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Ankle pain can be excruciating often times making a simple step almost impossible.  What is a Talonavicular fusion?  What are the indications for a Talonavicular fusion?  What are the complications from a Talonavicular fusion?  What does life look like after talonavicular fusion?   Let’s dig in.

Foot Anatomy

The foot is compromised of  26 bones.  The talus bone, the second largest bone in the foot is shaped like the hump of a turtle. The navicular bone is a smaller rectangular shaped bone located immediately in front of the talus.  The talus bone is critical as it absorbs the forces of walking, standing and running and transfers them to the other bones in the foot (1).Running after talonavicular fusion is often impaired, shortened by concentrated pain and tense, overworked and neighboring ligaments.

When two bones come together they form a joint.  Think of the thigh bone and shin bone.  So too with the bones in the foot.  The talus bone connects with both the tibia (shin bone) and the navicular bone and in so doing forms two important joints.

Tibiotalar Joint (The Ankle joint)

Talonavicular Joint

The joint is named after the two bones that come together and form a joint.  For example, the talonavicular joint is formed by the talus and the navicular bone.

What Is a Talonavicular Fusion?

A talonavicular fusion is a surgical procedure where the talus bone and the navicular bone are fused together.  After the foot is cut open, a portion of the joint and cartilage is amputated and removed.   The talus and navicular bones are then bolted together typically with screws and hardware (2).   A talonavicular fusion may also involve packing the joint with bone (3).   The surgery is performed in an operating room with either a general anesthetic or spinal block.

Indications for Talonavicular Fuson

Arthritis

There are two major types of arthritis, rheumatoid and osteoarthritis.   The former is an autoimmune disease where one’s own immune system attacks a given patient’s joints whereas the later is due to wear and tear.  Advanced arthritis of the talonavicular joint can be an indication for fusion (4).

Deformity of the Foot

Clubbing of the foot is the most common deformity of the foot for which talonavicular fusion is performed.

Bone Death

Death of the Talus and or Navicular bone also referred to as necrosis, is a serious condition.  It is one of the listed indications for talonavicular fusion (5).

Tendon injury

The posterior tibial tendon is a critical tendon in the foot that creates and maintains the arch in your foot. Injury or absence of the posterior tibial tendon is an indication for talonavicular fusion (6).

Severe Fracture

Extensive injury to the talus and navicular bones can be treated with talonavicular fusion.

Talonavicular Fusion Complications

Life after a  talonavicular fusion may include one or more complications which include:

Pain

Escalation of pain may be transient or permanent. Pain may also arise from the site of a bone graft

Infection

Infection may involve the skin, bone or both, and require antibiotics.

Not Healing

Despite hardware and bone graft, a fusion may not heal which is referred to as a failed fusion or pseudoarthrosis.  It occurs in 3-5 % of talonavicular fusions (7).

Hardware Fracture

The screws and plates used to fuse the talonavicular joint my break requiring additional surgery.

Nerve Damage

There are multiple nerves in the foot which are susceptible to injury that can result in temporary or permanent damage.

Life After Talonavicular Fusion

All joints in the body are intended to move.  The fusion of a given joint has consequences.  The talonavicular joint absorbs the forces from the body and transfers them into the foot.  The fusion of the talonavicular joint changes this and results in additional forces placed upon the remaining joints in the foot.   Additional stress can prematurely wear out the remaining joints in the foot.  This phenomenon is called adjacent segment disease.  It is very common in patients who have low back fusions,  To learn more about adjacent segment disease please click on the video below.

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New Nonsurgical Treatment Options

At the Centeno-Schultz Clinic, we are experts in ankle pain and dysfunction.  Treatment options include PRP and bone marrow concentrate.  Both are precisely injected by board-certified, fellowship-trained physicians under x-ray or ultrasound guidance, or both.  Ankle sprains with injury to the supporting ligaments can compromise the stability of the ankle joint leading to premature wear and tear and eventual arthritis.  Tendons, ligaments and arthritic ankle joints can be injected with PRP and bone marrow to stimulate your body’s own healing system.

In Conclusion

What can you expect from life after Talonavicular fusion?  Talonavicular fusion is a fusion of the talus and navicular bones.  It is often recommended in those patients who have severe ankle arthritis, deformity, bone death, tendon injury, and severe fractures.  Complications include pain, infection, nerve damage, hardware fracture and failure to heal.  Fusion forever changes the biomechanics of the foot and ankle.  The fusion of the talonavicular joint increases the forces that are placed on the remaining joints in the foot.  This can lead to premature wear and tear and early onset arthritis.  PRP and Bone Marrow concentrate are effective nonsurgical options for ankle injuries that avoid the risks and permanent complications associated with surgery.

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1.Krause M, Rupprecht M, Mumme M, Püschel K, Amling M, Barvencik F. Bone microarchitecture of the talus changes with aging. Clin Orthop Relat Res. 2013;471(11):3663–3671. doi:10.1007/s11999-013-3195-0.

2.Harper MC, Tisdel CL. Talonavicular arthrodesis for the painful adult acquired flatfoot. Foot Ankle Int. 1996;17(11):658-61.DOI: 10.1177/107110079601701102.

3.Barkatali BM, Sundar M. Isolated talonavicular arthrodesis for talonavicular arthritis: a follow-up study. J Foot Ankle Surg. 2014;53(1):8-11.DOI: 10.1053/j.jfas.2013.09.009.

4.Lechler P, Graf S, Köck FX, Schaumburger J, Grifka J, Handel M. Arthrodesis of the talonavicular joint using angle-stable mini-plates: a prospective study. Int Orthop. 2012;36(12):2491–2494. doi:10.1007/s00264-012-1670-y

5. Kitaura Y, Nishimura A, Nakazora S, et al. Spontaneous Osteonecrosis of the Tarsal Navicular: A Report of Two Cases. Case Rep Orthop. 2019;2019:5952435.doi: 10.1155/2019/5952435.

6. Harper MC, Tisdel CL. Talonavicular arthrodesis for the painful adult acquired flatfoot. Foot Ankle Int. 1996;17(11):658-61.DOI: 10.1177/107110079601701102.

7. Kindsfater K, Wilson MG, Thomas WH: Management of the Rheumatoid Hindfoot With Special Reference to Talonavicular Arthrodesis. Clin Orthop. 1997, 340: 69-74. 10.1097/00003086-199707000-00010.

 

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