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Objectives and questions: Talonavicular (TN) arthrodesis is a well-established surgical intervention for addressing isolated joint pathology and deformity within the medial column of the foot. While traditional open approaches allow for precise joint preparation and fixation, they are associated with considerable soft tissue morbidity. Minimally invasive (MIS) techniques have emerged as a potential alternative, yet comparative evidence regarding their efficacy and safety remains limited.

Material and methods: Retrospective cohort (2021–2025) of symptomatic TN-joint pathology treated with MIS or open TN arthrodesis. Primary outcomes were radiographic union and maintenance of medial column alignment, assessed by weightbearing tarso-metatarsal angles in dorsoplantar and lateral projections. Secondary outcomes included operative time and early postoperative complications. Group comparisons used nonparametric tests; effects were reported as Cohen’s d where appropriate.

Results: A total of 56 feet (55 patients) were included, with 32 procedures performed using a MIS technique and 24 via an open approach. The mean follow-up was 361 ± 69 days, with a minimum radiographic follow-up of 6 months. Radiographic union was achieved in 55 of 56 feet; the single nonunion occurred in the open group and required revision. Postoperative tarso-metatarsal angles approached physiological values in dorsoplantar and lateral views, without statistically significant intra- or intergroup differences. Operative time did not differ significantly between groups (MIS: 59.2 ± 35.6 minutes vs open: 69.6 ± 35.1 minutes; p = 0.415). Aside from the symptomatic nonunion, no complications such as wound healing disorders, infections, thromboembolic events, or implant-related issues occurred in either group.

Discussion and conclusions: MIS TN arthrodesis achieves radiographic outcomes and early complication rates equivalent to those of the open approach, with a potential advantage regarding perioperative soft tissue management. These findings support the consideration of MIS techniques as a viable and safe alternative to traditional open techniques. Further prospective studies with longer follow-up are needed to confirm these observations.