Foot Fusion Surgery

Foot Fusion Surgery

Foot Fusion Surgery

Foot Fusion Surgery

What is foot fusion surgery?

Foot fusion surgery is a procedure to fuse together two bones in the feet, when a severely damaged joint between them is causing pain. If you’ve had trauma to your feet in the past, rheumatoid arthritis or if you have really flat feet, this can cause damage to the articular cartilage that lines the joint, and eventually arthritis.  This causes pain, stiffness and swelling in the joint, and cause considerable problem with walking, getting shoes to fit, and even social isolation.

The joints that are typically affected by arthritis are the big toe (sometimes called ‘Hallux Rigidus’) and the midfoot joints which make up the arch of the foot.

Sometimes people have pain from arthritis in the back part of the foot and ankle, in an area known as the Chopart joint (comprising the talonavicular and calcaneocuboid joints), and the subtalar joint (the joint between the foot and the ankle).

If you’re struggling with foot arthritis that’s not responded to physiotherapy, orthotics, or injection treatments, fusion surgery may be an option for you.

What does the foot fusion surgery involve?

Foot fusion surgery is usually carried out under a general anaesthetic. It’s sometimes a day case procedure, but after more complex fusion surgery, you might need to stay in hospital overnight. It can also be carried out under a spinal anaesthesia or with a nerve block (awake surgery).

An incision (usually short) is made over the damaged joint, and then the damaged joint ends are removed, and the ends of the bones are fixed together with screws or plates.  These are permanent fixations, and occasionally I may need to use a bone graft (harvested from another area of the body, or ‘off the shelf’) to ensure a good join.

Fusion surgery of hindfoot, like the subtalar joint, can be carried out arthroscopically (by keyhole), even in the case of multiple joints, but if there is a big deformity that needs to be corrected, I may need to perform ‘open’ surgery, through a slightly larger incision.

Does it matter that the joint is fused and won’t move?

If you’re dealing with foot arthritis, chances are you’re already struggling with stiffness in the affected joint, which is also painful. The goal of fusion is to end the pain (I describe it as going from stiff and painful to stiff and pain-free). While this may mean sacrificing some range of motion, in most cases the other joints in your foot can compensate for this and allow you to move around relatively normally.

What’s the recovery like after foot fusion surgery?

After the surgery you’ll spend a short time in the recovery area, and then you’ll return to the ward. Local anaesthetic will have been injected into the foot so that it will feel numb and pain free when you wake up. Your foot will be in a plaster cast, and you’ll need to keep the weight off your foot for around six weeks. This means using crutches and it’s also very important to keep your foot elevated (above your heart level) as much as possible during the day.

We’ll meet in clinic two to three weeks after your surgery, your cast, dressing and stitches will be removed, and a new cast applied.  When we meet again at the six-week stage, we’ll take an X-ray to check all is well in terms of the bone alignment and healing of the fusion site. You can typically come out of the plaster cast, and into a boot and start weight bearing again. This is the stage when you can start progressing with your physiotherapy.

When can I drive after foot fusion surgery?

You need to be able to operate the controls of your car and be able to perform an emergency stop by applying the foot break hard. For most people, they can confidently do this at around 3 months post-surgery, but if you drive an automatic car, and it’s your left foot that’s been operated on, you can drive when you feel able.

When can I return to work after foot fusion surgery?

It’s important not to try to rush back to work before you are ready, and I recommend to patients that if they have a desk-based job, they may be able to return 4-6 weeks after the surgery (ensuring they are elevating their foot whilst working). If you have a manual job, or one that requires you to be on your feet all day, you may need to take 3 months off work.

How successful is foot fusion surgery?

90% of patients report that they have had an excellent outcome after their fusion surgery.

It will take a good 3 months for the bones to fully fuse, but most patients will experience the benefit of good levels of pain reduction by 6 weeks. You could expect to get back to your usual activity level within 3 to 6 months after the surgery.

Are there any risks with having fusion surgery?

No surgery is entirely without risk, but my team and I take great care to reduce the risk of complications and ensure the best possible outcome. When it comes to foot surgery, there are several potential complications that patients should be aware of:

  • Infections are relatively rare (<1%), but in the event that one does occur, it can typically be treated successfully with antibiotics. In some instances, however, the infection may be deeper and require surgical intervention to effectively manage it.

  • Damage to nerves, blood vessels and tendons is rare, occurring in less than 1% of patients.

  • Delayed or non-union of the bones can also occur in some patients (less than 5%), particularly those who smoke or have other medical problems. If this happens, further immobilization in plaster or additional operations may be necessary.

  • Painful or tender scars are another potential issue following foot surgery. However, most patients find that any discomfort or numbness around the scar area generally resolves with time.

  • One uncommon but serious complication is complex regional pain syndrome (CRPS), which can cause pain, swelling, and discomfort. While it is impossible to predict who may experience this problem, working closely with a physiotherapist and getting the foot and ankle moving early has been shown to significantly reduce the risk. Overall, though, with proper care and attention, most patients experience successful outcomes following foot surgery.

  • When you are inactive in a cast, it can increase the risk of forming a blood clot in your leg. This is known as a Deep Vein Thrombosis (DVT) and can be quite painful. To prevent this from happening, you will receive injections of blood thinners into your stomach for the first 6 weeks after the operation if you are over the age of 16. This helps to decrease the risk of these clots forming. However, it’s important to note that clots can still occur and cause swelling and discomfort in the limb. In rare cases, these clots can break off and travel through the bloodstream to the lung, causing a Pulmonary Embolus (PE). This can be life-threatening, which is why we take steps to identify and prevent clots as much as possible.

  • Another risk to consider is the rare possibility of complications related to anaesthesia. To help you understand these risks better, the anaesthetist will meet with you on the day of surgery to provide more information about you options for anaesthesia and answer any questions you may have.

I will take time to talk through the surgery with you, and ensure that all your questions have been answered, so that you are happy with your decision.

What can I do to reduce the risks?

To optimize your recovery after surgery, there are a few simple steps you can take that can make all the difference. Adding Vitamin C and Vitamin D supplements to your daily routine can speed up the healing process.

If you smoke, it’s crucial to quit since smoking can impair healing and increase your risk of complications. Additionally, maintaining a healthy weight and staying active an have a positive impact on foot-related issues. Although these measures may appear minor, they can significantly boost the success of your surgery.