Tendon arthroplasty for basal fourth and fifth metatarsal arthritis

Department of Research Services, Miller Orthopaedic Clinic, Charlotte, NC 28203, USA.
Foot & Ankle International (Impact Factor: 1.51). 06/2002; 23(5):440-6.
Source: PubMed


Arthritis of the fourth and fifth tarsometatarsal joints, recalcitrant to nonoperative treatment, presents a difficult clinical situation. As part of the lateral rays, these joints have considerable motion, making fusion a very disabling operation. Between 1990 and 1998, 12 patients, who had failed nonoperative treatment, underwent resection arthroplasty of the base of the fifth or fourth and fifth metatarsals with tendon interposition. Preoperative differential injections had confirmed the source of pain in eight cases. Patients were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot scale; a visual analogue scale to assess perception of pain and disability; a satisfaction index; and, where possible, a comprehensive physical examination. At an average of 25 months follow-up, the average AOFAS score was 64.5. On the visual analogue scale, pain improved an average of 35% and disability improved 10%. Six of the eight patients who participated in this study were satisfied with the operation and would undergo the procedure again for similar symptoms. Patients with a higher postoperative score on the AOFAS midfoot rating scale were statistically more likely to have had a positive differential injection preoperatively. We believe a lateral column tarsometatarsal resection arthroplasty is an effective salvage operation when lateral column midfoot arthritis is confirmed by differential injection and nonoperative measures have provided inadequate relief.

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    • "While some centres may be continuing to collate this information within their institution for future publication, treatment of lateral column arthralgia refractory to all attempted conservative management is probably most reliably treated by fusion. Evidence for this procedure is based on the largest patient group of all the discussed operative interventions, and achieves a higher postoperative VAS score than that reported following interpositional procedures [34] [35] [37] [38]. It is widely agreed that careful attention to surgical technique and reduction of the columns are mandatory in achieving a good result [5] [24] [34]. "
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