Including ankle, subtalar joint, midfoot, triple arthrodesis, and 1st toe fusion
The following is a general guideline. Keep in mind that post-op care may vary.
Arthrodesis or fusion of joints in the foot ankle ankle is a procedure that is intended to decrease pain coming from arthritic joints (loss of cartilage and joint space) or to correct a deformity of the foot or ankle. Patients with arthritis frequently have a history of trauma, such as a foot or ankle fracture, or even multiple ankle sprains. Deformities of the foot and ankle may also come from trauma, as well as from torn tendons or ligaments. The pain may also result from rheumatoid arthritis and occasionally primary (genetic predisposition) osteoarthritis. All of these conditions cause decreased or abnormal motion of the affected joints. However, there is enough motion in the joint to cause pain with walking and other activities. Unfortunately, there is no way of maintaining the motion and eliminating pain (there is no cure for arthritis), which is why we fuse or attach the bones together. The bones are held in position with screws and/or metal plates. By eliminating (fusing) the joint, we eliminate most if not all of the pain in the joint.
Non-operative treatments for foot and ankle arthritis may include wearing a stiff-soled shoe or orthotics, steroid injections, or wearing a rigid or supportive brace. While these therapies do not fix the problem, they can reduce pain and “buy time” if you are not ready for an operation. Fusing the joint significantly decreases or eliminates pain.
Preparing for the surgery
When your surgery is scheduled, you will be given a pre-surgery packet including information on location of the surgery. Most of the time, this operation is performed at an outpatient surgery center. Patients over the age of 50 and those with certain health conditions will require blood work-up and EKG. Blood thinners should be discontinued prior to the surgery. This includes Coumadin, Plavix, aspirin, anti-inflammatory medicines (ibuprofen, naproxen, Aleve, Motrin, diclofenac, etc.), glucosamine, and herbs that may cause thinning of the blood. If you have questions about discontinuing certain medicines, please contact the office at least two weeks prior to your surgery. If you are on prescribed medicines such as Coumadin or Plavix, meet with your primary care doctor prior to discontinuation. Should you have questions about any particular medicine you are on, please address far in advance. It is also very helpful to schedule a pre-operative appointment about a week prior to your surgery to discuss the surgical procedure in detail and review any final questions you may have.
Length of Procedure
These procedures typically take 1 1/2 to 2 hours. You are required to be at the surgery center 1 hour before the scheduled start of the procedure, and will need to stay in recovery room for approximately 1 hour after surgery.
You will undergo general anesthesia for this procedure and you will also receive a regional block. This is a process in which the anesthiologist injects numbing medicine into a nerve in the back of your knee, providing pain relief for the first 12-24 hours after the surgery. You will have an opportunity to speak with the anesthesiologist about the general anesthesia and block prior to your surgery.
You will be provided with a prescription for pain medicine at the time of surgery or at your pre-operative evaluation. If you would like your prescription before the surgery, contact the office two weeks prior to your scheduled procedure. These types of stronger (narcotic) pain medicines cannot be called into your pharmacy. Most patients are able to wean off of the pain medicine within 2-3 weeks of the surgery and transition to over-the-counter (OTC) analgesics (anti-inflammatory medicines or Tylenol). Most of the pain medicine we prescribe contains Tylenol (acetaminophen or APAP). Therefore, Tylenol should not be taken in combination with the pain medicine. It is recommended that you do not exceed 2 grams of Tylenol/day. The pain medicine we typically prescribe contains either 325 mg or 500 mg of Tylenol (APAP). Some common side effects of narcotics include itching, nausea and constipation. Should you experience these side effects, there are medicines that can be prescribed to counteract them. Because constipation is so common, consider starting an over-the-counter stool softener such as Colace when you begin taking the pain medications. Also, maintain a high fiber diet (25g/day for women and 35g/day for men) and stay well hydrated.
