Talonavicular Arthrodesis – Foot Fusion Surgery
Talonavicular arthrodesis is a surgical procedure to permanently fuse the joint between the talus and navicular bone in the foot, relieving pain caused by severe deformity or arthritis.
Things worth knowing about "Talonavicular Arthrodesis"
Talonavicular arthrodesis is a surgical procedure to permanently fuse the joint between the talus and navicular bone in the foot, relieving pain caused by severe deformity or arthritis.
What is Talonavicular Arthrodesis?
Talonavicular arthrodesis, also known as talonavicular fusion, is a surgical procedure in which the joint between the talus (ankle bone) and the navicular bone is permanently fused. This joint, referred to as the talonavicular joint, plays a key role in the movement of the hindfoot and midfoot as well as in maintaining the arch of the foot. The primary goal of the procedure is to eliminate pain, improve stability, and restore proper weight distribution across the foot.
Indications – When Is the Procedure Performed?
Talonavicular arthrodesis is recommended when conservative treatments such as physiotherapy, orthotic insoles, or medications no longer provide adequate relief. Common indications include:
- Osteoarthritis of the talonavicular joint: Advanced cartilage degeneration causing persistent pain
- Rheumatoid arthritis: Inflammatory joint destruction in the hindfoot and midfoot region
- Pes planovalgus: Severe flatfoot deformity with collapse of the longitudinal arch
- Posterior tibial tendon insufficiency: Failure of the posterior tibial tendon leading to progressive foot deformity
- Post-traumatic arthritis: Joint degeneration following fractures or dislocations
- Neuropathic arthropathy (Charcot foot): Joint destruction due to nerve damage, commonly seen in diabetes mellitus
Surgical Technique
The procedure is typically performed under general or spinal anesthesia. The surgeon exposes the talonavicular joint, removes the remaining articular cartilage, and prepares the bone surfaces for optimal contact. The bones are then fixed in a functionally favorable position using metallic implants – most commonly screws, and occasionally plates or staples. To support bone healing, bone graft material (autologous or allograft bone) may be added to the fusion site.
Isolated or Combined Arthrodesis
Talonavicular arthrodesis can be performed as an isolated procedure or in combination with additional joint fusions. In cases of severe hindfoot deformity, it is often performed as part of a triple arthrodesis (talonavicular, calcaneocuboid, and subtalar joints) to provide comprehensive hindfoot stabilization.
Postoperative Care and Rehabilitation
After surgery, the foot must be immobilized for several weeks. The typical rehabilitation process includes:
- Non-weight-bearing on the operated foot for 6–8 weeks using crutches
- Use of a cast or specialized boot for stabilization
- Regular X-ray follow-ups to monitor bone healing
- Physiotherapy to restore strength, balance, and gait
- Full weight-bearing is generally permitted after 10–14 weeks, depending on healing progress
Benefits and Risks
Talonavicular arthrodesis provides significant pain relief and improved stability for most patients. However, because the joint is permanently fused, some natural foot movement is lost. This may occasionally lead to increased stress on adjacent joints over time. Potential risks of the procedure include:
- Failure of bone union (nonunion or pseudarthrosis)
- Wound infection or implant-related complications
- Nerve injury and transient pain
- Risk of deep vein thrombosis
- Residual stiffness in neighboring joint areas
References
- Zwipp H., Rammelt S. (2014): Tarsal Arthrodeses. In: Foot and Ankle Surgery Atlas. Springer Verlag.
- Mosier-La Clair S.M. et al. (2000): Talonavicular arthrodesis for the treatment of posterior tibial tendon dysfunction. Foot & Ankle International, 21(12), 1000–1007.
- O'Malley M.J. et al. (2003): Isolated talonavicular arthrodesis for treatment of rheumatoid arthritis of the talonavicular joint. Foot & Ankle International, 24(1), 19–23.
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