| THE PROBLEM
We recommend fusing (stiffening) of the joints in the back of your
foot for two basic reasons:
1. You have pain in those joints from arthritis or other problems.
This is often from an old injury, joint diseases like rheumatoid
arthritis, or from a growth defect where the bones do not completely
separate as they are made. Arthritis can also occur in this area
without a known cause. |
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2. The back of your
foot is not in the right alignment to both put the ball of the foot flat
on the floor and keep the heel straight at the same time. Sometimes making
the joints in the back of the foot stiff is the only way to straighten
the foot out and hold it there.
THE SURGERY |
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Often we only need to fuse the joint right under
your ankle called the "subtalar joint" We get at it through
a short incision on the outside of the foot, and we hold the bone
still by putting a screw through the heel.
The screw needs to stay in for at least 6 months. About 15% of
the time, patients have a little tenderness over it and ask us to
take it out as a simple day surgery. |
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If your arthritis is more widespread or we need to realign the foot more,
we will also fuse two other joints right in front of the subtalar joint
called the "calcaneocuboid joint" and the "talonavicular
joint." |
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To do this, we have to add a short incision on the
inside of the foot. We use screws to hold these joints still as
well.
When all three joints are fused, most doctors call the surgery
a "triple arthrodesis." |
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Smoking keeps bones from healing well, especially in the foot. You should
not smoke for at least 3 months. Also, if you take anti-inflammatory drugs
like Advil, Naprosyn, or aspirin you should stop them 5 days before surgery
because they can thin your blood.
AFTER THE SURGERY Subtalar fusion is done as an outpatient. Most triple arthrodesis patients
stay one night
AFTER THE SURGERY: You will have a large bulky dressing in place. Keep
your foot elevated above your heart as much as possible for the first
week. YOU CANNOT WALK ON THE FOOT. Some patients like to practice with
crutches before having surgery. |
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1-3 DAYS: Because the first dressing
is put on tightly, we need to see you in the office within the first
few days to put a new one on. You may then walk in a hard post-op
shoe we will give you.
10-14 DAYS: We will take your stitches out, and you may begin walking
in regular shoes. At this point, you need to work on moving your
toe with your hand to get the motion of the joint back. We have
no objection to supervised physical therapy, but it is not usually
needed.
2 WEEKS: We will take out your stitches and put on a removable
cast boot. You must wear this all the time (even at night) and take
your foot out only to gently wash it.
6 WEEKS: If your X-rays show healing, we will let you slowly start
putting weight on the foot. |
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| 3 MONTHS: Most patients can begin weaning out of the boot. Begin by wearing
the boot only when you go outside the house for two weeks, then not at
all. Triple arthrodesis patients often take a little longer. We will let
you know when it is safe to take each step.
3 ½ - 6 MONTHS: Most patients are back to regular shoes and activities.
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