THE MAXWELL-BRANCHEAU ARTHRORESIS (MBA)IMPLANT FOR FLEXIBLE FLATFOOT

IntroductionExcessive Pronation hypermobile foot during propulsion phase of gait

Arthroereisis Concept allow for normal subtalar joint motion while blocking excessive motion (normal = 4-6 degrees pronation)

SymptomsFoot fatigueLeg and arch painNight crampsWalking intemperanceAthletic abstinenceSedentary hobby pursuitAbnormal shoe wear

MBA IMPLANT

Surgical Technique Locate the sinus tarsi

The IncisionIncision 1-3cm* over sinus tarsi along the relaxed skin tension linesCare should be taken to avoid the intermediate dorsal cutaneous nerves as well as the sural nerve.

DissectionThe deep fascia is identified an opened allowing entrance into the sinus tarsi.

Probe InsertionThe yellow probe instrument is positioned perpendicular to the wall of the calcaneus, angled slightly posterior and superior, and inserted through the sinus tarsi into the sinus canalis until tenting is noted on the medial aspect of the foot.

Guide wire InsertionA guide pin is then inserted.

A medial incision is not recommended.

Implant Insertion

This is the proper position for the implant

Subcutaneous closure should approximate the skin edges

ForefootToRearfootPosition IsImproved

Post-op AFO Boot

MBA INCIDENTALS

Schedule one foot at a time.Allow crutches as needed.It is better to under correct.Advise parent of temporary in-toe gait after surgery.Use Derma Bond if child is apprehensive.

(Adjunctive procedures if indicated)

Picture of implantPicture of instrument set