Under general anesthesia, and following preparation for aseptic surgery, a 20-gauge hypodermic needle is inserted in the proximal intertarsal joint. This needle will mark the placement of the proximal edge of the T-plate to be used for the arthrodesis. (See arrow Figure 2.)

The proximal edge of the plate is placed against the needle, and two screws are placed in the central tarsal bone. One screw is placed in the distal intertarsal bone, the next screw is placed eccentrically through the oblong hole into the metatarsus, and the remaining screws are placed in a centered position. (See Figure 3). The apparent space under the plate proximally is actually filled with less-ossified periosteal new bone. Bending of the screw in the third tarsal bone is probably the result of the eccentric placement of the fourth screw.