The medial column carries the majority of body weight through the stance phase of gait. When the first tarsometatarsal joint or the naviculocuneiform joint becomes unstable or arthritic, fusion of the affected segment restores a stable, plantigrade first ray. A dedicated medial column plate gives the construct compression across the joint line and a fixed contour that holds the corrected alignment while the arthrodesis consolidates.
The best-known application is the Lapidus procedure — first tarsometatarsal arthrodesis for hallux valgus with hypermobility of the first ray. The same plate geometry serves medial midfoot fusions in progressive collapsing flatfoot deformity, where the naviculocuneiform segment is included in the correction. Implant selection, joint preparation and screw configuration remain the decision of the operating surgeon.
