Triple Arthrodesis

Triple arthrodesis/fusion is a reliable and effective method of treating arthritis of the joints of the hindfoot and correcting deformity. In a triple arthrodesis three joints (subtalar, talo-navicular and calcaneo-cuboid) are fused together. After a triple arthrodesis most patients have considerably less pain and improved foot function.

There are a number of steps to triple arthrodesis surgery. These include:

• Nerve block, general anaesthetic, antibiotics
• Incisions over inside and outside of the foot
• Removal of remaining cartilage from the subtalar, talo-navicular, and calcaneo-cuboid joints
• Insertion of bone graft (often from the heel bone) and other cells to stimulate fusion
• Fixation with screws and staples
• Check x-rays
• Closure of wound with stitches
• Back slab

All surgical procedures carry some risk. The risk of complications with triple arthrodesis surgery is low. Some of the risks of surgery include:

• Infection
• Problems with wound healing
• Nerve injury causing numbness, tingling and/or pins and needles
• Non-union (when the bones don't join together)
• Mal-union (when the bones fuse in the wrong position)
• Deep venous thrombosis/pulmonary embolism (the risk of DVT increases with smoking, the oral contraceptive pill and hormone replacement therapy, immobility and obesity)
• Anaesthetic complications
• Drug allergy
• Ongoing pain

Rest

• You will have a cast on your leg. Keep foot elevated as much as possible, especially for initial 72 hours. Keep dressings dry and intact until post operative appointment.
• Mobilise short distances as pain allows, aim to remain in your own home for the first few weeks limiting long periods of standing or mobilising
• Do not bear weight for the first six weeks

Pain

• Pain relief may be required for up to 6 weeks; depending on your other medications this may include:
• Regular paracetamol, anti-inflammatory drugs and break through opiate type medications
• A regular blood thinning medication will also be prescribed for 2 weeks

Driving

• Any surgery performed on the right foot or both feet will mean no driving for a minimum of 6 weeks
• If surgery was performed on the left foot then driving in an automatic is possible, but Dr Phegan would recommend waiting a minimum of two weeks before attempting to drive

Driving any vehicle with a cast or boot is potentially hazardous and you should consider this before getting behind the wheel.

Follow up

• Keep all dressings dry and intact for the first two weeks
• Removal of stitches/sutures typically occurs at an appointment with Dr Phegan and his in-house therapists at 10-14 days at first post operative appointment. Very occasionally some sutures need to stay in for longer
• Your appointment will be booked by Dr Phegan and a confirmatory SMS will be sent informing you of the time and date for follow up

Typical milestones

• 2 weeks: Wound review and removal of sutures, change from cast to boot, commence rehabilitation
• 2-6 weeks: regular physiotherapy to increase range of motion
• 6 weeks to 3 months: work on swelling reduction, scar massage and mobility. Progress weight bearing
• Full recovery 6-12 months

Every patient's recovery is individual and depends on the severity of the injury and the complexity of the surgery.