While fixation of the focal prosthesis remains challenging, placing it slightly proud can help reduce stress on talar cartilage. However, excessive proud positioning increases stress on tibial cartilage and should be avoided. Proper prosthesis placement is critical for optimal stress reduction. Furthermore, fixation in the talus reduces trabecular bone strain, potentially mitigating bone loss and enhancing implant stability.
Ramos et al. (Fri,) studied this question.