Introduction Defined as arthritis of the midfoot which includes the following joints naviculocuneiform joint intercuneiform joint metatarsal cuneiform Pathophysiology etiology idiopathic (primary) osteoarthritis is most common form of midfoot arthritis posttraumatic inflammatory pathoanatomy large forces seen by joints that have limited motion soft tissues that support joints see abnormally high forces over time results in midfoot collapse Presentation Symptoms midfoot pain (and in arch) with push off Physical exam inspection deformity shows longitudinal arch collapse with weight bearing midfoot collapse (look like PTTI) forefoot abduction hindfoot valgus equinuus contracture of achilles tendon halux valgus palpation palpation of arch/midfoot leads to pain 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 inflammatory etiology consistent with symmetric degeneration across midfoot abduction of forefoot Differential PTTI post-traumatic Lis-Franc injury Lateral ankle instability Treatment Nonoperative NSAIDS, activity modification, orthotic/bracing indications first line of treatment modalities steroid injections under radiographic guidance can be diagnostic and therapeutic orthotics cushioned heel longtidunal arch supports stiff sole with a rocker bottom Operative midfoot arthrodesis, +/- TAL, +/- hindfoot realignment indications failure of non operative management outcomes midfoot joints are non-essential joints arthrodesis results in close to normal foot function Achilles tendon lengthening/hindfoot realignment may need to be done concomitantly Technique Midfoot arthrodesis approach realignment arthrodesis close to full physiologic foot function, especially during push-off, can be established tarsometatarsal joints are 2-3 cm deep and warrant appropriate preparation prior to fusion realignment arthrodesis fusion of the first ray via the first tarso-metatarsal joint fusion of the second/third rays via the naviculocuneiform/intercuneiform joints do not fuse the 4th/5th tarsometatarsal joints the lateral ray mobility facilitates foot accomodation during stance interpositional arthroplasties of the 4th/5th tarsometatarsal joints select cases will maintain length of lateral column can assist with gait accommodation instrumentation may use screws, staples, plates designed for midfoot fusions concomitant procedures Achilles tendon lengthening hindfoot realignment
Technique Guide CPT Codes: 28725 Arthrodesis; subtalar Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Subtalar Arthrodesis Orthobullets Team Foot & Ankle - Midfoot Arthritis Technique Guide Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC. Tarsalmetatarsal Arthrodesis Orthobullets Team Foot & Ankle - Midfoot Arthritis
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (SBQ12FA.15) An active 70-year-old female presents to your office with increasing foot pain over the last several years. She enjoys walking however is limited to 2 blocks due to pain. Her pain is greatest with "push off". She has attempted shoe wear modifications, orthotics, physical therapy and non steroidal anti-inflammatories with limited relief of her symptoms. Her current weight bearing radiographs are seen in Figures A, B and C. What is the most appropriate treatment at this time? Review Topic | Tested Concept QID: 3822 FIGURES: A B C Type & Select Correct Answer 1 Platelet rich plasma injection 1% (33/2469) 2 Proximal medial opening wedge of first metatarsal 4% (93/2469) 3 Dorsal exostectomy of the midfoot 14% (354/2469) 4 Midfoot arthrodesis 66% (1640/2469) 5 Double calcaneal osteotomy with lateral column lengthening 14% (336/2469) L 3 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (1) Podcasts (1) Login to View Community Videos Login to View Community Videos 2017 Current Solutions in Foot & Ankle Surgery Midfoot Arthritis: What to Do with the NC/4-5 TMT?: Michael Clare, MD (CSFA #4, 2017) Foot & Ankle - Midfoot Arthritis 5/12/2017 361 views (3) Foot & Ankle⎜Midfoot Arthritis Team Orthobullets 4 Foot & Ankle - Midfoot Arthritis Listen Now 12:42 min 10/21/2019 60 plays (1)