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mahadevan
consultant foot and ankle surgeon
Hindfoot and Double / triple fusions (Arthrodesis)
What are hindfoot and double / triple fusions ?
​These procedures are done for painful arthritic joints or deformities where conservative treatments such as anti-inflammatory medication, injections and orthotics / splints have been tried without success. The overall aim is to reduce the pain caused by the arthritis and deformity. Damaged arthritic joints are removed with surgical instruments and then fused (arthrodesed). The joints are made completely stiff, but you will still be able to move the joints in the foot; thus maintaining good function. A hind foot fusion includes the ankle and subtalar joints. A triple fusion includes the subtalar (STJ), talonavicular (TNJ) and calcaneocuboid (CCJ) joints; whereas a double fusion preserves the CCJ.
How is it done?
This surgical procedure is typically performed under general anaesthesia and is often accompanied by a nerve block to alleviate pain. Occasionally, a spinal anaesthetic may be recommended. The operation takes approximately 1.5 to 2 hours. Admission is scheduled on the day of the operation, and discharge will be scheduled for the same day, unless an overnight stay is necessary due to individual circumstances.
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Surgery is an open procedure where the damaged joint surfaces are removed and prepared down to bleeding bone and the joint is then held together with metal hardware including nails, screws, staples and plates (see X-rays below). Bone graft may be used to augment healing.
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Your leg will be in plaster or a boot for up to 12 weeks. You will be on crutches with little weight on the operated leg for the initial 6 weeks. After 6 weeks, you may start increasing your weight-bearing through the plaster or boot.
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X-rays before and after a hind foot fusion with a nail for severe deformity.
X-rays before and after a triple fusion with screws and staples for arthritis.
Aftercare and FAQs
It is important to keep the leg elevated as much as possible especially for the first 2 weeks. Your first clinic follow-up is usually 12 to 14 days after surgery.
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Wound care – The plaster should be kept dry. At your first clinic appointment, wound inspection and suture removal will be undertaken.
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Work - If you have a sedentary job you should be able to return to work within 2 weeks (if you can arrange safe transport). If your job is physical, you may need to stay off work until the boot / cast is removed.
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Recovery - Your ankle will continue to improve up to 12 months following surgery. Intermittent swelling and aches are common in the initial phase of recovery.
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Driving - You will not be able to drive for 12 weeks following surgery. However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 weeks following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
Flying after surgery - It is generally recommended to wait at least six weeks to fly. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.
​What are the surgical risks?
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Infection
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Nerve damage – causing numbness and painful scar
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Deep vein thrombosis (DVT) and pulmonary embolism (PE) – blood clots in the vein or lungs – to reduce this risk you would be prescribed heparin injections for a few weeks (unless contraindicated)
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Delayed union or non-union of the fusion - 5 to 8% of operations do not fuse and require further treatment (revision). This means that the bones do not knit together firmly. The risk of non-union is increased if you smoke.
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Residual pain in other joints
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Prolonged recovery
It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.