The bones of the hindfoot are the talus and calcaneus.&nbsp; Anteriorly these bones articulate respectively with the navicular and cuboid bones of the midfoot at the transverse tarsal joint.&nbsp; This joint is also known as Chopart’s joint.&nbsp; The calcaneus is the largest bone in the foot and articulates with the talus above.&nbsp; It is the main weight bearing structure of the foot and makes up the posterior point of the weight bearing “tripod”.&nbsp; The Achilles tendon inserts on the posterior process of the calcaneus and is responsible for the majority of dorsiflexion strength needed for the push-off phase of ambulation.&nbsp; The talus articulates with the calcaneus below and the ankle mortise above.&nbsp; This dense bone is responsible for ankle motion in ambulation. &nbsp;

Foot and Ankle

Procedure

The MIS FiberTak Achilles SpeedBridge repair implant system is a novel concept in Achilles reattachment following Haglund’s debridement. This repair enables an hourglass pattern of FiberTape® suture and knotless rip-stop sutures to be laid over the tendon’s distal end in a completely knotless 4-anchor configuration. The Achilles SpeedBridge repair provides rigid tendon fixation with improved tendon-to-bone opposition, allowing for immediate postoperative weightbearing and range of motion.1
 
Reference 
1. Arthrex, Inc. Data on file (APT-01462, APT-00924, APT-01140). Naples, FL; 2020.

Minimally Invasive FiberTak® Achilles SpeedBridge™ Repair Implant System

The FiberTak® Achilles SpeedBridge™ implant system is a novel concept in Achilles reattachment following Haglund’s debridement. This repair enables an hourglass pattern of FiberTape® suture and knotless rip-stop to be laid over the tendon’s distal end in a completely knotless 4-anchor configuration. The Achilles SpeedBridge repair provides rigid tendon fixation with improved tendon-to-bone opposition, allowing for immediate postoperative weightbearing and range of motion.1&nbsp;
 
Reference
 
1. Arthrex, Inc. Data on file (APT-01462, APT-00924, APT-01140). Naples, FL; 2007-2019.

Tendon Fixation for Achilles Insertional Tendinopathy

FHL tendon transfer is used for reinforcement of an Achilles repair. Arthrex has developed the Tenodesis Tension-Slide Technique for FHL tendon transfer. The flexor hallucis longus tendon is traced to the calcaneus and harvested. The Tenodesis Graft Sizing Kit is used to determine the tendon diameter and which size implant system to open. The FHL tendon is then transferred to the posterior calcaneus and stabilized with the DX button on the plantar cortex, as well as a Tenodesis screw for aperture fixation.

FHL Tendon Transfer

Achilles Insertional Tendinopathy

Human

It is characterized by pain over boney prominences or spurs located at the posterior superior aspect of the calcaneus.&nbsp; Arthrex has developed the Achilles SpeedBridge, Achilles SutureBridge,&nbsp;and Bio-Tenodesis techniques&nbsp; to address this type of pathology.&nbsp;&nbsp;

Secondary (C)

Achilles Midsubstance SpeedBridge repair combines the minimal incision PARS technique with 2 SwiveLock® anchors into the calcaneus for a knotless repair. This procedure eliminates the weakest part of an Achilles repair, the knots, by using interference fixation of the suture after reapproximating the tendon rupture. The PARS technique or a traditional repair can be used on the proximal stump and then the suture is passed percutaneously through the distal stump to the Achilles insertion site. By eliminating the knots, the repair may provide additional strength than the traditional open repair while limiting wound issues with a small incision.
The newly launched PARS SutureTape provides the surgeon with 1.3 mm SutureTape suture which offers increased resistance to tissue pull-through, stronger knotted and knotless fixation, tighter and smaller knot stacks and better all-around handling characteristics.1
Reference
1. Arthrex Research and Development. LA1-00038-EN_B. 2017.

Achilles Midsubstance SpeedBridge™ Repair

FiberWire® suture can be used for open Achilles repair. As compared to standard polyester suture, FiberWire suture has superior strength that provides tighter loop security during knot tying and increased knot integrity, while reducing knot profile.1
 
Reference 
1. Arthrex, Inc. Data on file (APT-2799). Naples, FL; 2015.

PARS SutureTape Technique for Achilles Rupture

Achilles Rupture

Achilles tendon ruptures are common in the elite and recreational athlete and most often occur in the non-insertional region of the tendon complex. Arthrex has developed the Percutaneous Achilles Repair System (PARS). This allows less dissection, faster technique, less wound issues, and preservation of the blood supply to the peritenon. This technique utilizes #2 FiberWire.

The Arthrex Ankle Fusion Plating System provides a complete solution for ankle fusion with a comprehensive offering of anatomy-specific titanium plates for both tibiotalar and tibiotalocalcaneal arthrodeses.
The ankle fusion set includes anterior and lateral TT fusion plates along with posterior and lateral TTC fusion plates that allow a variety of screw options, including 4.5 mm and 5.5 mm cortical and cancellous screws. Specific instrumentation designed to prepare the fusion sites is included in one comprehensive system.

Ankle Fusion

The DualCompression hindfoot fusion nail is intended to facilitate tibiotalocalcaneal arthrodesis to treat severe foot/ankle deformity, arthritis, instability, and skeletal defects. The superelastic nitinol inner core of the nail provides sustained compression across both joints when instrumentation is removed during bone resorption or joint settling.

