Expected Post Operative Course of a Mid-Foot Fusion

AIM:
To stabilise and improve the position of the fore foot against the rearfoot. In addition, the aim is to substantially reduce pain in the foot.

HOW:
By fusion of one or more of the joints in the middle of the foot. In most cases this involves surgery on the LisFranc joint, which is made of 5 individual joints. Your surgery will involve fusion of some or all of these joints and sometimes the surrounding joints. The technique of fusion involves the removal of cartilage and firm fixing together by pins, screws and/or plates of two bones. Once bone grows across the space where the joint was, a fusion has occurred and a patient can start weight bearing (6 to 12 weeks after surgery).

WHAT IS THE EFFECT OF THE FUSION?
The purpose of the surgery is to reduce pain and improve function. Although the fusion of the joint(s) will reduce available movement in the mid-foot, in most cases arthritic changes have already occurred in these joints and therefore they have already become stiff. Therefore most patient report that they do not notice much difference in mobility of their foot after surgery compared to before surgery. However they do notice improved comfort.

ADDITIONAL PROCEDURES:
Depending on the patient's condition the Podiatrist may need to perform other procedures in addition to the fusion of the mid-foot. One or more other joints may need to be fused to further stabilise the foot and eliminate pain. Tendons may need to be lengthened, shortened, or transferred to aid in the correction of the patient's foot condition.

WHERE:
This surgery is performed in a hospital. Most times the surgery can be safely and efficiently performed on a same day basis. In certain circumstances an over night stay in hospital is required but your Podiatrist will inform you if this is necessary. It is very important that you follow all the post operative instructions provided to you by the Podiatrist in order to be as comfortable as possible and to aid in obtaining the best result from your surgery. Often a medical practitioner will be involved in providing management of the medical component of the hospital stay.

ANAESTHESIA:
General anaesthesia in combination with local anaesthesia is most often used. Where appropriate a sedation type of anaesthetic in combination with local anaesthetic is used instead of general anaesthetic. Either way, the patient has a numb foot for many hours after surgery.

PAIN RELIEF:
The first form of pain relief used is the application of ice, elevation and a cast (to control swelling). In addition to this a local anaesthetic block keeps the patient's foot numb for many hours after surgery  

POST OPERATIVE COURSE:
For the first 3 days ice and elevation are used to control swelling. At 24 to 48 hours after surgery the patient begins dangling the leg over the side of the bed and with good progression is able to ambulate using a walking frame or crutches.

For the duration of time that the patient is non-weight bearing there is some risk of a vein clot or D.V.T. (Deep Vein Thrombosis) forming in one or both legs. Therefore in some patients medication is used to "thin" the blood. For the time the patient is in hospital a small injection is given under the skin once or twice a day in order to achieve this. After discharge an oral medication is used for this purpose. The medication may be in the form of Aspirin or a stronger medication (Warfarin). Usually a medical practitioner is used to manage this therapy. This therapy is combined with use of a compression stocking on the non-operative leg to prevent the formation of vein clots.

The patient is discharged from hospital the day of surgery or after a 1 night stay.

Usually the cast is left in place for between 6 to 8 weeks. It is very important to the success of the surgery that no weight be placed on the operative foot until the Podiatrist instructs the patient to do so. This is between 6 to 12 weeks after surgery. Your Podiatric Surgeon will instruct you as to when weight bearing should begin. Do not start walking on the operated side until you have been advised to do so, failure to follow this advice will compromise your surgery.

SHOWERING:
This is best performed by sitting on a plastic stool inside the shower with your operated foot on another stool outside the shower. Alternatively, if you can manage it you can sit in the bath with the foot over a plank of wood over the top of the bath. Do not attempt to stand in the shower with a bag over your cast. This method invariably leaks and it is most unsafe as there is a good chance of falling over.

Once the cast has been removed the patient is able to get the foot wet as well as start rehabilitative exercises in preparation for walking. At this time, a below knee compression stocking is utilised to control swelling. This stocking is used for 6 to 12 months after surgery.

A series of post operative Xrays are taken to check that bone healing is occurring. This is usually at 8 weeks,12 weeks and 12 months. A return to walking occurs via a slow and progressive program. A new orthotic device is prepared before the patient starts to walk and is fabricated ready for a return to walking.

A special brace and crutches are used for walking. After 2 weeks the crutches are not usually needed. The brace is then used for a further 2 to 8 weeks. A return to normal footwear occurs with lace ups at about 12 to 16 weeks and all forms of footwear at 4 to 6 months. The foot and ankle appear "different" compared to the other side for 12 to 18 months.


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