A triple arthrodesis is a commonly performed procedure for chronic tendon ruptures and partial foot dislocations resulting from flat foot or hindfoot arthritis. Non-surgical treatment often begins with a fracture brace to control initial pain and swelling. The tendon dysfunction may then be treated with a permanent ankle or leg brace. If non-surgical treatment does not relieve your symptoms satisfactorily or if signs of progressive flattening are noted, surgery is recommended.
Surgery involves fusion of the four hindfoot bones (the calcaneus, talus, navicular and cuboid). Tendon balancing and bone grafting procedures are performed with this surgery to improve results, and pain relief is excellent. Gait improves significantly because of decreased pain but, 20 percent of up and down motion and all of side to side to side motion is lost. The surgery may be performed on an inpatient or outpatient basis depending on your particular needs.
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For more information about the triple arthrodesis procedure, keep reading.
What Happens Before Triple Arthrodesis?
The surgery center will give you individualized advice on how to prepare in the days leading up to surgery. On the day of surgery, the anesthesiologist will administer regional anesthesia known as a popliteal nerve block. You will be placed on your stomach and a small needle is used to inject Novocain-like medication around the nerve in your leg. It gives complete pain relief that lasts for 12 to 36 hours. Patients report extraordinary satisfaction with this type of anesthesia. You will be given antibiotics just before surgery to help prevent infection.
What Happens During Triple Arthrodesis?
During the surgery you will undergo general anesthesia. A tourniquet will be placed around your thigh. Incisions will be made along the foot, ankle, back of the leg, and bottom of the heel. Bone graft is taken from the knee. The joints have their surfaces roughened to imitate a fracture. The foot is repositioned to recreate an arch and balance it beneath the leg. Screws are used to hold the bones in place while they grow together. Tendon balancing is performed. X-Rays taken during the surgery confirm the correction of the foot misalignment. The wounds are closed with stitches and staples.
What Happens After Triple Arthrodesis?
You will be admitted to the hospital once your anesthesiologist is satisfied that you have recovered. Inpatient stays usually vary from 1-3 days. Physical therapy will teach you how to walk with crutches or a walker. Take your narcotic pain control medications before falling asleep or as you feel the “numbing” effect wearing off. Remember, post-operative pain is much easier to control with prevention. Schedule your post-operative visit for two weeks after surgery when you are able.
Triple Arthrodesis General Recovery Timeline
This timeline is a general guideline. Your post-operative course may vary.
| Elevation | 23 hours / day for 3 days; then keep elevated as needed. Swelling may last over 4 months. |
| Motion | Move your toes and knee when the block resolves. This will decrease pain and swelling, and improve healing. |
| Walking | If you are healing well begin partial weight bearing at 6 weeks in cast or fracture brace when you have permission. Once the fusion heals you may weight bear without restrictions. |
| Bathing | Keep cast dry. Use a Xerosox. There are no restrictions after the cast is removed. If you have an External fixator, wash daily and follow instructions. |
| Pain Control | Expect to use strong narcotics for the first 3-5 days. Wean off as soon as you are comfortable using Tylenol or Ultram (Rx only). NSAIDS will slow healing. |
| Work | Return depends on specific demands. It is safe to return to sedentary work at 10 days post-op. Return to heavy labor will take at least 3 months. |
| Driving | Patients with left foot surgery may drive an automatic transmission. Patients with right foot surgery must wait until healing is adequate and they feel safe. |
Routine Clinic Visits
| 2 weeks | XR, cast exchange and stitch removal. |
| 6 weeks | XR, Earliest time of bone healing to permit weight bearing activity. The time to return for your next visit varies significantly. |
| 3+ and 6 months | Return for recheck and XRs; Strength improves over then next year. Minimal feelings of discomfort may linger, your overall comfort level improves over a year. |
| ********** | If at any time during your post-operative period you notice any drainage or foul odor from your incision, a temperature of more than 100.4 degrees and/or increased swelling or tenderness, you should contact our office. |
For more helpful tips, check out these rehab exercise videos that will help you recover, or reach out to Dr. Silverman for more information!