Metatarsal-Cuneiform Fusion Surgery

Arthritis and Cartilage Erosion in Joints

Arthritis, a condition that affects millions worldwide, involves the inflammation of one or more of your joints, leading to pain and stiffness that can worsen with age. One of the primary culprits behind the discomfort and reduced mobility associated with arthritis is the erosion of cartilage. Cartilage is a resilient and smooth tissue that covers the ends of bones where they form a joint, allowing them to glide over one another with minimal friction. Unfortunately, when this cartilage wears down over time, the bones lose their protective covering and begin to rub against each other. This not only causes the characteristic pain of arthritis but can also lead to swelling, a decrease in joint mobility, and the development of bone spurs.

Degenerative Joint Disease (DJD) in the Midtarsal Joints of the Foot

Specifically focusing on the foot, Degenerative Joint Disease (DJD), commonly known as osteoarthritis, can significantly impact the midtarsal joints, including the metatarsal cuneiform joints. These joints play a pivotal role in the stability and flexibility of the foot, essential for walking and weight-bearing activities. DJD in these areas leads to the breakdown of cartilage, resulting in pain that can range from mild discomfort to severe, debilitating pain, depending on the extent of the disease's progression.

Symptoms and Limitations

Patients with DJD in the midtarsal joints often report a variety of symptoms that affect their quality of life. These can include sharp or aching pain in the midfoot, especially during movement or after prolonged periods of rest; swelling and tenderness around the affected joints; a feeling of stiffness in the foot in the morning or after sitting for long periods; and a noticeable decrease in the range of motion of the foot. As the condition progresses, it may become difficult to walk, climb stairs, or engage in activities that require foot flexibility and strength. The limitations imposed by DJD in the metatarsal cuneiform joints can be significant, affecting not only physical capabilities but also impacting emotional well-being due to reduced mobility and independence.

The Procedure

Fusion Procedure for the Midtarsal Joints

The fusion procedure, also known as arthrodesis, is a surgical intervention aimed at alleviating pain and restoring stability in the midtarsal joints affected by Degenerative Joint Disease (DJD). This procedure involves removing the remaining cartilage from the affected joints and then joining the bones together so they can heal into a single, solid unit. The goal is to eliminate the pain caused by bone rubbing against bone and to provide a more stable, pain-free foot. Below is an overview of the steps involved in the fusion procedure:

Preparation of the Joint Surfaces: The surgeon removes the damaged cartilage to prepare the bones for fusion.

Alignment and Fixation: The bones are aligned in their correct positions, and internal fixation devices are used to hold them together.

Closing the Incision: Once the bones are properly aligned and secured, the surgical incision is closed.

Types of Internal Fixation Used in Midtarsal Joint Fusion

The choice of internal fixation device is crucial for the success of the fusion procedure. These devices help maintain the proper alignment of the bones while they fuse together. Several types of internal fixation can be used, each with its own advantages:

Screws: One of the most common fixation devices, screws provide strong fixation and can be used in various configurations to secure the bones.

Plates: Metal plates can be attached to the bones with screws, offering additional stability, especially in cases where multiple bones need to be fused.

Staples: Compressive staples are a low profile fixation technique that provides compression and stability that does not require a lot of bone destruction.

Pins or Wires: For smaller bones or in areas requiring more delicate fixation, pins or wires may be used.

External Fixators: In some cases, external frames that attach to the bones through the skin may be used temporarily to hold the bones in place from the outside.

Each type of internal fixation has specific indications based on the patient's individual anatomy, the extent of the disease, and the surgeon's preference. The choice of fixation method will be discussed during the preoperative planning phase, taking into account the goals of surgery and the expected recovery process.

No Weight Bearing Cast

Fusion procedure require no weight bearing, meaning no weight is to be placed on the foot during the recovery.  To help in the stabilization of the fusion, a below the knew cast may be applied.  This prevents muscle contracture at the region of the fusion and allows for the best chances of success.  It is important you do not place any weight on the cast, and always use crutches, a knee scooter or a wheelchair.   In some cases, we may be able to use a walking boot.