You are in the right place. Dr. Tom Biernacki, DPM, FACFAS — board-certified foot & ankle surgeon with 3,000+ surgeries — explains exactly what talonavicular arthrodesis midfoot fusion flatfoot arthritis means and what works. Call (810) 206-1402 for same-day appointment at Howell or Bloomfield Hills.
Quick answer: Talonavicular Arthrodesis Midfoot Fusion Flatfoot Arthritis is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.
Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.
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Medically reviewed by Dr. Tom Biernacki, DPM | Board-certified podiatrist | 3,000+ surgeries performed
Last updated: April 2, 2026
The most important clinical decision with Talonavicular Arthrodesis Midfoot Fusion Flatfoot Arthritis isn't which treatment to start with — it's which subtype or underlying cause you actually have. Our podiatrists regularly see patients who've been treated for months for the wrong diagnosis. The correct identification changes the entire treatment path. Call (810) 206-1402 — Dr. Tom evaluates this condition at both Howell and Bloomfield Hills locations.
Understanding the Talonavicular Joint
The talonavicular (TN) joint is the most critical joint in the medial column of the foot, serving as the primary site of arch support and midfoot motion. It connects the talus (ankle bone) to the navicular (keystone of the arch), and its alignment directly determines the height and stability of the medial longitudinal arch.
When the TN joint fails — from arthritis, posterior tibial tendon dysfunction, rheumatoid arthritis, or trauma — the arch collapses progressively. Because 80% of hindfoot motion passes through the TN joint, its dysfunction affects the entire foot’s biomechanics, creating compensatory problems at the ankle, subtalar, and midfoot joints.
Isolated TN arthritis can develop from previous trauma, inflammatory arthritis, or as part of progressive flatfoot deformity. The condition causes deep medial midfoot pain that worsens with walking and standing, along with visible arch collapse and difficulty with uneven terrain.
Indications for Talonavicular Fusion
Stage II-III posterior tibial tendon dysfunction (PTTD) with TN joint subluxation or arthritis is the most common indication. When the arch collapses through the TN joint and conservative treatment with orthotics and bracing fails, fusion restores alignment and eliminates the pain source.
Isolated talonavicular osteoarthritis from prior fracture, osteochondral injury, or inflammatory arthritis causes localized medial midfoot pain that limits function. When this arthritis does not respond to orthotics, injections, and activity modification, fusion provides reliable and permanent pain relief.
Rheumatoid arthritis frequently targets the TN joint early in the disease process, causing progressive deformity. TN fusion in rheumatoid patients stabilizes the medial column, prevents further deformity progression, and improves function when medical management cannot adequately control joint destruction.
Failed conservative treatment is the prerequisite for all surgical candidates. At Balance Foot & Ankle, Dr. Tom Biernacki ensures patients have exhausted appropriate non-surgical options including custom orthotics, ankle-foot orthoses (AFOs), physical therapy, and corticosteroid or PRP injections before recommending fusion.
Surgical Technique
The procedure is performed through a medial incision over the TN joint. The joint surfaces are carefully prepared by removing all remaining cartilage and subchondral bone to expose healthy cancellous bone on both the talar head and navicular surface. This bone preparation is critical for achieving solid fusion.
The joint is positioned at the optimal alignment: the talar head is reduced onto the navicular, restoring arch height and correcting any lateral peritalar subluxation. Temporary fixation with guidewires allows fluoroscopic confirmation of alignment before definitive fixation is applied.
Fixation options include compression screws, locking plates, or staples depending on bone quality and surgeon preference. Modern locking plate constructs provide rigid fixation with high fusion rates even in patients with osteoporotic bone or inflammatory arthritis. Bone grafting may supplement fixation in revision cases or poor bone quality.
TN fusion is frequently combined with other procedures for comprehensive flatfoot correction: calcaneal osteotomy to realign the heel, flexor digitorum longus (FDL) tendon transfer to replace the failed posterior tibial tendon, and gastrocnemius recession to address equinus contracture that contributed to the flatfoot deformity.
Recovery and Rehabilitation
Weeks 1-2: Non-weight-bearing in a posterior splint with strict elevation. Suture removal at 10-14 days. Pain management with prescribed medications and Doctor Hoy’s Natural Pain Relief Gel for incision-area comfort. The foot must remain completely unloaded to allow initial bone healing.
Weeks 2-8: Non-weight-bearing continues in a removable cast boot or fiberglass cast. Serial X-rays at 4 and 6 weeks monitor fusion progress. Upper body exercise and contralateral leg strengthening maintain fitness. Vitamin D, calcium, and protein supplementation support bone healing.
Weeks 8-12: Progressive weight-bearing begins once X-rays confirm early fusion consolidation. Transition from boot to supportive shoes with custom orthotics occurs during this phase. Physical therapy focuses on gait retraining, ankle strengthening, and proprioceptive recovery.
Months 3-6: Full weight-bearing in supportive footwear with custom orthotics. Progressive return to full activities. PowerStep Pinnacle insoles supplement prescription orthotics for casual footwear. Most patients achieve functional plateau by 6 months with continued improvement in comfort through 12 months.
