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Midfoot Arthritis: Nonoperative Options and Decision Making for FusionNonoperative Options and Decision Making for Fusions

Rao, Smita PT, PhD; Nawoczenski, Deborah A. PT, PhD; Baumhauer, Judith F. MD

Techniques in Foot & Ankle Surgery: September 2008 - Volume 7 - Issue 3 - p 188-195
doi: 10.1097/BTF.0b013e3181758713

Arthritis of the midtarsal and tarsometatarsal joints (midfoot) has emerged as a challenging problem because of its high potential for chronic foot pain and functional disability. Although the incidence of patients presenting with midfoot arthritis is increasing at an alarming rate, guidelines for clinical decision making are lacking in the literature. The primary aim of treatment is to afford pain relief by enhancing midfoot stability and modifying loads sustained at the inflamed joints. These treatment goals are attempted initially through conservative management such as orthoses followed by surgery. This manuscript discusses strategies for conservative management and details the operative techniques for tarsometatarsal fusion. In addition, outcomes after intervention are presented.

Department of Physical Therapy, Ithaca College-Rochester Center, and Department of Orthopedics, University of Rochester, Rochester, NY

Address correspondence and reprint requests to Smita Rao, PT, PhD, 1100 S Goodman St, Ste G-20, Rochester, NY14609. E-mail:

This work is also supported in part by the following: Arthritis Foundation (Post-doctoral fellowship to Dr Rao), Arthritis Foundation Chapter Grant (Drs Rao and Nawoczenski), and the American Orthopaedic Foot and Ankle Society Research Award (Drs Rao, Nawoczenski, and DiGiovanni).

© 2008 Lippincott Williams & Wilkins, Inc.