06/17/2019    Christopher Hood, Jr, DPM

Lateral Column Fusions vs. Arthroplasties of the Metatarsal Cuboid Joints

Coincidentally, I will be lecturing on this topic
at the APMA The National 2019 in Salt Lake City
on July 12th during the “Surgical Blitz” series.
Because of this, I can at least offer a
literature based response.

When you look at the literature with respect to
lateral column perceived arthritis in conjunction
with medial and middle column arthritis and the
treatment options, it tends to lean towards
either no intervention or arthroplasty. It is
common opinion that a fusion should not be
performed either in isolation or in conjunction
with a 1-2-3 TMT fusion.

The reason is as you have stated in wanting to
keep the motion in the lateral column which is
fundamental in foot function, shock absorption
(stress/load accommodation and transfer), and
acting as a “mobile-adapor” segment. Attempted
fusion the lateral column has left authors
stating patients complained of a stiff foot and
has resulted in complications such as lateral
column metatarsalgia, stress fractures, or non-
union to the fusion site. Others have stated in
looking at sub-groups in midfoot fusion
populations with and without lateral column that
no formal difference was found in outcomes. (Mann
RA. JBJSam, 1996. 8816654; Sangeorzan BA. FAI,
1990. 2307374)

Imaging tends to be misleading with studying
noting radiographic evidence of lateral column
arthritis but minimal/no lateral midfoot pain
(Raikin SM. FAI, 2003. 12956562; Sangeorzan BJ.
FAI, 1990. 2307374; Komenda GA. JBJSam, 1996.
8934480) and bone scans frequently showing
lateral column uptake without corresponding
clinical symptoms (Komenda GA. JBJSam, 1996.
8934480; Berlet GC. FAI, 2002. 12043990). Berlet
et al has stated that patients should not be
considered for any lateral column procedure
unless there is significant pain relief with a
differential, intra-articular joint injection
that is performed under fluoroscopy to confirm
needle placement (Berlet GC. FAI, 2002. 12043990)

Most authors that have published on this (which
is minimal) and the chapters in both McGlamry’s
and Mann’s offer arthroplasty techniques. This
includes the below brief examples with citations
for your reading preference on the specific
surgical technique and patient outcomes [NOTE:
All citations are formatted as (Author. Journal,
Year. PubMed ID#)]:

• Berlet, et al. – use of a peroneus tertius or
EDL-4th tendon anchovy roll placed in a resected
joint space, isolated per joint. (Berlet GC. FAI,
2006. 12043990)
• Shawen, et al. – use of a ceramic spherical
implant in the resected lateral column space,
isolated per joint. These implants are FDA-
approved for hand (carpometacarpal joint) and
foot (4-5/TMTJ). (Shawen SB. FAI, 2007. 17697654)
• Chang, et al, – similar technique as Shawen, et
al with use of ceramic spherical implant,
isolated per joint. (Chang TM. McGlamry 4th. Ch
82 - Lateral column arthroplasty)
• Koenis, et al, – 4th and 5th metatarsal base
wedge resection with plantar apex and dorsal
base, isolated per joint (different wedge
technique for 4th and 5th-cuboid articulation).
(Koenis MJJ. FAS, 2015. 25682411)
• Hood, et al. – 4th and 5th metatarsal base and
cuboid resection with placement of fascia lata
graft as biological spacer. (Hood CR. Techniques
in Foot and Ankle Surgery, 2017. Not PubMed
Indexed)

Christopher Hood, Jr, DPM, Nashville, TN

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