Arthrodesis, the medical term for fusion, involves locking bones together by eliminating joint cartilage and fostering a "bone bridge" across the joint. Triple arthrodesis, specifically targeting the hindfoot, addresses various painful foot deformities by fusing three pivotal joints beneath the ankle: the talonavicular, subtalar, and calcaneocuboid joints. A double arthrodesis would involve fusion of the talonavicular and subtalar joints only.
Understanding Diagnosis
Indications for hindfoot fusion encompass severe arthritis, instability, or deformities unresponsive to conservative treatments. Conditions such as profound flatfoot, abnormal bone connections, excessively high arches, and neuromuscular-induced joint instability may also warrant fusion. However, patients still undergoing growth spurts are not ideal candidates due to potential additional deformities. Factors such as tobacco use, active infections, or impaired healing may elevate surgical risks. Non-surgical interventions like bracing and anti-inflammatory medications are explored before considering fusion, prioritizing procedures preserving joint integrity.
Surgical Technique
During a double or triple arthrodesis, Dr. Kamel makes incisions on each side of the foot (or one side, in the case of a double arthrodesis), accessing and preparing each joint by removing cartilage and refining bony surfaces. Subsequently, the joints are positioned appropriately, and hardware is utilized to stabilize the reconstruction and facilitate fusion.
Recovery
Healing rates vary, influenced by multifactorial aspects. Initially, the foot is immobilized in a splint and kept elevated with no weight-bearing for about two weeks to foster skin healing and minimize swelling. Sutures are typically removed within 2-3 weeks post-surgery. Various weight-bearing protocols are employed, however patients are usually weight-bearing in a walking boot by 6-8 weeks, and into regular shoes by 3 months time.
Risks and Complications
While complications, including anesthesia-related risks, infections, nerve or vessel damage, and blood clots, are inherent in any surgery, most patients find satisfaction post-fusion, prioritizing pain relief over limited motion. The primary short-term risks involve wound breakdown and infections, mitigated by abstinence from smoking, elevation of the foot, weight avoidance, and maintaining cleanliness of the surgical site. Long-term implications may include arthritis development in adjacent foot and ankle joints, however this is gradual and can take many years to become apparent and symptomatic.
In essence, a double or triple arthrodesis offers a viable solution for debilitating foot deformities, prioritizing pain reduction and stability. By embracing informed decision-making, comprehensive treatment, and diligent rehabilitation, patients can embark on a journey towards enhanced foot function and improved quality of life.
Make An Appointment
If you're experiencing any foot or ankle conditions, we’re here to help. Schedule an appointment today to get the care you need.