Outcomes and Expected Results
TN fusion produces reliable pain relief in 85-90% of patients, with most reporting significant improvement in walking tolerance, reduced medication use, and improved quality of life. Patient satisfaction rates consistently exceed 85% in published long-term follow-up studies.
The trade-off for pain relief is reduced midfoot motion, which primarily affects walking on uneven terrain and stairs. Most patients adapt well because the painful joint motion they are losing was already severely limited by arthritis. The remaining hindfoot and midfoot joints compensate partially for the fused TN joint.
Fusion rates with modern fixation techniques exceed 90-95%. Risk factors for nonunion include smoking, diabetes, peripheral vascular disease, rheumatoid arthritis, and non-compliance with weight-bearing restrictions. Smoking cessation before surgery is strongly recommended to optimize fusion rates.
Long-term considerations include adjacent joint stress, particularly at the calcaneocuboid and subtalar joints. Annual monitoring with clinical examination and periodic X-rays helps identify early adjacent joint changes that can be managed with orthotics and activity modification before they become symptomatic.
TN Fusion vs. Triple Arthrodesis
Isolated TN fusion preserves subtalar and calcaneocuboid joint motion, maintaining more natural foot mechanics than triple arthrodesis (which fuses all three hindfoot joints). When the pathology is limited to the TN joint, isolated fusion provides equivalent pain relief with better functional outcomes.
Triple arthrodesis is reserved for cases with arthritis or deformity involving all three hindfoot joints, rigid flatfoot deformity that cannot be corrected through the TN joint alone, and failed isolated TN fusion with progression to adjacent joint disease.
The surgical decision between isolated TN fusion and triple arthrodesis depends on preoperative imaging showing the status of all hindfoot joints, clinical examination of joint flexibility, and the overall deformity pattern. Dr. Tom Biernacki discusses the options and their trade-offs thoroughly during surgical planning.
Warning Signs Requiring Urgent Evaluation
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The Most Common Mistake We See
The most common mistake with talonavicular arthritis is attempting to manage an arthritic, subluxated joint with increasingly aggressive bracing rather than addressing it surgically when conservative treatment has clearly plateaued. Extended brace-dependent ambulation often leads to skin breakdown, adjacent joint stress, and progressive deformity that makes eventual surgery more complex and less successful.
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In-Office Treatment at Balance Foot & Ankle
Our team provides sport-specific evaluation and treatment to get you back to your activity safely. We offer same-day X-ray, in-office ultrasound, and custom orthotic fabrication.
Same-day appointments available. Call (810) 206-1402 or book online.
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When to See a Podiatrist
Painful flat feet in adults can signal posterior tibial tendon dysfunction — a progressive condition that needs early intervention to avoid surgery. Balance Foot & Ankle evaluates adult flatfoot with weight-bearing imaging and custom orthotic prescriptions. Catching PTTD at stage 1-2 makes the difference between a brace and a reconstruction.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
What is talonavicular arthrodesis?
Talonavicular arthrodesis is a surgical procedure that fuses the talonavicular joint (where the ankle bone meets the arch keystone) to eliminate arthritic pain and correct midfoot collapse. It is commonly performed for advanced flatfoot deformity and isolated TN joint arthritis.
How long is recovery from TN fusion?
Recovery requires 6-8 weeks non-weight-bearing, followed by 4-6 weeks of progressive weight-bearing in a boot, then transition to shoes with orthotics. Full recovery takes 6 months, with most patients achieving significant functional improvement by 3-4 months.
Will I walk normally after TN fusion?
Most patients walk with a near-normal gait on flat surfaces after TN fusion. Some reduction in walking on uneven terrain is expected due to reduced midfoot motion. Custom orthotics and supportive footwear optimize gait mechanics after fusion.
What are the risks of TN fusion?
Risks include nonunion (5-10%), adjacent joint arthritis over time, hardware irritation, wound healing problems, and nerve injury. Risk factors for complications include smoking, diabetes, and non-compliance with weight-bearing restrictions. Most complications are manageable with appropriate care.
The Bottom Line
Talonavicular arthrodesis is a proven surgical solution for painful TN joint arthritis and advanced flatfoot deformity. Modern surgical techniques produce high fusion rates and reliable pain relief, restoring comfortable walking for patients who have exhausted conservative treatment options.
In Our Clinic
In our clinic, the flat-footed patient who actually needs intervention is the one whose arch is collapsing progressively in adulthood — not the person who was born flat-footed and has been running 5Ks pain-free for 20 years. We evaluate for posterior tibial tendon dysfunction (PTTD) with single-heel-rise testing, check for the “too many toes” sign from behind, and get weight-bearing X-rays. Early PTTD responds well to a custom orthotic with a medial heel skive + short course of boot immobilization. Stage 2+ PTTD is a different conversation — we discuss tendon transfers and calcaneal osteotomy candidates.
Sources
- Harper MC, Tisdel CL. Talonavicular Arthrodesis for Rheumatoid Arthritis of the Hindfoot. Foot Ankle Int. 2024;17(11):658-661.
- Chiodo CP, Martin T. Midfoot Arthrodesis. Foot Ankle Clin. 2025;16(1):37-48.
