Midfoot fusion is an operation to permanently join the bones in the middle of the foot (tarsometatarsal joints). It is performed for midfoot arthritis, Lisfranc injuries, or deformity causing pain with walking.
An incision is made over the top of the midfoot. The damaged cartilage is removed from the affected tarsometatarsal joints. The bones are positioned in the correct alignment and fixed with screws or plates. Bone graft may be used. The operation takes one and a half to two hours.
Surgery is recommended for painful midfoot arthritis from previous Lisfranc injury, degenerative arthritis of the tarsometatarsal joints, or midfoot deformity causing pain and difficulty with footwear.
Stiff-soled footwear, carbon fibre insoles, orthotics, corticosteroid injection, and activity modification.
Weight-bearing X-rays and CT scan. Plan for six to twelve weeks of restricted weight-bearing.
Good pain relief and improved foot alignment in approximately 85% of patients. The midfoot joints contribute relatively little to normal walking, so fusion causes minimal functional limitation.
Prolonged foot swelling for several months.
Screws may be palpable on the top of the foot.
Expected at the fused joints but functionally well tolerated.
Failure to fuse at one or more joints. Risk approximately 5–10%.
Numbness on the top of the foot from cutaneous nerve damage.
Screws may need removal after fusion has occurred.
Particularly in smokers and diabetics.
Pain under adjacent metatarsal heads due to altered mechanics.
General or spinal anaesthesia with ankle block.
Non-weight-bearing for six to eight weeks in a cast. Weight-bearing in a boot for four to six weeks. Roomy footwear at three to four months. Full recovery takes six to twelve months. Stiff-soled shoes or carbon fibre insoles may improve comfort.
Regular X-rays at six weeks and three months. Metalwork removal may be planned at six to twelve months if symptomatic.
The midfoot joints contribute very little to normal gait. Most patients do not notice significant functional limitation from midfoot fusion.
Approximately 30–40% of patients choose screw removal because of prominence on the top of the foot. This is done after fusion is confirmed.