TRIPLE ARTHRODESIS

Expected Post Operative Course of a Triple Arthrodesis

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 3 joints in the back part of the foot. These joints include the subtalar joint, calcaneo cuboid and talonavicular 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 joints were, a fusion has occurred and the patient can start weight bearing (8 to 12 weeks after surgery)

WHERE:
This surgery is performed in a hospital. Generally the patient is required to be in hospital for 1 to 3 days. A medical practitioner assesses the patient before surgery so they can provide management of the non surgical component of the hospital stay. If needed the patient is seen by the medical practitioner on a daily basis.

ANAETHESIA:
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.

Between 3 and 7 days the cast and dressing are removed and the wounds are checked to see that healing is progressing as expected. A new dressing and fibreglass cast is applied and the patient is able to discharge from the hospital. 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.

The fibreglass cast is removed at 4 to 8 weeks after surgery depending on the case. This allows the patient to get the foot wet as well as to start rehabilitive 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 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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