Midfoot Fusion

Tarsometatarsal joints are the small joints in the middle foot. Osteoarthritis, rheumatoid arthritis or other conditions may damage these joints. The joints may wear out, collapse, cause severe foot deformity and affect the function of the foot. Tarsometatarsal joint fusion is a surgical procedure that fuses the bones of the middle foot to overcome the painful movement and correct deformities in the tarsometatarsal region.

What are the indications for tarsometatarsal joint fusion?

Midfoot tarsometatarsal joint fusion is indicated when conservative approaches, such as medications, steroid injections, activity modifications, custom orthotics and modified footwear, fail to provide pain relief. The fusion can treat foot deformity, arthritic tarsometatarsal joints, as well as correct the front and back area of the foot.

How is tarsometatarsal joint fusion performed?

Midfoot tarsometatarsal joint fusion is performed under the effect of general or regional anaesthesia. Your surgeon will make 3-4 cm long cuts on the upper or inner surface of the foot. The doctor will open the joints, remove the joint surface, reshape it and correct the deformity. The joints are then fixed and kept in place using screws, plates and staples. During the fusion, your surgeon may add bone grafts to fill the gaps between the joints, if necessary. This procedure stabilises the joints, prevents movement and provides pain relief. ​

What are the steps for post-surgical care?

After the surgery, keep the operated foot elevated to decrease swelling. After the swelling has reduced, the foot will be put in a plaster cast from knee to toes for about 8 to 12 weeks until the bones have fused. You may have to use crutches for a few weeks. Your physical therapist will guide you to walk without putting pressure on the operated foot. Avoid driving and vigorous exercises for a few weeks after surgery. Follow-up X-ray images will be taken to check for bone fusion.

What are the associated risks and complications?

As with any procedure, midfoot tarsometatarsal joint fusion may involve certain risks and complications such as:

  •     Infection and swelling
  •     Non-union of bones
  •     Nerve injury
  •     Malpositioning of the fused bones
  •     Loosened pins and screws
  •     Rarely, deep vein thrombosis or pulmonary embolism