Arthrodesis using a distraction technique for isolated talonavicular joint arthritis

Distracted talonavicular joint

Abstract

Isolated talonavicular (TN) joint arthritis is uncommon because the TN joint is typically affected together with other midfoot articulations. As a multiaxial component of the medial column, the TN joint plays a key role in stability during gait. TN arthrodesis is indicated in conditions such as post-traumatic arthritis, rheumatoid arthritis, posterior tibial tendon insufficiency, and structural foot deformities, with generally favorable clinical outcomes. We report a 52-year-old woman with rheumatoid arthritis who presented with severe dorsal right foot pain, most pronounced during the mid-stance phase of gait. Clinical and radiographic evaluation demonstrated isolated TN arthritis without subtalar or talocalcaneal involvement. Arthrodesis was performed using a distraction technique with a monolateral external fixator to maintain a neutral midfoot position and help prevent collapse of the medial arch. The patient experienced progressive pain relief and functional improvement during follow-up, with substantial reduction in pain and restoration of independent ambulation. This case suggests that external fixation with distraction may represent a useful alternative technique for isolated TN arthrodesis and warrants evaluation in larger series.