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mahadevan
consultant foot and ankle surgeon
When is this procedure recommended?
This type of surgery is undertaken when there is painful arthritis in the tarso-metatarsal joint(s) which are in the middle of your foot. The operation involves removal of cartilage from either side of the arthritic joint, the ends of these bones are held together by a metal plates and screws while the bone fuses. The benefit of this operation is reduced pain and improved comfort during walking. The main disadvantage is the long period of time it takes for the bone to fuse.
What does surgery involve?
The procedure is routinely performed under general anaesthetic and frequently combined with an anaesthetic block for pain relief. You will usually stay in hospital for a night following surgery.
The affected joint is accessed via an incision on the top of your foot. The damaged cartilage is then removed and the bones held together with a metal plates and screws (see X-rays below) while the bone knits together (fuses). Occasionally, a piece of bone will need to be inserted into the gap formed by removing the joint. This piece of bone will be taken from the heel and requires another incision around the heel.
After surgery you will be placed into a below-knee plaster cast. You will be protected in plaster or boot for up to 9 weeks. You will need to be non-weight bearing for the first 6 weeks and then fully weight bearing in a boot for another 2 to 3 weeks.
Aftercare and FAQs
Your first clinic follow-up is usually 12 to 14 days after surgery. It is important to keep the leg elevated as much as possible especially for the first 2 weeks. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home.
Wound care – The backslab should be kept dry. At your first clinic appointment, wound inspection and suture removal would be undertaken.
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.
Recovery - Your foot will continue to improve up to 12 months following surgery. Intermittent swelling and aches are common in the initial phase of recovery.
Driving - You will not be able to drive for 9 to 10 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.