Management of 4th and 5th tarsometatarsal joint osteoarthritis

NewsBot · Jul 13, 2013

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Review of the evidence: Surgical management of 4th and 5th tarsometatarsal joint osteoarthritis
David F. Russell, Rupert D. Ferdinand
Foot and Ankle Surgery; Article in Press

Osteoarthritis of the lateral tarsometatarsal joints is less common than that which is seen in the 1st–3rd tarsometatarsal joints. Despite a suspected increase in incidence of tarsometatarsal arthritis and consequently the burden of disability and economic impact, guidelines for treatment and decision making remain scarce. When conservative treatment fails, lateral column osteoarthritis can severely limit a patient's mobility, lifestyle, and present a difficult management problem for the foot and ankle specialist. Evidence for the surgical techniques used in treatment of lateral column osteoarthritis is limited and sporadic within the literature. This article aims to summarise and compare the evidence for these surgical management options.

This article looks at aetiology and epidemiology, with a summary of the biomechanics of the region and a comprehensive review of the literature regarding surgical treatment options.
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NewsBot · Oct 3, 2018

First Tarsometatarsal Joint Shape and Orientation: Can We Trust in Our Radiographic Findings?
Cesar de Cesar Netto, MD, PhD, Jackson Staggers, BS, Walter Smith, BS, Sung Lee, BS, Sierra Phillips, MD, Martim
Pinto, MD, Alexandre Godoy Dos Santos, MD, Lauren Roberts, MD, Bahman Sahranavard, MD, Ashish Shah, MD
AOFAS Annual Meeting 2018 1

Introduction/Purpose: Studies have demonstrated that patients with hallux valgus (HV) deformities have increased mobility in
the first tarsometatarsal (TMT) joint. Anatomical factors widely considered to play a role in the instability are shape and frontal
plane orientation of the joint. An oblique rather than horizontal orientation of the articular surfaces and a round shape, rather
than a flat shape, are believed to predispose to the deformity. The purpose of this study was to assess whether the shape and
angulation of the first TMT joint are affected by the positioning of the foot and orientation of the x-ray beam.
Methods: Ten adult above knee fresh frozen cadaveric specimens were used, with a mean age of 79.9 (range, 54-88) years. There
were no clinical forefoot deformities noted in any of the feet. One of the specimens had moderate ankle arthritis and one had a
mild cavus-varus. A radiolucent loading apparatus was built that, allowing neutral positioning of a plantigrade foot and controlled
angulation of 5o, 10 o, 15o and 20o in dorsiflexion, plantarflexion, inversion and eversion. Fluoroscopic images were obtained of
each cadaveric specimen in all seventeen different positions, with the x-ray beam perpendicular to the floor and aiming to the base
of the 1st metatarsal. Two blinded orthopaedic surgeons independently measured the 1st tarsometatarsal (TMT) joint angle and
graded the distal articular cartilage of the medial cuneiform as flat or curved. Readers also graded the image quality into assessing
the joint into “Low”, “Intermediate” and “Good”.
Results: 1st TMT joint angle was 112.92o ± 6.89o. Values were significantly different between cadaveric specimens (p<.0001).
There was a tendency for increased valgus angulation of the joint in images positioned in neutral, plantarflexion and inversion and
decreased valgus angulation with dorsiflexion and eversion.Regarding the shape of the distal articular cartilage of the medial
cuneiform, joints with flat configuration showed significantly increased mean 1st TMT joint angle when compared to curved
surfaces (115.9o vs. 110.7o, p<.0001). In 8 out of 10 of the cadaveric specimens (80%) the shape of the 1st TMT joint changed
between curved or flat configuration depending on the positioning of the foot. In only 2/10 (20%) the joint configuration remained
the same for all different positions (one flat and one curved).
Conclusion: Our cadaveric study found that the shape and angulation of the first TMT joint is affected by the positioning of the
foot and orientation of the x-ray beam. Clinical usefulness of the 1st TMT radiographic anatomical characteristics is limited and
should not influence in the treatment of patients with possible instability the first tarsometatarsal (TMT) joint.
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