1. Pediatric Obesity The Foot ConnectionNew Treatment
UpdatesMichael E. Graham, DPM, FACFAS, FSPS, FAENSMacomb,
Michigan
2. Childhood obesity is on the rise.www.HyProCure.com
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5. Obesity leads to manyother health problems We have to
eliminateobesity in order to treatthese other diseases,otherwise
thesecondary healthproblems will continueto get worse, not better
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6. Obesity TreatmentDid you know: Only 21% of 64 obesity
programs resultedin a short-term weight-loss Of that 21%, it was
only a small change WHY? www.HyProCure.com
8. Obesity Treatment Decreased food intakeis only part of
theequation We have to get thesekids moving This increases
theirmetabolismwww.HyProCure.com
9. Exercise is important to maintainingproper body
weight.Exercise leads to increased metabolismand decreased weight.
www.HyProCure.com
10. Sounds Good, BUTWhat if they have bad
feet?www.HyProCure.com
11. Feet are the foundation to the body.www.HyProCure.com
12. Stability of the hindfoot mechanism iscritical for
standing, walking, and running. www.HyProCure.com
13. Bad Feet = Increased Pain = Decreased Exercise Majority of
obese childrenalso have faulty footmechanics
(talotarsaldislocation) Like driving your car withunbalanced,
worn-out tiresand with the steering out ofalignment its not fun
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14. They Suffer When They Exercise 4 to 5 times your body
weighttravels through each foot whenwalking and up to 10 times
whenrunning When everything is aligned, thisis still considerable
force But when talotarsal dislocationoccurs: Muscles, tendons and
ligaments have to compensate for the excessive, abnormal strain The
soft tissues first have to bring the hindfoot bones back into
normal alignment and then do their regular job to propel the foot
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15. They Suffer When They Exercise Over time, the
faultymechanics in the foot willcause symptoms to developthroughout
the rest of thebody
16. TaloTarsal Dislocation Syndrome This translates to
excessive motion that can potentially affect the Knee Pelvis Hips
Lower Back Spine NeckJaw(far more than just the foot)
17. TaloTarsal Dislocation Syndrome Did you know the average
person takes 7,000 steps/day 49,000 steps/week 196,000 steps/month
2,352,000 steps/yr 11,760,000 steps in 5 years 22,520,000 steps in
10 years 47,040,000 steps in 20 years 116,600,000 steps in 50 years
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18. Think about it Even if our foot is slightly out ofalignment
the years of standing,walking and running are going totake their
toll Early on, dont feel the ill-effects,but eventually the signs
andsymptoms will appear Just like this car tire Its not IF, its
WHEN www.HyProCure.com
19. Finally, most people will just give up Why keep torturing
yourself? You are rewarded with pain.Increased activity = Increased
painDecreased activity = Decreased pain www.HyProCure.com
20. We have to stabilize their feet Brings us right back to
thestability of our feet But how can we really dothis?
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21. TaloTarsal Dislocation The dynamic displacement of the
talus (anklebone) off the tarsal mechanism (hindfoot bones)
Reducible/flexible: occurs when weight bearing(standing, walking,
running) Results in excessive motion of the joint(hyperpronation)
Leads to excessive forces on supporting tissues(tendons, muscles,
ligaments)www.HyProCure.com
22. TaloTarsal Mechanism Relationship of the articularfacets of
the talus on thecalcaneus and navicular Four (4) articular contact
points Posterior, middle & anterior talocalcaneal Talonavicular
Supination/pronation There should be very littletalotarsal motion
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24. Radiographic Evaluation TaloTarsal Dislocation Lateral view
Talar declination > 26 degrees Anterior deviated cyma line
Obliterated sinus tarsi Dropped" navicularNSP Compare Neutral vs.
