Title : MIS Talo Navicular (TN) arthrodesis: Technique and results
Abstract:
Objective: 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.
Indications: 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 multi-level hindfoot reconstruction.
Contraindications: 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.
Surgical Technique: Talonavicular fusion is performed via a minimally invasive, percutaneous approach using cannulated compression screws.
Postoperative Management: Postoperative care included six weeks of mobilization in a below-knee walker with foot contact but without active loading. After radiological assessment at six 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.
Results: 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). Substantial functional improvement was observed across the cohort. The mean 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 tarso-metatarsal 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.
Keywords: Arthritis. Minimally Invasive Surgery. Flatfoot. Hindfoot. Lower ankle joint
