Allograft Bone-Block Plantarflexion First Tarsometatarsal Arthrodesis: Short-term Outcomes

Nacime Salomao Barbachan Mansur; Aly Fayed; Rogerio Chinelati; Eli Schmidt; Matthieu Lalevee; Cesar de Cesar Netto

doi:10.1177/10711007251363926

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Allograft Bone-Block Plantarflexion First Tarsometatarsal Arthrodesis: Short-term Outcomes

Journal article

Peer reviewed

Allograft Bone-Block Plantarflexion First Tarsometatarsal Arthrodesis: Short-term Outcomes

Nacime Salomao Barbachan Mansur, Aly Fayed, Rogerio Chinelati, Eli Schmidt, Matthieu Lalevee and Cesar de Cesar Netto

Foot & ankle international, Vol.46(11), pp.1248-1258

11/2025

DOI: 10.1177/10711007251363926

PMID: 40938130

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Abstract

Patients with progressive collapsing foot deformity (PCFD), hallux valgus (HV), and midfoot arthritis (MA) could benefit from a bone-block tarsometatarsal (TMT) arthrodesis. The allograft wedge, producing distraction and plantarflexion, provides a stable medial column while correcting the deformity, but with increased risk of pseudoarthrosis. The objective of this study was to report the clinical nonunion and results of the bone-block first-TMT arthrodesis in collapsed feet. In this short-term prospective cohort (mean follow-up 17 months) we evaluated patients with PCFD, HV, and MA who underwent allograft bone-block first-TMT fusion between August 2020 and November 2022. Patients were kept nonweightbearing for 6 weeks and followed, having a WBCT at 3 months and subsequent follow-ups. Bone healing was determined by at least 50% of bone trabeculae crossing both graft interfaces. Complications were documented. Forefoot arch angle (FAA), Meary angle, talonavicular coverage angle (TNCA), middle facet subluxation (MFS), and foot and ankle offset (FAO) were obtained, as well as PROs. Sixty-four patients (67 feet) were included, mean age 54.0 (18-77), body mass index 31.6 (29.6-33.6), 17.3 months (6-33) follow-up. Median allograft size was 8 mm (5-19 mm). Clinical nonunion rate was 11.9%, minor complications 2.9%, and major complications 5.9%. Tomographic healing at 3 months occurred in 86.4% and 66.7% at the most recent WBCT (mean: 10.1 months; 6-29). Improvement ( < .001) in FAA of 6.9 degrees (5.8-7.9), MFS of 22.6% (19.8-25.4), TNCA of 13.5 (12.1-14.3), Meary angle of 8.1 degrees (6.7-9.5), and FAO of 3.8% (3.1-4.6) were found. PROs improved for VAS, PROMIS-PH, PROMIS-PI, Pain Catastrophic Scale, and EFAS ( < .001). Although the first-TMT bone-block arthrodesis restored many markers associated with foot collapse and alignment, the clinical nonunion rate was 11.9%, which is in the top range of the literature for TMT fusions. The use of allograft wedges can explain our findings. Tomographic healing, initially 86.4% at 3 months, decreased to 66.7% at the most recent follow-up.

Fusion

arthrodesis

PCFD

complications

bone-block

Lapicotton

hallux valgus

arch

collapse

midfoot arthritis

Details

Title: Subtitle: Allograft Bone-Block Plantarflexion First Tarsometatarsal Arthrodesis: Short-term Outcomes
Creators: Nacime Salomao Barbachan Mansur - MedStar Union Memorial Hospital
Aly Fayed - University of Iowa
Rogerio Chinelati - University of Kentucky
Eli Schmidt - University of Iowa
Matthieu Lalevee - Université de Rouen Normandie
Cesar de Cesar Netto - University of Iowa
Resource Type: Journal article
Publication Details: Foot & ankle international, Vol.46(11), pp.1248-1258
DOI: 10.1177/10711007251363926
PMID: 40938130
NLM abbreviation: Foot Ankle Int
ISSN: 1944-7876
eISSN: 1944-7876
Publisher: Sage; THOUSAND OAKS
Language: English
Electronic publication date: 09/12/2025
Date published: 11/2025
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984961104502771

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