[Minimally invasive arthrodesis of the talonavicular joint]

The primary objective of minimally invasive talonavicular arthrodesis is to achieve realignment and biomechanical stabilization of the hindfoot through targeted fusion of the talonavicular joint.

This procedure is indicated in cases of idiopathic or posttraumatic talonavicular joint arthritis, with or without associated malalignment. It may also serve as part of a multilevel hindfoot reconstruction.

Contraindications include general medical inoperability and local infection at the surgical site. Relative contraindications may include severe peripheral vascular insufficiency or systemic conditions impairing wound or bone healing.

Talonavicular fusion is performed via a minimally invasive, percutaneous approach using cannulated compression screws.

Postoperative care consisted of 6 weeks of mobilization in a below-knee walker with foot contact but without active loading. After radiological assessment at 6 weeks, a gradual transition to full weight-bearing in a stable shoe with a rigid sole was initiated. Physical therapy supported the restoration of mobility and gait function. Thromboprophylaxis was maintained until full mobilization.

In this retrospective analysis, 31 patients (32 feet) met the inclusion criteria and were evaluated. Of these, 18 underwent isolated talonavicular arthrodesis, 6 received an additional calcaneal osteotomy, and 8 underwent combined talonavicular and subtalar arthrodesis. The mean clinical follow-up was 131 days (± 89.9). Marked functional improvement was observed across the cohort. The mean American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score increased from 54.5 ± 17.4 preoperatively to 90.3 ± 9.6 at final follow-up, a change that was statistically significant (p < 0.0001) and associated with a very large effect size (Cohen's d = 2.71). Stratified analysis revealed that patients with lower baseline scores demonstrated greater relative improvement, while those with higher initial scores still achieved excellent absolute outcomes. Radiographic assessment demonstrated a marked postoperative correction of the tarsometatarsal angle, with the mean dorsoplantar angle improving from -4.6° (± 11.8) to -0.03° (± 1.5; p = 0.072), and the lateral angle from -3.8° (± 11.8) to -0.4° (± 2.4; p = 0.113). Although both changes narrowly missed statistical significance, they reflect a consistent and clinically relevant restoration of medial column alignment. Importantly, no postoperative complications-such as pseudarthrosis, wound healing disturbances, implant-related symptoms, or neurovascular impairment-were observed during the follow-up period, underscoring the procedural safety and reproducibility of the technique.

IV (Retrospective case series).