A subtalar fusion is performed for chronic tendon ruptures, calcaneus or talus fractures and many other causes of hindfoot arthritis. If non-surgical treatment of cortisone injections and a permanent brace do not relieve the symptoms, a fusion of the talus and calcaneus is recommended.
Pain relief is excellent and gait improves significantly because of decreased pain, but 20 percent of the up and down motion and most of the side to side to side motion is lost as a result of the fusion. Learn more about the procedure below.
Are you suffering from a subtalar fracture or hindfoot arthritis?
If so, let Dr. Silverman help. For more information about the subtalar fusion procedure, keep reading.
What Happens Before A Subtalar Fusion?
The surgical center will provide you with individualized advice in the days and weeks leading up to your operation. On the day of your surgery, the anesthesiologist will give you a regional anesthesia known as a Popliteal nerve block. You will be given medication to induce “twilight sleep”, placed on your stomach, and a small needle will be used to inject Novocain-like medication around the nerve in the back of your leg. It gives complete pain relief that lasts for 12 to 36 hours after surgery. Patients report extraordinary satisfaction with this type of anesthesia. You will be given sedatives during the surgery. Rarely, patients require general anesthesia. You will receive antibiotics just before surgery to help prevent infection.
What Happens During A Subtalar Fusion?
During the surgery you will be put into a relaxed state by the medication delivered through the I.V. A tourniquet will be placed around your calf. You will not feel the pressure because of the nerve block. Incisions will be made along the foot, ankle, back of the leg and bottom of the heel. A bone graft is taken from the knee. The joints have their surfaces roughened to imitate a fracture. The foot is re-positioned to recreate an arch and balance it beneath the leg. Screws are used to hold the bones in place while they grow together. Tendon and ligament 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 A Subtalar Fusion?
You will be permitted to leave the surgical center 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.
Subtalar Fusion General Recovery Timeline
This timeline is a general guideline. Your post-operative course may vary.
| Elevation | 23 hours / day for 10 days; 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 8 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. |
| Dressing | Please see pin care instructions if you have an external fixator otherwise, keep casts on and clean. |
| 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 staple 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; 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.