This 2010 narrative review from Patel et al. surveys the anatomy, biomechanics, etiology, diagnostic workup, and both nonsurgical and surgical management options for midfoot (TMT and naviculocuneiform) arthritis, with particular attention to why medial and lateral columns require different treatment strategies.
When a patient presents with dorsal midfoot pain and bossing at the first or second TMT joint — especially with a history of Lisfranc injury or progressive flatfoot — start with rigid full-length carbon inserts and rocker-bottom shoes; if surgery is needed, plan medial/middle column fusion but treat lateral column symptoms with motion-preserving interpositional arthroplasty rather than reflexively fusing all five rays.
This 2010 narrative review from Patel et al. surveys the anatomy, biomechanics, etiology, diagnostic workup, and both nonsurgical and surgical management options for midfoot (TMT and naviculocuneiform) arthritis, with particular attention to why medial and lateral columns require different treatment strategies.
When a patient presents with dorsal midfoot pain and bossing at the first or second TMT joint — especially with a history of Lisfranc injury or progressive flatfoot — start with rigid full-length carbon inserts and rocker-bottom shoes; if surgery is needed, plan medial/middle column fusion but treat lateral column symptoms with motion-preserving interpositional arthroplasty rather than reflexively fusing all five rays.