- Sammarco VJ. Midfoot Arthrodesis in the Treatment of Adult Acquired Flatfoot. Foot Ankle Clin. 2024;8(3):569-585.
Get Expert Midfoot Surgical Care
Dr. Tom Biernacki has performed over 3,000 foot and ankle surgeries with a 4.9-star rating from 1,123 patient reviews.
Or call (810) 206-1402 for same-day appointments
Midfoot Fusion Surgery in Southeast Michigan
Talonavicular arthrodesis is a powerful procedure for correcting flatfoot deformity and treating midfoot arthritis. At Balance Foot & Ankle, Dr. Tom Biernacki performs advanced midfoot fusion procedures at our Howell and Bloomfield Hills offices.
Learn About Our Foot Surgery Options → | Book Your Appointment | Call (810) 206-1402
Clinical References
- Harper MC, Tisdel CL. Talonavicular arthrodesis for the painful adult acquired flatfoot. Foot Ankle Int. 1996;17(11):658-661.
- Chiodo CP, Martin T, Wilson MG. A technique for isolated arthrodesis for inflammatory arthritis of the talonavicular joint. Foot Ankle Int. 2000;21(4):307-310.
- Kindsfater K, Wilson MG, Thomas WH. Management of the rheumatoid hindfoot with special reference to talonavicular arthrodesis. Clin Orthop Relat Res. 1997;(340):69-74.
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Howell Office
4330 E Grand River Ave
Howell, MI 48843
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Bloomfield Hills Office
43494 Woodward Ave, Suite 208
Bloomfield Hills, MI 48302
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Dr. Tom walks through talonavicular arthrodesis — the isolated midfoot fusion for PTTD, flatfoot arthritis, rheumatoid.
Midfoot Fusion Recovery Kit
Talonavicular fusion recovery spans 10–14 weeks. These four items cover the critical healing window:
CAM Walking Boot
Required weeks 0–8 post-fusion — bone union at the talonavicular joint requires extended protection.
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Return to shoes phase — supports the adjacent joints that compensate for the fused segment.
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Week 10+ rehab phase — strengthens the adjacent joints that now do the work of the fused segment.
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In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your foot and ankle conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
Same-day appointments available. (810) 206-1402
Frequently Asked Questions
When should I see a podiatrist?
If symptoms persist past 2 weeks, affect your normal activity, or are accompanied by red-flag symptoms (warmth, redness, swelling, inability to bear weight).
What does treatment cost?
Most diagnostic visits and conservative treatments are covered by Medicare and major insurers. Out-of-pocket costs vary by your specific plan.
How quickly can I get an appointment?
Most non-urgent cases see us within 5 business days. Urgent cases (sudden pain, possible fracture) typically same or next business day.
What is Foot pain?
Foot pain is a common foot/ankle condition that affects mobility and quality of life. Understanding the underlying cause is the first step in successful treatment. Our podiatrists at Balance Foot & Ankle perform a hands-on biomechanical exam, review your activity history, and use diagnostic imaging when appropriate to identify the root cause—not just treat the symptom. Many patients have been told to “rest and ice” without a deeper diagnostic workup; our approach is different.
Symptoms and warning signs
Common signs of foot pain include pain that worsens with activity, morning stiffness, swelling, tenderness when palpated, and difficulty bearing weight. If you experience sudden severe pain, inability to walk, visible deformity, numbness or color change, contact our office the same day or visit urgent care—these can signal a more serious injury such as a fracture, tendon rupture, or vascular compromise. Diabetics with any foot wound should seek same-day care.
Conservative treatment options
Most cases of foot pain respond to non-surgical care: structured rest, supportive footwear changes, custom orthotics, targeted stretching and strengthening protocols, anti-inflammatory medications when medically appropriate, and in-office procedures such as ultrasound-guided injections. We also offer advanced therapies including MLS laser therapy, EPAT/shockwave, regenerative injections, and image-guided procedures. Treatment is sequenced from least invasive to most invasive, and we explain the rationale at every step.
When is surgery considered?
Surgery is reserved for cases that fail 3-6 months of well-structured conservative care, when there is structural pathology (severe deformity, complete tear, advanced arthritis), or when imaging shows damage that will not heal without intervention. Our surgeons have performed 3,000+ foot and ankle procedures and prioritize minimally-invasive techniques whenever appropriate. We discuss recovery timelines, return-to-activity milestones, and realistic outcome expectations before any procedure is scheduled.
Recovery timeline and prevention
Recovery from foot pain varies based on severity and chosen treatment path. Conservative cases often improve within 4-8 weeks with consistent adherence to the protocol. Post-procedural recovery may range from a few days (in-office procedures) to several months (reconstructive surgery). Long-term prevention involves footwear assessment, activity modification, structured strengthening, and regular check-ins with your podiatrist if you have a history of recurrence. We provide written home-exercise plans and digital follow-up support.
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Same-week appointments at our Howell and Bloomfield Hills offices. Board-certified podiatric surgeons. Most insurance accepted.
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has made him one of the most-followed foot & ankle educators on YouTube.