We recommend fusing (stiffening) of the joints in the back of your foot for two basic reasons:
- 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.
- 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.
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.
If your arthritis in more widespread or we need to realign the foot more, we will also fuse two other joints right in the front of the subtalar joint called the “calcaneocuboid joint” and the “talonavicular joint”. 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”.
Smoking keeps from bones 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 Asprin, you should stop then 5 days before surgery because they can thin your blood.
Subtalar fusion is done as an outpatient. Most triple arthrodesis patients stay one night.
After the Surgery: You will have a large, bulky dressing that comes up to just below the knee. 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 on crutches before having surgery.
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.
3 Months: Most patients can begin weaning out of the boot. Begin by wearing the boot only when you go outside the house for 2 weeks, then not at all. We we will let you know when it’s safe to take each step.
3 ½-6 months: Most patients are back to regular shoes and activities.