TALONAVICULAR FUSION

Expected Post Operative Course of a Talonavicular Fusion

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

HOW:
By fusion of a major joint in the middle of the foot, called the talonavicular joint. 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 (8 to 12 weeks after surgery).

ADDITIONAL PROCEDURES:
Depending on the patient's condition the Podiatrist may need to perform other procedures in addition to the fusion of the talonavicular joint. 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. Generally the patient is required to be in hospital for 1 to 2 days. Often a medical practitioner will provide management of the non surgical component of the hospital stay. The patient is seen by the medical practitioner on a daily basis if necessary.

ANAESTHESIA:
General anaesthesia in combination with local anaesthesia is most often used. Where appropriate a sedation type of anaesthetic in combination with spinal or epidural block 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 soft compression 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. Physiotherapy is begun at this time. Often a drain has been applied to the wound to remove fluid from the surgical site. This is removed at this time.

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 for some patients a 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 between 1 to 2 days after surgery

Between 3 and 7 days the cast and dressing are removed and the wound is checked to see that healing is progressing as expected. A new dressing is applied and the fibreglass cast is bi-valved and made into a removable splint. 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 8 to 12 weeks after surgery.

At 3 weeks after surgery 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 4 weeks, 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 4 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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