How To Manage Isolated Lateral Column Pain

By Thomas J. Chang, DPM

The lateral column of the foot includes the calcaneus, the cuboid, the fourth and fifth metatarsals as well as the calcaneocuboid (CC), cuboido-metatarsal and intermetatarsal joints. Injuries to the midtarsal joints are relatively uncommon. However, when these injuries do occur, there is a debate on the best way to approach the treatment.1   Traditionally, patients with CC joint arthrosis in combination with midtarsal or subtalar joint pain have undergone a triple arthrodesis. The notion of performing isolated fusions has previously been disregarded since the general belief is the surrounding joints would break down over time. Over the past 20 years, bone block distraction arthrodesis of the CC joint has been popularized for flatfoot reconstruction.    There has been little written in the literature on addressing isolated lateral column pain. In my experience, one can have success with fusion of the calcaneocuboid joint but it is not usually beneficial to fuse the fourth and fifth cuboido-metatarsal joints. Accordingly, let us take a closer look at these clinical scenarios.

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