Triple Arthrodesis
Surgery
Triple arthrodesis is the procedure where the three joints in the back of the foot, below the ankle, are fused. Surgery to get different bones to grow together is called Arthrodesis, or Fusion. The talus, calcaneus, navicular and cuboid bones are all made to grow together into one bone mass. This is the common surgical technique used to treat hindfoot arthritis. It can also be used for treating hindfoot deformities, instability problems, and the residuals of posterior tibial tendon problems.This surgery requires hospitalization for at least one night, and often two. You will require a General anesthetic or Spinal anesthetic.
During the surgery two incisions will be made about the inside and outside of the hindfoot.
The bone ends are prepared by removing any remaining cartilage, and the bones put together and held with some combination of screws and bone staples.
A Bone Graft is often used to fill any gaps in the bones, and improve the chances of solid fusion. This is routinely taken from the iliac crest, above the hip. That will be taken from the same side as the foot.
Day of Surgery
At the end of the surgical procedure the wounds are covered and a Short Leg Plaster Splint is applied. That dressing gives support to the foot, holding it securely. That should be left in place until I change it at the first post-operative office visit.
You will be given crutches or a walker at the hospital, and I want you to not put any weight on that leg for 6 weeks. In the hospital a physical therapist will instruct you in using the crutches or walker. Do not walk on the splint.
You must remain Non-Weightbearing on the surgery side for 6 Weeks.
When your pain is under control, and you can safely get around without putting weight on the ankle, you may go home.
Look here for things to watch after Inpatient Surgery.
Post-operative Course
The first post-operative visit is usually 7 – 10 days after surgery. At that time I will remove the splint and dressings, wash your foot, and generally take out the skin Staples or Stitches.
I will then put your leg into a Short Leg Cast. This is not a walking cast, so you will still need to use the crutches or walker. You will wear this until 6 weeks after the surgery. Do not walk on the cast.
The second post-operative visit is usually at the 6 week point. At that time I will remove the cast, and check to make sure that everything is healing satisfactorily. I will then have you go into a CAM Walker, and you will wear that for Protected Weightbearing for an additional 6 weeks. You must wear it when you do any walking.
I will ask to see you next after an additional 6 weeks, the 3 months point after surgery. I will have you get an Xray then to make sure that the arthrodesis is healing satisfactorily, and there are no problems with the metal implants. I will allow you to go into a regular shoe then.
Most people “wean” off the CAM Walker and back into a regular shoe. This takes a variable amount of time, and depends on how comfortable the regular shoe feels. It may take a few days, or up to a month.
Most patients have swelling about the surgical area that lasts for about 4 months after surgery. It generally takes 9 – 12 months for complete healing to occur.
Final Results
The goal of the surgery is to leave you with a painless foot that will allow normal walking. How successful that will be is variable. It is usually possible to make the foot pain-free for daily activities. Most patients will have some degree of soreness that is hopefully mild. Most patients will notice discomfort when the weather changes.
Loss of hindfoot motion will put a restriction on the types of shoes you can wear. Generally a flat shoe will be okay. You will probably not be able to wear a heel over 1 inch.
Loss of hindfoot motion will make walking on any surface that is irregular difficult. That would include gravel, sand, or on a trail. You may have trouble walking well along an incline. You should be able to walk on flat surfaces fine.
It usually takes one year for maximum improvement to occur.
Complications
Complications can occur with any surgery. Go here for a general discussion of Surgical Complications.
Specific risks of this surgery include the possibility of the bone not healing, or non-union, and implant problems. It would be rare for triple arthrodesis to cause problems in the ankle joint in the future. You may develop arthritis further down in the foot over the ensuing years.