Arthrodesis of the Fourth and Fifth Tarsometatarsal Joints of the Midfoot

Abstract

Maintaining mobility of the fourth and fifth tarsometatarsal joints has been reported to be important in arthrodesis of the midfoot. A review of the records at a tertiary care center of 23 patients (28 feet) with arthrodesis of these joints and a minimum 2-year follow-up showed that 22 complete midfoot arthrodeses were performed as part of the correction for a neuroarthropathic rocker-bottom deformity. Six arthrodeses of the fourth and fifth metatarsal joints were performed on normosensate feet with painful arthritis involving the lateral joints. Clinical and radiographic fusion occurred in 26 of 28 feet. Comparing average preoperative and postoperative scores, functional incapacity from lateral midfoot pathology decreased (8.4/10 to 2.2/10), overall pain scores improved (5.1/10 to 1.3/10), pain scores in the arthritic subgroup decreased (8.2/10 to 2.4/10), and the modified overall AOFAS midfoot score improved (35/100 to 78/100).

The injuries to the fourth and fifth tarsometatarsal joints: A review of the surgical management by internal fixation, arthrodesis and arthroplasty

“…Raikin et al 32 once reported 23 cases of arthrodesis of the fourth and fifth TMT joints with severe deformity and pain. They determined the arthrodesis can produce good outcomes for pain relief and functional improvement, although 13 cases complained subjective stiffness of the lateral foot.…”

Plantar and Calcaneocuboid Joint Pressure after Isolated Medial Column Fusion versus Medial and Lateral Column Fusion: A Biomechanical Study

“…3,6,7,9,12 Others consider it acceptable to fuse both the medial and the lateral column in the setting of painful arthritis or deformity. 10,11 While it is generally accepted that maintaining motion at the fourth and fifth TMT joints is preferable, the alternatives to fusion of these joints have shown limited success 2 and medial and lateral fusion is indicated in significant deformity or arthritic pain in the lateral column. The biomechanical effect of medial and lateral fusion has not been investigated.…”

Ayak bileği, subtalar ve ayak orta kısım eklemlerinde osteoartroz

“…Raikin ve Schon, dördüncü ve beşinci tarsometatarsal artrodez sonrası inceledikleri 23 hastanın 13'ünde (%57) ağrı-nın azaldığını ve fonksiyonların arttığını göstermişler-dir. [33] Yazarlar düzeltilemeyen lateral-orta ayak deformitesinde, rocker bottom ayakta ve ciddi ağrıda lateral kolon artrodezini önermiştir. Çoğu yazar, lateral kolon için konservatif tedaviden yanıt alınamazsa, tendon interpozisyonu ile lateral kolon tarsometatarsal rezeksiyon artroplastisini önermektedir.…”