Midfoot arthritis- current concepts review

Abstract

Midfoot arthritis causes chronic foot pain and significant impairment of daily activities. Although post traumatic arthritis and primary osteoarthritis are the most common pathologies encountered, surgeons need to rule out inflammatory causes and neuropathic aetiology before starting treatment. Steroid Injections are invaluable in conservative management and have diagnostic value in guiding surgical treatment. For the definitive surgical option of fusion there are a variety of fixation devices available. A successful union is linked to a satisfactory outcome which most authors report to be in the range of 90% following the key principles of careful patient selection, pre-operative planning, adequate joint preparation and a stable fixation.

The sub-specialty of foot and ankle is evolving fast

“…To showcase the importance of foot and ankle disorders, we have included several high-quality reviews and original research articles, annotations, along with some very interesting case reports and technical tips. The variety of publications, in this special issue, range from fractures, 4,5 arthritis, 6 diabetic foot problems, 7,8 tendon transfer for the foot drop, 9 hallux valgus, club foot and Morton's neuroma. There are also articles on ultrasound-guided regional anaesthesia in foot and ankle surgery and on postoperative rehabilitation.…”

Lesser Tarsal Metatarsal Joint Fusion Using Nitinol Staples, Bone Marrow Aspirate Concentrate, and a Calcaneal Bone Dowel: A Technical Note

“…Most commonly, the use of compression plating attached dorsally has been employed but others have described the use of lag screws, Kirschner wires, plates, and staples fashioned out of Kirschner wires. 6 Although these constructs have provided varying results with certain studies obtaining a 92% union rate, many constructs result in a nonunion rate of 3% to 11%. 2,6 In a biomechanical study comparing nitinol staples to claw plating and cross screws, Aiyer et al 1 demonstrated a significant increase in contact force and area across the arthrodesis site with the use of nitinol staples.…”

“…6 Although these constructs have provided varying results with certain studies obtaining a 92% union rate, many constructs result in a nonunion rate of 3% to 11%. 2,6 In a biomechanical study comparing nitinol staples to claw plating and cross screws, Aiyer et al 1 demonstrated a significant increase in contact force and area across the arthrodesis site with the use of nitinol staples. Another added benefit—likely attributable to the slender nature of the staple—is the reduced soft tissue burden compared to a prominent dorsal plate, which has demonstrated a 9% complication rate of screw irritation or breakage in previous studies.…”

“…With an overall nonunion rate ranging from 3% to 8%, and as high as 11.4% in other studies, determining proper management for TMT arthritis can be a challenging problem. 2,6 Although many fixation options exist-including plates, screws, Kirscher wires, and staples with or without autologous vs allograft bone graft-no construct has proven superior to others in lowering nonunion rates. 6 One specific technique, first described by Cloward in neurosurgery literature for acute fractures of the cervical spine, entails the use of a bone dowel and for an interbody fusion.…”

“…2,6 Although many fixation options exist-including plates, screws, Kirscher wires, and staples with or without autologous vs allograft bone graft-no construct has proven superior to others in lowering nonunion rates. 6 One specific technique, first described by Cloward in neurosurgery literature for acute fractures of the cervical spine, entails the use of a bone dowel and for an interbody fusion. 3 This technique has since been adapted to various areas of the human body, including the foot and ankle literature.…”