Plantar and Calcaneocuboid Joint Pressure after Isolated Medial Column Fusion versus Medial and Lateral Column Fusion: A Biomechanical Study

Abstract

We compared forefoot and calcaneocuboid pressure in isolated medial column fusion (1-3 tarsometatarsal fusion) versus medial and lateral column fusion (1-5 tarsometatarsal fusion) in a neutral, inversion, and eversion loading model in stance gait phase. Twelve fresh-frozen cadaveric specimens were cyclically loaded to 720 N at 0.5 Hz for 30 cycles. Plantar and calcaneocuboid joint pressures were measured in neutral, inversion, and eversion in the intact foot, with isolated medial column fusion, and with medial and lateral column fusion. Lateral pressure was higher in the medial and lateral column fusion group than isolated medial column fusion and intact in neutral (55.8 +/- 14.8 versus 46.2 +/- 13.6 and 45.5 +/- 14.8 kPa, respectively) and eversion (80.7 +/- 18.4 versus 61.8 +/- 13.7 and 60.2 +/- 18.2 kPa, respectively) (p < or = 0.001). Calcaneocuboid pressure was higher in medial and lateral column fusion than isolated medial column fusion and intact in neutral (1436.7 +/- 210.6 versus 1073.7 +/- 282.5 and 1084.9 +/- 337.6, respectively; p = 0.001) and inversion (1518.3 +/- 270.5 versus 1310.5 +/- 298.8 and 1237.1 +/- 401.9, respectively; p = 0.02). Using combined position data, calcaneocuboid pressure was significantly higher in the medial and lateral column group than in both other groups. The isolated medial column fusion group did not differ significantly from the intact group in any measurement. Medial and lateral column fusion significantly increased lateral and calcaneocuboid pressures with loading compared with isolated medial column fusion and the intact state. No difference was observed between isolated medial column fusion and the intact state. It may be advisable to avoid fusing the lateral column in tarsometatarsal arthrodesis if possible to avoid pressure increase in the forefoot and hindfoot.