| Presentation |
- Symptoms
- midfoot pain (and in arch) with push off
- Physical exam
- palpation of arch/midfoot leads to pain
- deformity shows
- longitudinal arch collapse with weight bearing
- midfoot collapse (look like PTTI)
- forefoot abduction
- hindfoot valgus
- equinuus contracture of achilles tendon
- halux valgus
|
| Imaging |
- Radiographs
- lateral
- loss of co-linearity between talus-1st MT (Meary's line)
- apex of deformity is at the level of the midfoot
- may show collapse of longitudinal arch
- AP
- arthritic signs in midfoot
- abduction of forefoot
|
| Differential |
- PTTI
- post-traumatic Lis-Franc injury
- Lateral ankle instability
|
| Treatment |
- Nonoperative
- NSAIDS, activity modification, orthotic/bracing
- indications
- modalities
- steroid injections under xray guidance; can be diagnostic/therapeutic
- should include longitudinal arch supports, a stiff sole & possibly a rocker bottom
- Operative
- midfoot arthrodesis with bonegraft and internal fixation
- indications
- failure of non operative management
- outcomes
- midfoot joints are non essential joints with fusion typically resulting in near normal foot function
- Achilles tendon lengthening/hindfoot realignment
- may need to be done concomitantly
|
| Technique |
- Midfoot arthrodesis
- realign & fuse the 1st ray through the TMT & 2nd/3rd ray via the naviculocuneiform and intercuneiform joints
- tarsometatarsal joints are 2-3 cm deep and warrant appropriate preparation prior to fusion
- do not fuse the 4th/5th tarsometatarsal joints to maintain the foot's ability to accommodate to the ground during stance
- interpositional arthroplasties can be considered in select cases to maintain length of lateral column and assist with gait accommodation
- may use screws, staples, plates designed for midfoot fusions
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