The Case for Talonaviculocuneiform Arthrodesis

Early studies argued the case against isolated talonavicular or triple arthrodesisTriple arthrodesis in Müller-Weiss diseaseMüller-Weiss disease, as they did not address disease at the naviculocuneiform (NC) articulations and yielded poor outcomes. Instead, they advocated talonaviculocuneiform (TNC) arthrodesis, fusing the talonavicular joint and NC1, and leaving NC2 and NC3 untouched. Others have followed suit, with some adding a reverse V-shaped plantar closing wedge to correct the flattened medial arch. Bony defects resulting from excision of necrotic bone at the lateral navicular are replaced by autogenous tricortical iliac crest bone grafts (TICBG). Some centers deliberately exacerbate the medial talonavicular subluxation and interpose TICBG’s between the talar head and middle/lateral cuneiforms bone duo, leaving NC1 out of the fusion mass. Most centers would now include all 3 NC joints. The most rational approach would be to reduce the medial talonavicular subluxationTalonavicular subluxation, which is achievable by releasing the medial soft tissues and clearing any obstructions laterally at the 4-corners4-corner release including the cervical ligament and osteophytes at the calcaneocuboid jointCalcaneocuboid joint. Consideration should be given to additional calcaneocuboid joint arthrodesis to decrease stress across the TNC arthrodesis and minimize its risk of nonunion.