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Background
Midfoot arthritis is a challenging problem causing chronic foot pain and impeding daily activity. There is not much written about this subject in literature and is often not well known by orthopaedic surgeons. The primary aim of treatment is to afford pain relief by enhancing midfoot stability and modifying loads sustained at the inflamed joints. The initial treatment is conservative with inserts and orthoses. Surgery, more specifically midfoot arthrodesis, is the next step when conservative management fails. The arthrodesis should be limited to the symptomatic joints but it is often difficult to determine which joints cause the symptoms. With this manuscript we would like to underline the importance of a precise anatomic preoperative diagnosis, review our surgical experience and discuss the different surgical fixation possibilities in midfoot arthrodesis.
Methods
Between 2006 and 2011 24 patients (26 feet) with midfoot osteoarthritis underwent selective arthrodesis after conservative management had failed. Preoperative examinations, fixation method, complications and outcome were noted.
Results
We achieved union in 25 feet. There was one delayed union and one non-union. There were no infections but 3 patients had chronic regional pain syndrome. Reoperation was required in one foot because of non-union and one for symptomatic hardware removal.
Conclusion
Midfoot arthrodesis is an effective treatment for osteoarthritis of the joint. Identification of the affected joints is important to stipulate the extensiveness of the arthrodesis.
The reported operative treatment of primary osteoarthrosis of the metatarsocuneiform joint has focused primarily on methods of arthrodesis. Arthrodesis of the metatarsocuneiform joint can result in complications in the older or obese patient who is unable to tolerate nonweight bearing. Age and health status can also increase the rate of nonunion and venous thromboembolism, especially in the immobile patient. We present a technique not previously described. The procedure is presented as an alternative to arthrodesis and involves resection arthroplasty of the metatarsocuneiform joint.
Surgery for midfoot osteoarthritis
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