What to expect during the first two weeks
After the surgery, you will be placed in a non weight-bearing (NWB) plaster splint. You will be given crutches at the surgery center. If it is difficult for you to use crutches, you may want to obtain a knee scooter or roll-about at a local medical supply store. Most insurance companies do not cover the cost of a knee scooter, though a prescription is often required. Please contact the office at least two weeks in advance if you would like a prescription for a scooter. It is recommended that you keep your leg elevated above the level of your heart most of the time for the first 72 hours after your surgery. This will decrease both swelling and pain. Keep dressings dry at all times. For showering, consider covering the splint in a garbage bag, duct taping the edges. You may also obtain a cast-cover, available in the office and at most drugstores. They cost around $30 and are reusable. Do not attempt to remove the splint at any time.
What to expect at your first post-operative appointment:
10-14 days after your surgery
This appointment may be scheduled prior to your surgery. The post-operative splint will be removed and the incision will be evaluated at that time. If the wound has healed properly, sutures will be removed. X-rays of your foot or ankle will be obtained to evaluate the position of the bones. You will then be placed in a non-weight bearing fiberglass cast. This cast will be worn for approximately 4 weeks. It is essential that you stay off of your operative leg during this time.
What to expect at your second post-operative appointment:
6-7 weeks after your surgery
Your second post-op appointment will take place four weeks after your 1st post-op appointment. During this appointment, the fiberglass cast will be removed. X-rays will be obtained to assess for healing at the fusion site. You will then be fitted with a removable walking cast (CAM walker). If there is adequate healing at the fusion site, you will be allowed to weight-bear as tolerated (WBAT) in the CAM walker between 6-8 weeks following the surgery. Consider partial weight-bearing (starting out placing about 50% of your weight on the operative leg), increasing to full weight-bearing (not using crutches) over the course of a few days. It is recommended that you wear the CAM walker at all times, including nighttime.
When wearing the CAM walker, consider obtaining a shoe that is of equivalent height for the opposite foot. This will decrease the likelihood of developing back pain caused by shoe height discrepancy. If you do not have a shoe of similar height, you may want to obtain an attachment for your shoe. This may be found out www.evenupcorp.com
What to expect at your third post-operative appointment:
11-12 weeks after your surgery
During this appointment, the CAM walker will be removed and additional x-rays will be obtained. If the x-ray shows that the fusion site has completely healed, you may “wean-out” of the CAM walker over the course of a couple of days. You may resume physical activity such as stationary bicycle and swimming. If you are comfortable on the stationary bicycle after a couple of weeks, you may transition to the elliptical machine (available at most gyms). You may also gradually introduce walking longer distances.
Further follow-up appointments may be required and will be determined on a case by case basis.
Common post-operative findings:
- Elevated temperature: It is common to experience a low-grade fever for up to 3 days following surgery. If you think you may have a fever, take you temperature with an accurate thermometer. If it is remains elevated above 101° F for more than 12 hours, or you if are still experiencing a temperature above 100° F more than 3 days following surgery, contact the office. You may take anti-inflammatory medications for the elevated temperature.
- Pain: For the 1-2 weeks after surgery, you may experience moderate-severe pain that responds to the pain medications you have been given. If the pain remains severe despite the pain medications, contact the office or the anesthesiologist at the surgery center. The pain will significantly decrease within 1-2 weeks following the operation. However, it is common to experience some amount of pain for up to 2-3 months after surgery. This pain is usually mild and occurs after increased physical activities. You can apply ice to your ankle or take anti-inflammatory medications of this occurs.
- Calf atrophy (decrease in calf size) due to long period of immobilization. This will improve as you perform rehabilitative exercises and resume activity (unless you have undergone an ankle fusion, in which case you will have permanent calf atrophy.
- Swelling: Ankle swelling may persist for several months after the surgery. Anti-inflammatory medicine, ice, and/or compression with an ACE bandage or compressive stocking may help to reduce swelling.
- Foot and Ankle stiffness: Will improve with rehabilitation exercises and resuming activity, except in the joints that were fused, where you will have permanent stiffness.
When to go to the emergency department or contact the office immediately
- Fever >101° F (see above)
- Severe calf pain
- Drainage from wound
- Sudden increase in warmth, redness in the surgical area
- You should go to the nearest emergency department if you experience chest pain, profuse sweating, shortness of breath, or rapid heart rate