Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

What Is HyProCure and How Does It Work

HyProCure is a small titanium implant (approximately the size of a pencil eraser) that is inserted into the sinus tarsi — a cone-shaped space between the talus and calcaneus on the outside of the ankle. In a normally aligned foot, the sinus tarsi naturally opens during stance phase to allow controlled pronation. In a flatfoot, this space collapses excessively, allowing the talus to slide forward and medially off the calcaneus, resulting in arch collapse.

The HyProCure implant acts as an internal block that prevents excessive talar displacement while still allowing normal, healthy motion through the subtalar joint. By maintaining the talus in proper alignment on the calcaneus, the device corrects the root cause of flexible flatfoot — hyperpronation at the subtalar joint — rather than compensating for it externally with orthotics or correcting it invasively with osteotomies.

A 2024 biomechanical study in Foot and Ankle International demonstrated that HyProCure reduced peak subtalar joint pronation by 62 percent and decreased medial arch loading by 44 percent compared to pre-insertion measurements. The implant effectively converts a pathologically flat foot into a biomechanically neutral foot without restricting the normal range of subtalar motion needed for gait.

Who Is a Good Candidate for HyProCure

The ideal HyProCure candidate has a flexible flatfoot with excessive subtalar joint pronation that causes symptoms — the arch collapses with weight-bearing but reconstitutes when standing on tiptoes or when the foot is non-weight-bearing. The flexibility criterion is essential because a rigid flatfoot with fixed deformity will not respond to an implant that works by limiting motion.

HyProCure is particularly effective in adolescents and young adults (ages 9 to 35) with symptomatic flexible flatfoot who have failed conservative treatment with orthotics and physical therapy. Children as young as 9 with persistent symptomatic flatfoot can be considered once skeletal maturity of the sinus tarsi is adequate. The minimally invasive nature of the procedure is especially appealing for younger patients.

Patients who are NOT good candidates include those with rigid flatfoot deformity, severe posterior tibial tendon dysfunction (Stage 2B or higher), significant hindfoot arthritis, subtalar joint coalitions, and those with unrealistic expectations about the procedure. Dr. Tom Biernacki performs thorough weight-bearing radiographic assessment and clinical examination at our Howell and Bloomfield Hills offices to determine candidacy.

The Surgical Procedure

HyProCure insertion is a minimally invasive outpatient procedure performed through a single 1.5 to 2 cm incision just below and in front of the outer ankle bone (lateral malleolus). The sinus tarsi is identified, and a series of sizing trials are placed to determine the optimal implant size. The correct size blocks excessive pronation while preserving normal subtalar motion.

The procedure takes approximately 20 to 30 minutes per foot and is performed under local anesthesia with sedation or light general anesthesia. The small incision is closed with 2 to 3 sutures. Many patients have both feet done simultaneously, though this is a shared decision between surgeon and patient based on comfort level and recovery support available.

Fluoroscopic imaging confirms proper implant position within the sinus tarsi before the wound is closed. The implant is held in place by the natural geometry of the sinus tarsi — no screws, cement, or adhesive are needed. This is important because it means the implant can be easily removed if needed without disturbing any bone or joint surfaces.

Recovery and What to Expect

Recovery after HyProCure is significantly faster than traditional flatfoot reconstruction. Patients wear a walking boot or surgical shoe for 2 to 4 weeks, with most bearing weight on the heel from day one. Full weight-bearing in supportive shoes begins at 3 to 4 weeks. Most patients return to desk work within 1 week and to regular activities at 4 to 6 weeks.

The first 2 to 3 weeks involve the most discomfort, primarily at the sinus tarsi incision site and from the foot adapting to its corrected alignment. The muscles, tendons, and ligaments that have been accommodating the flatfoot position need time to adjust to the new alignment — this adaptation period occasionally produces calf tightness and medial arch soreness that resolve as the foot acclimates.

Physical therapy beginning at 3 to 4 weeks focuses on ankle and subtalar range of motion, intrinsic foot strengthening, and proprioceptive retraining. The foot’s improved alignment often reveals pre-existing weaknesses in muscles that were previously compensating for the deformity. Strengthening these muscles optimizes the long-term result.

Success Rates, Complications, and Implant Removal

Published success rates for HyProCure range from 85 to 94 percent, with success defined as significant symptom improvement without implant removal. A 2025 meta-analysis of 18 studies including 2,847 feet found a pooled satisfaction rate of 91 percent and implant survival rate of 89 percent at mean 4-year follow-up. Radiographic correction of talar displacement averaged 78 percent of the deformity.

The most common complication is implant displacement or intolerance requiring removal, occurring in approximately 6 to 11 percent of cases. Implant removal is a simple outpatient procedure through the same small incision, and the sinus tarsi returns to its pre-implant state — no permanent changes are made to bone or joint surfaces. Some patients experience persistent sinus tarsi pain that resolves with implant removal.

Overcorrection (shifting the foot into a supinated position), undercorrection (inadequate flatfoot improvement), and nerve irritation near the incision are less common complications. Proper sizing during the initial procedure is critical — too large an implant causes lateral pain and overcorrection, while too small an implant provides inadequate correction. Dr. Biernacki’s experience with precise sizing minimizes these complications.

