Talotarsal Displacement leads to many different problems to our feet, knees, hips and back. This presentation presents a brief discussion of various treatment measures and provides a benefit risk analysis.

1. Talotarsal Displacement
Alternative Treatment Options

2. Treatment Goal
• Not to just cover-up/mask the pain with pills.
• Identify what caused the pain in the first place
and to eliminate the cause (cure it).
• If we only address the symptom(s) and not the
cause, the symptom(s) will continue until they
reach their breaking point.

3. Treatment depends
on the severity of the displacement.
• Observation – nothing?
• Shoe inserts/arch supports/orthotics?
• Reconstructive hindfoot surgery?
• Extra-Osseous TaloTarsal Stabilization?

4. Treatment Option- Observation
Did you know average person takes
• 7,000 steps/day
• 49,000 steps/week
• 196,000 steps/month
• 2,352,000 steps 1 year
• 11,760,000 steps 5 years
• 22,520,000 steps 10 years
• 47,040,000 steps in 20 years
• 116,600,000 steps in 50 years

5. Treatment Option- Observation
• These feet don’t
automatically fix
themselves.
• They don’t get better,
they get worse.

6. Treatment Option- Observation
• Symptom(s) will occur at the
weakest link.
• Most likely there will not be
any pain at the primary
deforming site (TTM)
• Unfortunately, attention is
focused on symptom relief
and the underlying etiology is
usually ignored or under-
treated.

7. Benefit – Risk Analysis
Observation
• Benefits:
– Non-surgical option
– Relatively inexpensive
– Does not rely on
compliance
– No anesthesia/surgical
risks
– Cheap and easy
• Risks:
– Progression of the disease
process
– Every step is inefficient
– Excessive abnormal strain
on supporting soft tissue
structures while standing,
walking or running
– Mal-alignment to other
structures within the foot
& ankle and also up the
musculoskeletal chain
– Leads to the many possible
long-term complications

8. Shoe insert-
• Maybe some patients will
benefit with relief, but what
if it doesn’t?
• There are pitfalls with these
devices such as expense,
compliance, replacement
costs and so on.
• Where is the proof that they
actually “fix” or reduce the
excessive hindfoot motion?

9. Treatment Option- orthoses/shoes
Do arch supports really stabilize the ankle bone?
Barefoot
Orthosis

10. This is the results of 20 years of shoes
inserts. Now there is only 1 option.

11. Benefit – Risk Analysis
Arch supports/Orthotics/Shoes
• Benefits
– Non-surgical option
– Relatively inexpensive
(compared to surgical
options)
– No potential
anesthesia/surgical
complications
• Risks
– Not proven to decrease
tissue strain
– Not proven to improve
radiographic
measurements
– Can lead to other
problems- increased pain
– Patient compliance issues
– Need new devices made
regularly
– Have to be worn in shoes

12. Treatment Option- Rearfoot Surgery

13. Benefit – Risk Analysis
Rearfoot Reconstructive Surgery
• Benefits:
– Radiographic correction
– Internal correction
– Does not rely on patient
compliance (once healed)
– May be covered by insurance
companies.
• Risks:
– Surgical risks
• Non-union
• Infection
• Need for revision
• Need to remove internal
hardware
– Can lead to arthritis in adjacent
joints
– Anesthesia risk (low)
– Very expensive
– Long recovery
• Cast
• Cannot walk on foot
• Edema, pain, stiffness
• Physical therapy

14. What can EOTTS Achieve?

15. What can EOTTS Achieve?

16. Benefit – Risk Analysis
EOTTS
• Benefits:
– Internal solution
– Minimally invasive, “fast”
– Extra-osseous (soft tissue)
– Reversible
– Proven to decrease strain
on supporting tissues
– Radiographic evidence
– Does not rely on patient
compliance (once healed)
• Risks:
– Device displacement
– Over/Under-correction
– Need for revision or
permanent removal
– Soft tissue adaptations
– General surgical risks