The Orthobullets Podcast CoinFlips | Foot & Ankle | Midfoot Arthritis in 60F
Dec 12, 2025
Selene Parekh, a faculty member at the Rothman Orthopaedic Institute specializing in midfoot arthrodesis, joins Nicholas Strasser, a foot and ankle surgeon at Vanderbilt, and Greg Kirwan, also from Rothman. They dive into the complexities of managing midfoot arthritis, debating the benefits of weight-bearing CT over traditional imaging. Topics like nonoperative management strategies, surgical options including fusions, and innovative techniques using nitinol plates take center stage. Their insights on postoperative care and biologics make for a fascinating discussion on optimizing outcomes.
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Use Weight-Bearing CT For Planning
- Get weight-bearing CT for midfoot and hindfoot cases to reveal underestimated pathology not seen on plain x-rays.
- Use the CT to precisely plan which joints need fusion to avoid missed pathology in the OR.
Obtain 3D Imaging Routinely
- Use CT (weight-bearing if available) routinely for hindfoot and midfoot workups to evaluate cysts and joint involvement.
- Consider MRI when soft-tissue or referral pain patterns are unclear.
Image-Guided Injections For Diagnosis
- Use diagnostic injections under imaging guidance for small midfoot joints to confirm the symptomatic joint.
- Prefer ultrasound or radiology-guided injections when available for accuracy.