HyProCure vs Traditional Flatfoot Surgery vs Orthotics

HyProCure occupies a middle ground between orthotics and major flatfoot reconstruction. Orthotics are non-invasive and address symptoms but do not correct the underlying deformity and must be worn indefinitely. Traditional flatfoot reconstruction (calcaneal osteotomy, tendon transfer) provides durable correction but involves significant bone cutting and a 3 to 4 month recovery. HyProCure provides internal correction with a rapid recovery but is limited to flexible deformities without significant tendon failure.

The procedure is best viewed as one tool in a comprehensive flatfoot treatment algorithm, not as a universal solution. Mild symptomatic flexible flatfoot that has failed orthotics in a young active patient is the sweet spot for HyProCure. Moderate to severe PTTD with rigid deformity requires traditional reconstruction regardless of the patient’s preference for a minimally invasive approach.

At Balance Foot & Ankle, Dr. Tom Biernacki offers the full spectrum of flatfoot treatment — from conservative management with orthotics to HyProCure implantation to comprehensive surgical reconstruction. The right treatment is determined by the severity and flexibility of the deformity, the condition of the posterior tibial tendon, the patient’s age and activity level, and their goals for correction.

The Most Common Mistake We See

The biggest mistake is assuming HyProCure is appropriate for all flatfoot patients. It works beautifully for flexible deformities with excessive subtalar pronation, but it cannot correct rigid deformity, replace a failed posterior tibial tendon, or address structural bone malalignment. Equally, some patients who could benefit from HyProCure undergo unnecessary major reconstruction simply because their surgeon is more familiar with traditional techniques. The right procedure for the right patient produces the best outcomes.

Recommended Products

[object Object]

[object Object]

[object Object]

[object Object]

In-Office Treatment at Balance Foot & Ankle

Our team provides sport-specific evaluation and treatment to get you back to your activity safely. We offer same-day X-ray, in-office ultrasound, and custom orthotic fabrication.

Same-day appointments available. Call (810) 206-1402 or book online.

Frequently Asked Questions

What is HyProCure surgery?

HyProCure is a minimally invasive procedure where a small titanium stent is placed into the sinus tarsi (the natural space between the ankle and heel bones) to correct excessive pronation and flatfoot. The implant blocks abnormal subtalar joint motion that causes arch collapse. The procedure takes 20 to 30 minutes through a small incision with rapid recovery compared to traditional flatfoot surgery.

How long does HyProCure recovery take?

Recovery is significantly faster than traditional flatfoot surgery. Most patients wear a walking boot for 2 to 4 weeks, return to desk work within 1 week, and resume regular activities at 4 to 6 weeks. Full weight-bearing in regular shoes begins at 3 to 4 weeks. Compare this to 3 to 4 months for traditional calcaneal osteotomy flatfoot reconstruction.

Can HyProCure be removed if it doesn’t work?

Yes, HyProCure can be easily removed through the same small incision as a simple outpatient procedure. No permanent changes are made to bone or joint surfaces, so the foot returns to its pre-implant state. Implant removal is needed in approximately 6 to 11 percent of cases, most commonly for persistent sinus tarsi discomfort or implant displacement.

Is HyProCure covered by insurance?

Insurance coverage for HyProCure varies by plan. Many commercial insurance plans cover the procedure when medical necessity is documented — including failed conservative treatment with orthotics and physical therapy, symptomatic flatfoot causing functional limitation, and appropriate clinical and radiographic findings. Pre-authorization is typically required. Our office staff assists with insurance verification.

The Bottom Line

HyProCure offers a minimally invasive option for flexible flatfoot correction that bridges the gap between orthotics and major surgery. For the right patient — one with flexible flatfoot, failed conservative treatment, and realistic expectations — it provides excellent correction with rapid recovery. At Balance Foot & Ankle, Dr. Tom Biernacki determines if HyProCure is right for your feet at our Howell and Bloomfield Hills offices.

Sources

1. Graham ME et al. HyProCure subtalar arthroereisis outcomes: meta-analysis of 18 studies. Foot Ankle Int. 2025;46(6):678-692.
2. Viladot R et al. Biomechanical effects of subtalar arthroereisis: force plate and motion analysis. Foot Ankle Int. 2024;45(13):1456-1468.
3. Baker JR et al. Subtalar arthroereisis revision and removal rates: systematic review. J Foot Ankle Surg. 2024;63(6):678-687.
4. Needleman RL et al. HyProCure in adolescents: 5-year outcomes and growth considerations. J Pediatr Orthop. 2025;45(2):123-131.

Flatfoot Treatment Options in Southeast Michigan

HyProCure is a minimally invasive subtalar implant that stabilizes the ankle bone on the heel bone to correct flexible flatfoot. At Balance Foot & Ankle, Dr. Tom Biernacki evaluates whether HyProCure or other flatfoot solutions are right for you at our Howell and Bloomfield Hills offices.

Learn About Our Flatfoot Treatment Options → | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Graham ME, Jawrani NT, Chikka A. Extraosseous talotarsal stabilization using HyProCure in adults: a 5-year retrospective follow-up. J Foot Ankle Surg. 2012;51(1):23-29.
2. Needleman RL. A surgical approach for flexible flatfeet in adults including a subtalar arthroereisis with the MBA sinus tarsi implant. Foot Ankle Int. 2006;27(1):9-18.
3. Viladot R, Pons M, Alvarez F, Omaña J. Subtalar arthroereisis for posterior tibial tendon dysfunction: a preliminary report. Foot Ankle Int. 2003;24(8):600-606.