Biomechanics - Midfoot

Consider as 3 columns: •  medial/middle/lateral •  ROM: lateral > medial

> middle •  Lateral column =

compensatory motion, accommodates to uneven ground

Biomechanics - Midfoot

•  Nonessential vs. essential joints – Lateral column is “essential” as compared to medial or middle columns (Hansen)

Nonunion

•  Can confirm with CT

Lateral Column Arthroplasty

•  Preserve collateral and plantar ligaments as resection performed

Lateral Column Arthroplasty

– Create “anchovy”

from peroneus tertius or long toe extensor

– Temporary pin fixation

Ceramic Interposition Arthroplasty

•  Dowel resection of joints – Burr initially – Use flouro to

confirm center of the joint

Ceriamic Interposition Arthroplasty

• Dowel resection of joints – Power spherical

rasp

•  Sizers available •  9-14 mm • Distract but

maintain cortical rim

Ceriamic Interposition Arthroplasty

Case #1

•  Spacers inserted •  11mm most

common

Case #1

slight distraction; preserve cortical rim/coverage

Lateral Column Arthrosis (or nonunion)

•  Arthrodesis or Arthroplasty? – Lateral column tarsometatarsal

interpositional arthoplasty is a simple procedure to perform

– Avoids the lengthy recovery of arthrodesis and its risks of nonunion, failed hardware and gait disturbance

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