Midfoot Fusion

The Problem

The middle part of your foot (called the “midfoot”) is made up of small bones. On the inside of your foot there are two rows of bones; the first called “navicular”. Just past this are bones called the “cuneiforms”. On the outside of the foot a single larger bone called the “cuboid” crosses the whole midfoot.

Arthritis of the midfoot means the smooth surface that covers the end of the bones (the cartilage) has been lost and there are usually bone spurs around the joints. This often occurs from injuries or diseases like rheumatoid arthritis, but it sometimes happens without any known cause. Most often joints where the midfoot joins the long bones that lead out to your toes (the “tarsometatarsal” joints ) are involved, and this can sometimes push the front part of your foot to the outside and make your arch flat. Other joints in the midfoot can get arthritis as well.

 

The Surgery

If you have pain from the joints in the midfoot, it can usually be relieved by fusing the joints that are involved (making the bones grow together). This makes your foot only a little bit stiffer; because the joints in the midfoot do not move very much to begin with. When we fuse the joints, we also straighten out the foot and raise your arch as much as possible.

The surgery is done through one, tow or three incisions on the top and inside of the foot. We hold the bones still with screws. These can come out after about 9 months, but on a very small number of patients are bothered by them enough to request it. Screw removal is a simple day surgery.

Smoking keeps from bones healing well, especially in the foot. You should not smoke for at least 3 months. Also, if you take anti-inflammatory drugs like Advil, Naprosyn or Asprin, you should stop then 5 days before surgery because they can thin your blood.

Surgery & Recovery

The surgery is done as an outpatient (you do not need to be admitted to the hospital).

After the Surgery: You will have a large, bulky dressing that comes up to just below the knee. Keep your foot elevated above your heart as much as possible for the first week. YOU CANNOT WALK ON THE FOOT. Some patients like to practice on crutches before having surgery.

2 Weeks: We will take out your stitches and put on a removable cast boot. You must wear this all the time (even at night) and take your foot out only to gently wash it.

6 weeks: If your X-rays show healing, we will let you slowly start putting weight on the foot.

3 Months: Most patients can begin weaning out of the boot. Begin by wearing the boot only when you go outside the house for 2 weeks, then not at all. We we will let you know when it’s safe to take each step.

3 ½ 6 months: Most patients are back to regular shoes and activities.