What is it?
The goal of this type of surgery is to fuse or glue together (arthrodesis) some of the small joints in the middle of the foot.
Indications for the surgery may be as a result of degenerative disease that has arthritis or as a result of trauma which is not amenable to reconstruction.
This type of surgery does not affect the up and down movement of the foot at all.
The side to side movement (inversion and eversion) of the middle of the foot is affected in a very minor way, but is difficult to feel this deficit is usually these patients have pain and stiffness to start with.
Screws with or without a small plate are inserted into the bones to hold the joints together while the fusion occurs.
Frequently we will use small amounts of bone graft which are taken from the bone bank to stimulate the bone healing.
Once the joint is fused the screws are not necessary, but are rarely removed unless hardware irritation occurs to the surrounding soft tissues or with shoe wear.
General Recovery Facts
- You will not be walking on the leg for about 6 weeks.
- In order to stay off your foot, you will need to use crutches, a walker, a wheelchair or a knee scooter type device called a roll-about.
- There will be a hard plaster bandage applied to the leg for two weeks after surgery.
- Your first follow up visit will be at approximately 2 weeks to inspect the cast or the wound wound if swelling was a concern initially at which point a cast will then be applied.
- You will usually have a removable Moon boot applied for you to wear once the cast is removed at 6-8 weeks.
- You may drive as soon as comfortable once the cast feels loose and no swelling with limb dependency is experienced, if surgery to the right foot you should be able to drive an automatic vehicle at 4 weeks. If on the left foot, you may drive between 6 and 8 weeks.
- You may begin to walk full weight-bearing with the Moon boot at about 6-8 weeks, depending upon your level of discomfort and the instructions given to you.
- Physical therapy for 1-2 months is helpful to regain the strength and movement.
- There will be moderate swelling of the foot, ankle and leg for about 9 months.
- You will be prescribed oral vitamin D 50,000 international units by mouth weekly until fusion is apparent on x-ray or CT scan.
Specific post-operative recovery
- Foot wrapped in bulky bandage/bandage with a half cast or a full circular cast.
- Ice, elevate, take pain and DVT prophylaxis medication as prescribed.
- Expect numbness in foot 12-24 hours then pain.
- Blood drainage through bandage is expected, do not panic unless continuous bleeding occurs.
- Do not change bandage under any circumstances, contact my rooms before any such thoughts cross your mind.
- First follow-up in the office, X-rays taken if any incidents have occurred (falls, pain out of proportion, sepsis).
- Wound inspection with dressing Sister if a half cast was applied at which point a full cast will be applied for a further 4-6 weeks.
- Most of the time absorbable sutures using these do not need to be removed and will dissolve with time.
- Wound therapy commences with micropore and Bactroban dressings for the next 4-6 weeks.
- May touch weight-bear on cast with crutches and post operative shoe once cast feels loose and not before.
- Overall limb is to be kept elevated more often than not on some pillows when awake and patient is to elevate the foot of the bed with 2 bricks or thick books while sleeping as the foot tends to fall off pillows when tossing and turning.
- This elevation protocol is to be continued throughout the recovery process until swelling is no longer an issue.
- CT scan taken to assess for early fusion and possible removal of cast.
- Cast is removed and converted to a Moon boot.
- Use the boot for about 4-6 more weeks.
- Full weight bearing is allowed to pain and swelling without crutches.
- The boot can be removed at night, and for gentle movement exercises, however for weight-bearing moon boot must be used.
- Swimming is permitted, but with limited pressure on the foot.
- Physiotherapy commences at this point as this is helpful in decreasing the swelling of the foot and improving range of motion for the next 1-2 months.
- Expect swelling in the foot for about 6 to 9 months.
- Third followup in rooms at 12 weeks with weight-bearing control x-ray.
- Moon boot is discontinued.
- Light nonimpact exercise may commence to pain and swelling.
- Continued range of motion exercises.
- Weight-bearing x-ray taken.
- Start normal exercise program, biokinetics therapy is useful at this stage and encouraged.
- Computer gait analysis may be necessary at this stage and orthotic arch support may be necessary and will be referred to my orthotist to have a custom-made orthotic for your foot and not an off-the-shelf product.
- You should wear a stiff soled shoe for one to two months.
- Six-month followup in consultation with weight-bearing control x-ray.
- Pictures taken for comparison to preoperative state.
- Functional outcome score taken.
- Return to normal function both for activities of daily living and exercise wise is expected at this stage.
- Residual swelling of the limb can be expected for up to 9 months post operatively.
- 1 year followup in consultation rooms with weight-bearing control x-ray.
- Pictures and video taken for comparison to preoperative state.
- Functional outcome score taken.