Exciting Out-Patient Permanent Cure

Hyperpronation is a very common condition of excessive motion of the rear foot which causes the appearance of a “collapsed arch” upon weight bearing. This motion leads to deformity of the foot and potentially knee, hip, and back problems. It occurs with every step a person takes and eventually leads to damage to the musculoskeletal system. This is why most people develop lower extremity symptoms by middle age, or even earlier depending on the degree of deformity. In other words, if your feet are “out of alignment”, sooner or later the effects will be felt.

Hyperpronation is present at the time of birth, and the age of onset of the symptoms depends on the degree of deformity. A child with a flatfoot may develop so called “growing pains” which is caused by abnormal excessive activity of the leg muscles required to propel the foot during normal ambulation.

X-ray picture of a flatfoot.


X-ray picture of a foot with normal sinus tarsi spacing.

Normal foot showing sinus tarsi spacing.

Common symptoms in children with excessive hyperpronation may include:

  1. Growing pains
  2. Flattened arch
  3. Out-toe walking
  4. Tip-Toe walking
  5. Early onset of structural deformities such as bunions and hammertoes
  6. Abnormal shoe wear patterns
  7. Always wanting to be carried
  8. Poor posture
  9. Knee, hip, back, neck problems
  10. Inactive child or slow runner

Adult symptoms may include:

  1. Foot deformities such as bunions, hammertoes, neuromas, ingrown toenails
  2. Painful heels or arches (plantar fasciitis/heel spur syndrome)
  3. Ankle pain or recurrent sprains
  4. Leg pains (shin splints, cramping, night cramps)
  5. Knee, hip, pelvis, back and neck pain


You should not wait to have pain or deformities to treat hyperpronation. As with any other deformity, the sooner treatment is initiated the better the outcome. Oral medications do not address the underlying deformity which is excessive motion of the ankle bone (talus) on the heel bone (calcaneus). Historically, arch supports have been the “gold standard” in treating abnormal foot motion. This type of treatment has been very successful in preventing the abnormal motion, but do not address the underlying internal cause of the deformity to afford a permanent cure. The other disadvantage of arch supports is that they will limit the shoes you may wear (no sandals or high heels) and when you are not wearing the supports, you will not be getting any correction of the deformity or relief of symptoms (ex. Barefoot).


X-ray picture showing sinus tarsi implant to correct flatfeet.

The implant re-establishes the sinus tarsi space found in a normal foot.

Subtalar arthroeresis is a very viable in office treatment option for the permanent correction of hyperpronation for anyone over the age of three years. The procedure involves placing a small medical grade titanium implant in the sinus tarsi, which is the opening between the talus and calcaneus. This acts as an “internal orthotic” to prevent the abnormal motion (collapse) between the two bones. The titanium is tolerated by the body without ill-effects. It is specifically designed to fit securely into the sinus tarsi without any type of internal fixation (ex. screws, pins, etc.). It does not deteriorate over time or set of a metal detector. It is stronger than bone. The procedure takes approximately 10-15 minutes and is performed though a small ¾ inch incision on the outside of the foot in an office or outpatient ambulatory center. It may be performed under local anesthesia or local anesthesia with light IV sedation. Also, since no boney structures are being disturbed, the procedure is totally reversible.

Post operatively, little pain medication is usually required. Partial weight bearing is allowed the day after surgery, and patients may return to shoes as tolerated after the first redressing usually 4 or 5 days after surgery. Sports activities can be increased to tolerance four weeks after surgery. Usually, orthotics are no longer necessary following the procedure.

Dr. Burton Katzen, class of “71” has been elected president of the Temple University School of Podiatric Medicine alumni board of directors.


An alumni dinner and reception will be held in conjunction with the national convention on July 15th at the Philadelphia Downtown Marriott.
For more information, click here.