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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Fuse Targeted Symptomatic Joints
- Fuse only symptomatic joints: typically second and third TMT and involved navicular-cuneiform facets.
- Avoid fusing 4th/5th unless the patient has clear lateral column symptoms.
Controversy Over Which NC Facets To Fuse
- Including multiple NC facets in the fusion may raise union rates, but experienced surgeons sometimes fuse only the involved facet with graft and modern fixation.
- Technique choice balances union risk against preserving mobility.
Avoid Routine 4th/5th Fusions
- Avoid routine fusion or interpositional arthroplasty for 4th/5th TMT joints unless clearly symptomatic.
- Consider simple debridement or cuneiformectomy only when already operating elsewhere and symptoms localize there.