OrthoPro, The Foot and Ankle Company

Benefits of the OrthoPro Subtalar Spacer STS

Concaved distal entrance into guidewire opening to allow self centering of guide pin for removal.

Space between the four proximal threads and three distal threads to allow soft tissue incapsulation to minimize migration.

More aggressive first thread for easier insertion.

Larger range of sizes 6.5 mm through 11.5 mm with larger special sizes if needed.

Implants sterilized with the tray in separate compartments.

Pricing is best in the industry.

Preoperative / 10 year old

One month post-operative

Subtalar Spacer Surgical Procedure

A linear incision of 2 to 3 cm in the relaxed skin attention lines over the sinus tarsi is created, just superior to the peroneal brevis tendon. The incision is deepened by a sharp dissection through the dermis and into the subcutaneous tissue only. Be aware of and avoid the intermediate dorsal cutaneous nerve at the end of the superior aspect of the incision.

A hemostat is then used to bluntly dissect the sinus tarsi. The dissection occurs on the inferior-most portion of the incision and along the floor of the sinus tarsi. The STS probe in then placed in this portal and advanced from lateral to medial in the sinus tarsi. The interosseus talar calcaneal ligament need not be visualized, nor should it be sectioned. The superior aspect of the calcaneus in the floor of the sinus tarsi may be visualized superior to the peroneal brevis tendon. A sinus tarsectomy is not performed.

With the use of the handle for the guidewire from lateral to medial, the STS guidewire is then placed into the channel created by the STS probe. The guidewire is advanced from lateral to medial until it can be palpated below the surface of the skin. The guidewire exits the sinus tarsi medially, just inferior and anterior to the tip of the medial malleolus. A medial incision, to advance the guidewire through the medial stab incision, is done at the surgeon’s preference or discretion.

The guidewire is then left in place coursing through the sinus tarsi. The STS system sizers can then be placed over the guidewire into the sinus tarsi. Sizes are as follows: 6.5, 7.5, 8.5, 9.5, 10.5, and 11.5. The sizers are placed over the guidewire into the sinus tarsi and the subtalar joint is then moved through a range of motion. The appropriate size is determined calcaneus everts to perpendicular or 2 to 3 degrees valgus. At this point, there should be an end fill or blocking of the subtalar pronation or calcaneal valgus position.

At the surgeons discretion, the sizer may then be removed and the corresponding trial implant may then be placed over the guidewire into the sinus tarsi. With the appropriately sized implant determined, the STS implant is placed over the guidewire. Then, with the assistance of a screwdriver, the implant is “screwed” into the sinus tarsi and its soft tissue components (including the interosseus talocalcaneal ligament). The surgeon may then place a freer elevator or his thumb against the lateral wall of the calcaneus just inferior to the incision

The implant is then screwed into the sinus tarsi in a clockwise direction. It is advanced until it is approximately 1 cm into the sinus tarsi from the lateral wall of the calcaneus. This is determined by the 1 cm mark on the screwdriver. The leading edge of the implant (tip) should be at the longitudinal bisection of the talas. At the surgeons discretion, an intraoperative C-arm or radiograph may be obtained to determine accurate positioning of the STS implant.

NOTE: The implant may shift medially or it may inadequately block the subtalar joint pronation it placed past the midline of the talas.

Once the STS implant is in accurate position, the screwdriver is carefully removed from the implant and the sinus tarsi. The guidewire is also carefully twisted and pulled out of the sinus tarsi. The surgical wound is then irrigated with antibiotic solution as determined by the surgeon. Wound closure is then done at the surgeons preference.

Click Here for a printable Instructions For Use (IFU) for our Subtalar Spacer System.