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

2. Introduction Excessive Pronation h ypermobile foot during propulsion phase of gait Arthroereisis Concept allow for normal subtalar joint motion while blocking excessive motion (normal = 4-6 degrees pronation)

3. Symptoms Foot fatigue Leg and arch pain Night cramps Walking intemperance Athletic abstinence Sedentary hobby pursuit Abnormal shoe wear

6. MBA ® IMPLANT

8. Surgical Technique Locate the sinus tarsi

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

10. Dissection The deep fascia is identified an opened allowing entrance into the sinus tarsi.

11. Probe Insertion The 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.

12. Guide wire Insertion A guide pin is then inserted. A medial incision is not recommended.

13. Implant Insertion

19. This is the proper position for the implant

20. Subcutaneous closure should approximate the skin edges

22. Forefoot To Rearfoot Position Is Improved

24. Post-op AFO Boot

25. 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)