Allograft Bone-Block Plantarflexion First Tarsometatarsal Arthrodesis: Short-term Outcomes

Area of Science:

• Orthopedic surgery
• Foot and ankle reconstruction
• Bone healing and fusion

Background:

• Progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA) present complex challenges.
• Bone-block tarsometatarsal (TMT) arthrodesis using allograft wedges offers deformity correction but carries a risk of pseudoarthrosis.

Purpose of the Study:

• To report the clinical nonunion rate and outcomes of first-TMT arthrodesis with bone-allograft wedges in patients with collapsed feet.

Main Methods:

• A prospective cohort study evaluated 64 patients (67 feet) undergoing first-TMT fusion with allograft bone-blocks.
• Follow-up included weight-bearing computed tomography (WBCT) at 3 months to assess bone healing, alongside radiographic measurements and patient-reported outcomes (PROs).

Main Results:

• The clinical nonunion rate was 11.9%, with minor and major complication rates of 2.9% and 5.9%, respectively.
• Tomographic healing was observed in 86.4% at 3 months, decreasing to 66.7% at later follow-ups.
• Significant improvements were noted in forefoot arch angle, Meary angle, talonavicular coverage angle, middle facet subluxation, foot and ankle offset, and various PROs (P < .001).

Conclusions:

• First-TMT bone-block arthrodesis effectively restored foot alignment and improved patient outcomes.
• The 11.9% clinical nonunion rate is comparable to the higher end reported for TMT fusions, potentially linked to the use of allograft wedges.
• A decrease in tomographic healing rates over time suggests ongoing challenges with complete fusion.