New EOTTS Classification System Identifies HyProCure® as Having Better Design and Patient Outcomes

Scientific study of Extra-Osseous TaloTarsal Stabilization devices validates key differences in HyProCure® that allow for better biomechanical functioning leading to improved success rates.
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Extra-osseous Talotarsal Stabilization


Macomb - Michigan - US


Oct. 11, 2012 - PRLog -- (MACOMB, MI) – A recent study, Extra-Osseous Stabilization Devices: A New Classification System published in The Journal of Foot and Ankle Surgery, Volume 51, Issue 5, Pages 613-619, September 2012, provides a systematic approach to classifying the differences in design features and biomechanical function of Extra-Osseous TaloTarsal Stabilization (EOTTS) devices.

A variety of conservative and operative treatment options have been used to eliminate or minimize the ill effects of talotarsal displacement, a condition in which the ankle bone displaces off the hindfoot bones, creating a misalignment of forces in the foot that in turn affects the rest of the body. This condition affects people of all ages throughout the world. Partial talotarsal dislocation can be the direct cause of numerous symptoms and secondary conditions, including fallen arches, plantar fasciitis (heel pain), overpronation/hyperpronation, bunions, heel spurs, knee pain, hip pain, back pain and even complications in the neck and shoulders. EOTTS corrects this condition permanently through a minimally invasive surgical procedure that offers improved stabilization over external measures and has a quicker recovery time than traditional hindfoot reconstructive surgery. Over the years many devices have been introduced, which differ in design, materials, orientation and biomechanical function.

The goal of this study was to classify EOTTS devices into categories based on design and biomechanical function, which may have an impact of the success rate of each type. This new classification system is intended to help researchers and surgeons become aware of the subtle yet important differences and associated benefits of each type of EOTTS device, which in turn will aid surgeons when making patient care decisions.

Four critical design/function aspects were determined on which to base classification; device geometry/shape, anatomical orientation within the sinus tarsi, anchoring location within the tarsal sinus, and mechanism of talar stabilization and biomechanical function. Two major categories were established, Type I and Type II EOTTS devices.

The results illustrated that Type I devices are cylindrical or conical in shape, inserted in a lateral-to–medial/oblique orientation, implanted with the leading anterior edge inserted up to the longitudinal talar bisection and are laterally anchored by soft tissues in the sinus tarsi. Type II device parameters were a lateral conical and medial cylindrical geometry, an anterior-distal-lateral to posterior-proximal-medial insertion, implanted with the leading anterior edge inserted medially beyond the longitudinal talar bisection and medially anchored by soft tissues within the canalis portion of the tarsal sinus. Type I EOTTS devices were shown to function as an impingement mechanism, blocking excessive motion, whereas, Type II devices, which includes HyProCure®, were shown to function by allowing normal helicoidal motion of the talus on the tarsal mechanism.

The partial dislocation of the talus on the tarsal mechanism is a triplane deformity. Displacement on any one of the four articular facets of the talotarsal mechanism leads to displacement at the other facets. The ideal method to stabilize the talotarsal mechanism is exactly at the axis of triplanar talotarsal motion. This is referred to as the “cruciate pivot point” and is generally located at the entrance of the canalis tarsi along the longitudinal talar bisection line.

It has been acknowledged that a device that better matches the anatomical shape of the tarsal sinus and follows its natural orientation would allow for better biomechanical functioning. The Type II device, HyProCure®, met the ideal parameters, which has an impact on the improved success rates. This improved design and function may also contribute to the success of Type II EOTTS devices in decreasing the effects of talotarsal displacement or even eliminating secondary pathologies.

To read the abstract of this study and find further research on the positive outcomes of EOTTS with HyProCure® visit the library section of

Working with physicians and local distributors on nearly every continent, GraMedica®, global orthopedic medical device company and maker of HyProCure®, strives to educate foot and ankle professionals on the importance of stabilizing the talotarsal mechanism.  GraMedica® works cooperatively with the Graham International Implant Institute (GIII), which has the mission of elevating the standard of care in the arena of Extra-Osseous TaloTarsal Stabilization through surgeon education.

Foot and ankle surgeons are invited to learn more about the HyProCure® device and procedure at, where they can also train online and/or find a live surgical training seminar in their area.

Potential surgical candidates, from China and around the world, can find out more about the HyProCure® solution and the devastating effects of talotarsal dislocation at Find a local HyProCure® specialist through the physician locator at

Susan Doherty, Director, Education & Physician Resources
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Tags:Hyprocure, Extra-osseous Talotarsal Stabilization, Hyperpronation
Location:Macomb - Michigan - United States
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