ray is usually ordered at this point to check the placement of the implant.

4-12 weeks: Gentle light unrestricted activity within your own level of comfort. Rest with foot elevated when able. After this you should be able to progressively walk without crutches and take weight through the foot. Slowly return to full activity. Your foot may still ache and be swollen at the end of the day.

Driving – Your surgeon will advise when you can start driving, usually 2-4 weeks after surgery.

You may drive if surgery is on the left foot, when you are off narcotics, and if your car is an automatic.

If surgery is on the right foot, you can drive when you are full weight bearing without aids and given clearance from your surgeon.

YOU CANNOT DRIVE WHILE YOUR FOOT IS IN A WALKING BOOT.

Do not drive until you are confident about controlling your vehicle and always check with your doctor and insurance company first.

Return to Worksedentary – If you work at a desk with minimal time on your feet and you are able to elevate your foot/feet, you may be able to return to work between 2-3 weeks.

Return to Work active – If you have a physical job or are standing a lot and unable to elevate your foot/feet, you may not be able to return to work until 4-6 weeks.

Low impact exercise8 weeks

High impact exercise12 weeks

As with any surgery, there are potential risks and complications associated with HyProCure® surgery. These include infection, bleeding, and nerve damage. However, these risks are rare, and most people who have the procedure experience little to no complications.

Surgery

Surgery is advised if non-surgical treatment fails.

FAQ

Is there drilling or screwing involved in the procedure? 

There is no drilling or screwing involved with the HyProCure® procedure. A small incision is made in the skin above the sinus tarsi and the stent simply slides into the natural space inside the foot. The threads on the stent are only to allow for the scar tissue to form around the grooves and lock the device in place during the normal healing process.

Are there any limitations, as far as sports go, after this procedure?

Once the tissues surrounding the stent are healed, there should be no limitation. The abnormal motion is no longer present and normal motion will occur. Usually, there is a significant improvement in running, jumping—any activity involving propulsion from the foot.

Can I still get MRIs, CT scans, etc. with HyProCure® in my foot?

Yes. HyProCure® is made from medical grade titanium. However, as with any procedural implant, you should inform your doctors of the implant and follow their recommendation.

If this procedure is performed on a child, does it have to be replaced later in life?

The short answer is likely no, but this is not a guarantee. Normally, once the stent is inserted into the foot it rarely has to be changed. The bones will continue to grow peripherally around HyProCure®.

What are the chances of having an allergic reaction to this implant?

Titanium is the choice material used in the body since it is the least reactive. HyProCure® is made entirely of medical grade titanium. Some patients develop what appears to be an allergic reaction, but this is the result of chronic inflammation of the foot.

Will I feel the implant in my foot?

As long as the implant does not displace, you should not be able to feel HyProCure® after the procedure.  Sometimes for the first few months a hard substance may be felt in the area of the surgery. This is scar tissue and should dissipate after several months if present at all.

Will there be a visible scar?

The incision is less than an inch long and slender and this part of the skin heals remarkably well. With time, the scar will continue to fade.

After the HyProCure® procedure, will I need to be pre-medicated prior to dental treatment or other future surgical procedures?

You will not need to pre-medicate prior to dental or other surgical procedures because the HyProCure® stent is not embedded into the bone.

Will this implant get rid of all the pains in my body?

No one can completely predict the outcome of any surgical procedure, but this solution should help improve your entire body’s alignment. As a consequence, reduction and relief of many pains caused by the foot imbalance will also be reduced or eliminated. However, it is possible that some of the joints and soft tissues in the body may have already suffered irreversible wear and tear, and in those cases other treatments or procedures might be necessary. In either case, correcting the root of the problem is still essential to stopping any further damage and to allowing for any additional therapies (if necessary) to be long lasting.

Will I still have to wear my orthotics after the procedure?

There are other reasons for orthotics to be worn. Orthotics can be used to off-weight prominent areas to the bottom of the foot. If those areas are not surgically addressed, then orthotics may still be required after the procedure.

Are there limitations to this procedure?

Yes, every surgical procedure has its limitations. In very severe cases of talotarsal displacement, other surgical procedures may be necessary to achieve optimum correction.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Podiatric Surgeon Dr Kim is the leading surgeon for Foot Surgery in Brisbane and Gold Coast, contact him today to see if you are a good candidate for HyProCure surgery.

No referral needed

Contact Us

A GP referral is welcome however it is not essential for your appointment

About

Dr Ji Soo Kim (Specialist Podiatric Surgeon) BPodM, DClinPod, FFPM RCPS(Glasg)

Book Appointment

Dr Kim has two offices, one located in Kelvin Grove, Brisbane. The other is in Southport, Gold Coast.

Please call 1300 522 096

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