Triple Arthrodesis
Fusion is locking the bones together. A triple arthrodesis is a fusion in the hindfoot (back of the foot) used to treat many types of painful foot deformities. This procedure fuses the joints under the ankle that allow the foot to move from side to side. These joints are the talonavicular, subtalar, and calcaneocuboid.
Surgeons try to avoid fusions, but sometimes pain and deformity are so severe that this procedure offers the best chance of producing a less painful foot with better alignment. Fusions often improve stability and allow for easier standing and walking. The hindfoot fusion is a time-tested, durable procedure.
Triple arthrodesis fuses three joints in the back of the foot: the talonavicular, subtalar, and calcaneocuboid.
Conditions
A hindfoot fusion is indicated for severe arthritis, instability, or a deformity that cannot be controlled with non-surgical treatments. Other conditions, such as severe flatfoot, abnormal connections between bones, excessively high arches, and joint instability due to neuromuscular disease, also can indicate the need for a fusion.
Patients who are still growing are not ideal candidates as they may develop additional deformity as they grow. Patients who use tobacco, have an active infection, or have poor healing potential are at higher risk for complications. Non-surgical measures such as bracing and anti-inflammatory medications should be tried first. If another surgical procedure that leaves the joint intact can achieve the same goal, it is preferred over a fusion.
Arthritis of the Foot and Ankle
The pain and stiffness you feel in your feet and ankles as you age could be arthritis. If left untreated, this nagging pain can get worse over time, eventually making it difficult to walk even short distances.
FlatFoot Deformity
Adult flatfoot is caused by changes in the tendon, impairing its ability to support the arch, thus resulting in the flattening of the foot.
Progressive Flatfoot (Posterior Tibial Tendon Dysfunction)
If this tendon becomes inflamed, overstretched, or torn, you may experience pain on the inner ankle and gradually lose the inner arch on the bottom of your foot, leading to flatfoot.
Surgery
In a triple arthrodesis, your foot and ankle orthopaedic surgeon makes one incision on each side of the foot, and works in each joint, removing cartilage, roughening bony surfaces, and filling defects. Once all the desired joints have been prepared, they are put into an appropriate position and hardware is placed to stabilize the reconstruction and promote healthy fusion.
Rehabilitation
The rate of healing is variable and is influenced by many factors. In general, the foot is kept elevated with no weight on it for the first two weeks to minimize swelling and allow for healing of the skin. Stitches may be removed 2-3 weeks after surgery.
Different weight-bearing protocols may be used. After signs of healing are noted, progressive weight bearing is allowed until full weight bearing is reached. This typically takes three months. A removable boot may be used rather than a cast.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
Most patients are satisfied with their outcome once they achieve successful fusion. In fact, most feel that the loss of motion is a very acceptable trade-off for pain reduction. In the first two to three weeks, the most likely complication is wound breakdown and/or infection. These are best avoided by not smoking, elevating the foot, avoiding any weight on the foot, and keeping the surgical dressing clean and dry.
The most common long-term consequence of triple arthrodesis is gradual development of arthritis in other joints of the foot and ankle. These changes can take years or even decades to develop and many never become noticeable to the patient.
