Monday, October 29, 2012

Possible Secondary Pathologies of Partial TaloTarsal Dislocation

The following conditions/pathologies may be caused by or have symptoms increased by talotarsal displacement:

PTTD (posterior tibial tendon dysfunction)
Plantar fasciitis
Achilles tendonitis
First ray deformities/bunions
Navicular drop (fallen arches)
Tarsal tunnel syndrome
Posterior tibial neuropathy
Musculoskeletal pain – knees, hips, back, etc

Find our more at

Saturday, October 27, 2012

Verifying Candidacy for Extra-Osseous TaloTarsal Stabilization with HyProCure®

It is important to document the presence of reducible/flexible talotarsal displacement. This is accomplished through:

Clinical exam
  • Weightbearing: To check for potential reducibility as the foot transitions from neutral to relaxed stance position.
  • Non-weightbearing range of motion exam: A stable talotarsal mechanism will have little triplane motion. Tested by loading the 4th and 5th metatarsal heads and moving the foot from a pronated to supinated position and back.
  • Gait analysis: Looking for evidence that could include “too many toes” sign, a prolonged period of pronation, calcaneal valgus and/or abductory twist.
Radiographic Analysis
  • Partial talotarsal dislocation can be seen in Lateral and AP weightbearing views.
  • It is important to take both as the deformity can have planal dominance.
  • If the deformity is flexible, neutral stance position x-rays should show normal radiographic measurements.
    • AP View

  • Talar 2nd metatarsal angle

  • Bisection of the talus should align lateral to the medial aspect of the 1st metatarsal

      •  Lateral View
    • Talar declination angle
    • Talocalcaneal angle“Open” sinus tarsi
    • Sustentaculum tali slightly dorsiflexed
    • Normal cyma line
    • Normal navicular height
    • In relaxed stance, will see at least one of the following:
      • AP view:
    • Talar 2nd metatarsal angle >16 degrees
    • Bisection of the talus medial to the medial aspect of the 1st metatarsal
      • Lateral view
    • Talus anteriorly displaced on the cyma line
    • Sustentaculum tali slightly plantarflexed
    • Loss of navicular height/navicular drop
    • Talar declination angle >21 degrees
    • Talocalcaneal angle >46 degrees

    Thursday, October 18, 2012

    Importance of Foot Alignment

    The foot is the foundation to the body. The alignment of the foot is crucial for proper foot function. This lecture discusses normal and abnormal alignment and the exact cause that leads to a faulty foot structure. Learn more at

    Tuesday, October 16, 2012

    GraMedica®: Our Core Beliefs

    We live up to our name! In the service of our customers, both patients and surgeons, we stand for Growth, Responsibility, Ambition, Motivation, Education, Dedication, Integrity, Customer Satisfaction and Accountability.

    Learn more here.

    Monday, October 15, 2012

    Adult Acquired Flatfoot

    Adult acquired is a very serious condition that can lead to many secondary deformities not only within the foot but also to knees, hips and the back. This presentation discusses a new proven procedure that may be able to help realign and there fix this problem at its root.

    Friday, October 5, 2012

    GIII® Announces Recipient of the 2012 “Game Changer” Award

    Leading Chinese Foot and Ankle Surgeon Bestowed Title of GIII® 2012 “Game Changer”.

    The 2012 “Game Changer” award, presented by the Graham International Implant Institute®, the training partner of GraMedica®, a global orthopedic medical device company, was presented to one of the leading foot and ankle specialists in all of China. Dr. Jian Zhong Zhang, M.D., Prof., Director of Foot and Ankle Services, Chief of the Department of Orthopaedics at Beijing TongRen Hospital and Capital Medical University, received the award during a ceremony at the 2012 TongRen Foot and Ankle Symposium, held in Beijing, China, September 14-16.

    Read more. 

    Thursday, October 4, 2012

    Changing Lives, One Step at a Time: HyProCure® Marks 8 Years

    HyProCure® was invented by Michael E. Graham, DPM, FACFAS, FAENS. In his practice, Dr. Graham specialized in the correction of foot and ankle instability. Recognizing the significant limitations of the sinus tarsi implants on the market, he developed HyProCure®. The device received FDA approval on September 16, 2004 and the first HyProCure® placement took place on September 22, 2004. As more and more doctors and patients gained awareness of both the condition and treatment, GraMedica®, global orthopedic medical device company and maker of HyProCure®, experienced rapid growth.

    Dr. Graham was determined to improve patient outcomes by providing this revolutionary solution. In order to share his knowledge and expertise with other foot and ankle surgeons, he founded the Graham International Implant Institute® (GIII®) in August 2006. The mission of GIII® is to elevate the standard of care in the arena of Extra-Osseous TaloTarsal Stabilization through education. Since the release of HyProCure®, many peer-reviewed studies have been published recognizing the proven results of this EOTTS device. Learn more at

    Wednesday, October 3, 2012

    Why is HyProCure® Different from Other Devices?

    A New Kind of TaloTarsal Stabilization

    One of the most important advantages of the HyProCure® system is the procedure itself. The actual surgery is minimally invasive, generally takes less than 15 minutes, requires only local anesthetic, and can actually be performed in-office, which makes it ideal for patients without insurance coverage.

    While the procedure is similar in principle to subtalar devices, there are several very important differences that need to be reviewed before you can perform the HyProCure® procedure safely and effectively. To aid you with this, we have prepared a fast-track online training program that will arm you with the core preparation to successfully perform the procedure. In addition, we also offer many hands-on training seminars year-round and throughout the world that can assist you in advancing your training and certification status.

    The complete details of the HyProCure® procedure itself will be covered during your training and certification process, whether online or at one of our seminars. We also invite you to review the procedure animation video below for a guided overview of the process.

    If you are a specialist interested in HyProCure training, please click here.

    Monday, October 1, 2012

    HyProCure® in Pediatric Patients

    Q. What happens to a pediatric patient when they mature and their bones grow to their adult size, will we need to revise the HyProCure® stent size?

    A. By the time a child is 3 to 4 years old the sinus tarsi is formed by the osseous structures from the talus and calcaneus. It is my belief that the sinus tarsi does not change in its dimensions (yet to be proven). This is based on the fact the most common HyProCure® size is 7 then 6 in adult patients. So, if a child already has a size 6 or 7, then they already have the most common adult size stent. 

    Learn more at