Say Goodbye to flat feet and fallen arches...

Pronation is a normal motion of the foot. Specifically, it is the complex motion between the ankle bone, which turns inward, and the rest of the foot which turns out. This is a very important function of the foot to aid walking, especially on uneven ground.

Hyperpronation is a very common deformity when there is excessive or too much pronation occurring in the foot. This excessive motion of the ankle bone and the rest of the foot will occur with every step taken; all resulting in the abnormal closure of the sinus tarsi.

The second most common conscious function of our body is walking. Walking is the best form of exercise we are told. However, there are many dangers of walking that can lead to more than just problems with our feet. The feet are the foundation to our body and even if there is just slight excessive pronation this will lead to other deformities to our body.

Growing Pains: This is actually an inflammation of the lining of the leg bones. In a hyperpronating foot, the leg muscles must work. This overactivity leads to greater pull of the muscle on the leg bones. After a day of play and once the child gets into bed for the night and is no longer walking/standing, the inflammation set-in and pain ensues. No bone in our body will hurt when it grows.

Flattened Arch: This is a very common finding. If the child is sitting with their foot off the floor they have a nice arch, but when they stand the arch flattens. However, hyperpronation can also be present with a high arched foot.

Out-toed Walking: Normally the feet should point straight in front of the legs when walking and if viewed from behind only the fifth toes of the foot should be seen. In a hyperpronated foot usually greater than the fifth toes can be seen. This is referred to "too many toes sign".

Tip-Toe Walking: This decreases the muscle activity and is more efficient in a hyperpronated foot.

Structural Deformities: Many times children have bunions, hammertoes, etc. at a very young age due to the hyperpronation.

Not wanting to wear shoes: Sometimes the shoes will hurt their feet due to the excessive motion occurring, which rubs on the feet causing blisters and pain.

Shoe laces coming untied: Again due to the excessive motion of the foot causing repetitive pressure to the sides of the shoes, which pull on the laces, eventually they become untied. Eventually the child will not want to tie the shoes in the first place or will get shoes without laces.

Always wanting to be held or sit down frequently when walking: Walking or standing is exhaustive due to the excessive muscle activity. After prolonged walking at the grocery store, shopping mall, or theme park the child with a hyperpronating foot will want to take very frequent breaks or if young enough will want to be held.

Poor posture: When the talus deviates, it alters the skeletal system affecting the knees, hips and back. When standing the back muscles try to compensate for this but only for short periods of time. Usually a child's shoulders will slump or they cannot stand on both feet for more than a few moments. Parents always try to reprimand the child but it is futile.

Knee, Hip, Back, Neck Symptoms: Any or all of these can be present in a child with a hyperpronated foot. Children should not suffer with these conditions at such a young age unless a deformity is causing this. Normally, these symptoms are associated after weight-bearing activities.

Inactive Child: If a child develops symptoms after a period of activity they will innately cease those activities.

The parent Sinus Tarsi Implant is self-seating/positioning whereas the other implants are not. The sinus tarsi is made up of the deeper canalis portion and the outer sinus portion. The procedure itself generally takes less than 15 minutes and is performed under twilight sedation.

A Permanent Correction

A small stent is placed into a space below the ankle bone which prevents the abnormal excessive motion, restoring normal motion. This is a minimally invasive procedure which can be performed from three years old and up. There is restoration of the normal motion between the talus and calcaneus.The correction is achieved internally, so no matter what style of shoe is being worn correction is being achieved. Additionally, regardless of whether or not a shoe is being worn, correction is being achieved.

A sinus tarsi stent cannot get lost or accidentally thrown out. Once placed it should remain in-situ for the rest of the patient’s life. It does not need to be replaced yearly. The metallic stents do not wear out. If for some reason the patient did not tolerate the correction or if the stent had some how become displaced it is possible for the stent to be removed without further damage to the space. These stents are not placed into a joint but a bone space. The sinus tarsi (sinus or canalis) does not contain any cartilage and therefore cannot develop arthritis. If the stent did not achieve the desired correction other additional surgical procedures could be performed in conjunction with subtalar arthroereisis. Additionally, worse case scenario the stent could be removed without any damage to the sinus tarsi and the more aggressive rearfoot surgical procedures could still be performed. A subtalar arthroereisis procedure is completely reversible.

Dr. Arabshahi has been designated as a Master Surgeon in the Salem/Portland area who does Sinus tarsi Implant.