DualCompression Hindfoot Nail

A triple arthrodesis is the fusion of the subtalar, calcaneocuboid, and talonavicular joints. Arthrex has developed 5.0 mm Large and 7.0 mm XL Compression FT Screws and DynaNite® Nitinol staples as options for this procedure. After removing any remaining cartilage and subchondral bone and applying biologic materials to accelerate fusion, apply fixation to compress and stabilize the joint.

Triple Arthrodesis

Ankle Arthritis

Ankle arthritis is most commonly the result of prior trauma to the ankle joint. Ankle fractures and other injuries may damage the cartilage, which leads to accelerated arthritis. Patients with ankle injuries are also susceptible to osteonecrosis, a condition where blood flow is decreased to a portion of the bone. Osteonecrosis can also lead to ankle arthritis.

Calcaneal fractures are typically the result of high-energy mechanisms such as a fall from a height or an automobile accident. Arthrex offers many solutions for these injuries, including:
<ul>
 <li>Calcaneal Fracture Management System (Includes perimeter and percutaneous plates)</li>
 <li>5.0/7.0 mm Compression FT Screws</li>
 <li>4.5/6.7 mm LPS Cannulated Screws</li>
</ul>

Calcaneal Fracture

Calcaneal fractures are typically the result of high-energy mechanisms such as a fall from a height or an automobile accident. Arthrex offers many solutions for these injuries, including:
<ul>
 <li>Calcaneal Fracture Management System (Includes perimeter and percutaneous plates)</li>
 <li>5.0/7.0 mm Compression FT Screws</li>
 <li>4.5/6.7 mm LPS Cannulated Screws</li>
 <li>Trim-It™ Pins - Bioabsorbable PLLA Pins</li>
</ul>

A calcaneal osteotomy is a common technique used to treat stage II flatfoot deformity. Arthrex's recently launched Minimally Invasive Surgery platform allows surgeons to perform this osteotomy through a tiny incision. Surgeons can then achieve fixation using the 7.0 mm Compression FT screws or the 6.5 Compression PT screws.
Alternatively, surgeons desiring a graduated shift can use the calcaneal step plate via a lateral approach.

Calcaneal Osteotomy for Flatfoot

The titanium Compression FT (fully threaded) screws come in 2.5 mm Micro, 3.5 mm Mini, 4.0 mm Standard, 5.0 mm Large, and 7.0 mm XL. The variable-stepped thread pitch and headless design helps reduce the risk of profile complications, provides compression, and allows for simplified insertion. Surgeons can now achieve zero-profile, stable fixation. The Compression FT family of screws now offers 5 diameters and 91 screw lengths to fit various orthopedic applications throughout the body.

Compression FT Screws

Arthrex offers surgeons an array of fixation options for the Cotton osteotomy. The titanium porous BioSync® wedges offer a zero-profile, stable construct, designed to exactly match the anatomy of the cuneiform. For surgeons who prefer allograft wedges, Arthrex also offers precontoured allograft AlloSync™ wedges designed with the same anatomical shapes and sizes as the BioSync family of products.

Cotton Osteotomy

FDL tendon transfer is used for posterior tibial tendon dysfunction. Arthrex has developed the Tenodesis Tension-Slide Technique for FDL tendon transfer. The flexor digitorum longus tendon is traced to the master knot of Henry and harvested. It is then transferred to the navicular and stabilized with the DX button on the dorsal cortex as well as a Tenodesis screw for aperture fixation. This procedure can be done in conjunction with the InternalBrace™ augmentation repair of the spring ligament.

FDL Tendon Transfer

Arthrex offers multiple implant options for lateral column lengthening procedures including the BioSync® titanium porous wedges or the AlloSync™ allograft wedges. Both products are available in several shapes and sizes, allowing surgeons to choose between a permanent structural implant or an allograft implant.

Lateral Column Lengthening (Evans Osteotomy)

The ProStop arthroereisis subtalar implant is intended to assist in treating the hyperpronated foot by stabilizing the subtalar joint. It is intended to block forward, downward, and medial displacement of the talus, thereby limiting excessive eversion of the hindfoot. The conical shape of the ProStop mimics tarsal canal anatomy for improved fit and resistance to implant migration, while the soft thread design supports better implant-to-bone contact.

ProStop® Arthroeresis

Subtalar arthrodesis is the fusion of the subtalar joint, between the talus and calcaneus. Subtalar arthrodesis can be fixated with Arthrex 7.0 mm XL Compression FT screws.

Subtalar Arthrodesis

Flatfoot

Adult acquired flatfoot deformity results from a progressive degeneration of the posterior tibial tendon, ultimately leading to arch collapse on the medial side of the foot. This deformity is characterized by a number of stages from I-IV ultimately describing the severity of the pathology. Over time, if left untreated, the deformity can advance into arthritis at the associated joints in the midfoot and hindfoot thus creating the need for fusions of those joints.
Arthrex has developed a comprehensive line of products to help surgeons treat their patients through all the major operative stages of flatfoot deformity, Stages II-IV. From soft-tissue procedures, to osteotomies, and ultimately fusions, Arthrex has flatfoot deformities covered.

Primary (B)

The Arthrex MIS product portfolio continues to grow with the introduction of the Minimally Invasive Bunionectomy System. This trajectory system helps achieve correction and fixation placement using a percutaneous approach. Designed to work with this specific system, the beveled fully threaded screws are angled to provide zero-profile fixation. Additionally, a dedicated power unit and instrumentation are available. The MIS line is further supported by Medical Education courses focused on minimally invasive techniques.