Relaxed Stance Position Sagittal plane dislocation
deformityRSPwww.HyProCure.com
25. Radiographic Evaluation AP view Talar 2nd metatarsal angle
should be < 16 degrees > 16 degrees = pathologic
displacementwww.HyProCure.com
26. Pes PlanoValgus versus TaloTarsal DislocationCIA* is flat
to negative CIA is normal to increasedPes PlanoValgus TaloTarsal
Dislocation*Calcaneal Inclination Anglewww.HyProCure.com
27. Treatment Options Observation Arch supports/orthoses
Special shoes or braces Rearfoot reconstruction surgery
Extra-Osseous TaloTarsal Stabilization
(EOTTS)www.HyProCure.com
28. Treatment Option- Observation Every step leads torepeated
destructiveforces acting on the Foot Ankle Knee Hip Pelvis Back
Shoulders Neck www.HyProCure.com
29. Treatment Option- Observation The feet dontautomatically
fixthemselves. They progressively getworse. www.HyProCure.com
30. Benefit Risk AnalysisObservation Benefits: Risks:
Non-surgical option Progression of the disease Relatively
inexpensiveprocess (still have to follow these Every step is
inefficient patients progress) Excessive abnormal strain Does not
rely on patienton supporting soft tissue compliancestructures No
anesthesia/surgical Mal-alignment to other risks structures within
the foot & ankle and also up the musculoskeletal chain Leads to
the worst possible long-term complicationswww.HyProCure.com
31. Treatment Option- Orthoses/Shoes Do arch supports
reallywork? Where is theradiographic proof ofrealignment of
theosseous structures?www.HyProCure.com
32. Benefit Risk Analysis Orthoses/Shoes Benefits Risks
Non-surgical option Not proven to decrease Relatively inexpensive
tissue strain (compared to surgical Not proven to improve options)
radiographic No potential measurements anesthesia/surgical Can lead
to other complicationsproblems- increased pain Patient compliance
issues Need new devices maderegularly Have to be worn in shoes
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34. Benefit Risk AnalysisRearfoot Reconstructive Surgery
Benefits: Risks: Radiographic correction Surgical risks Internal
correction Non-union Infection Does not rely on patient Need for
revision compliance Need to remove internal May be covered by
hardware insurance companies Anesthesia risk (low) Expensive Long
recovery www.HyProCure.com
35. Now I would like to introduce you to theworld
ofExtra-Osseous TaloTarsal Stabilizationwww.HyProCure.com
36. What is EOTTS? The use of an internaldevice to
preventexcessive motion of thetalus on the calcaneusand navicular
Differentiated from inter-osseous intra-osseous Purely a soft
tissueprocedure to improve thefunction of hindfootmechanism
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37. EOTTS Devices Made of titanium Not screwed into bone
Reversible Performed on childrenas young as 3 and older Tens of
thousands havebeen performedExample EOTTS
devicewww.HyProCure.com
38. What can EOTTS Achieve?www.HyProCure.com
39. What it cant fix.It cant fix everything, there are
limitations. Have to have a flexible deformity, that isthe talus
can be repositioned on the calcaneus. It will not increase
CIA.www.HyProCure.com
40. Who is a candidate for EOTTS Must have a flexibledeformity
(talus can berepositioned on tarsalmechanism) Three years of age
orolder (no upper agelimit)www.HyProCure.com
41. Who is not a candidate for EOTTS Rigid deformity Less than
three (3) years of age www.HyProCure.com
42. Benefit Risk Analysis EOTTS Benefits: Risks: Internal
solution Device displacement Minimally invasive, fast
Over/Under-correction Extra-osseous Need for revision or (soft
tissue) permanent removal Reversible Soft tissue adaptations Proven
to decrease strain General surgical risks on supporting tissues
Radiographic evidence Covered by most planswww.HyProCure.com
43. We have to stabilize their feet EOTTS really is the
bestoption Do not have issues withpatient compliance There is
supporting clinical &radiographic evidence ofimprovement
Reversible procedure www.HyProCure.com
44. Conclusions Talotarsal dislocation is not normal (sometimes
seenin children as flatfoot/navicular drop) There are better
options now that are time testedand proven It is a team approach
You have access to a great number of foot and anklespecialists who
are here to do their best to keep ourchildren active, healthy, and
happy www.HyProCure.com
45. Because at the end of the day,we are just trying our bestto
keep everyone walking. www.HyProCure.com
46. Please visit www.HyProCure.com for more valuable
information and tofind a HyProCure specialist near you.