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Foot Fusion Surgery
Foot fusion surgery is when separate bones in the foot are permanently joined together (fused). It can be used to treat arthritis (including rheumatoid arthritis), flat feet and fractures that haven’t healed naturally, or that are caused by long term deterioration of bones and cartilage.
Midfoot fusion can involve one or two bones being fused, or all of the midfoot joints that form the arch of the foot. The bones in the midfoot are naturally stiff, strengthening and supporting the foot. This means that, if they are fused, it doesn’t normally make much difference to movement.
Hindfoot fusion can involve permanently fixing the Chopart joint (which is made up of the talonavicular and calcaneocuboid joints) to treat hindfoot arthritis. These two joints are an ‘S’- shaped joint that crosses over the foot, dividing the hindfoot from the midfoot and forefoot. This joint is normally immobile so joining them permanently doesn’t normally affect movement.
What does surgery involve?
Surgery usually involves an overnight stay in hospital and is carried out while you are under a general anaesthetic (with a local anaesthetic in the foot to reduce pain following the operation).
The procedure can involve removing the damaged joint and permanently stiffening the bones using plates held by screws to enable the bones to join as they heal. This should result in reduced pain and stability of the joint. If necessary, a bone graft is carried out using bone from another area of your body (or using donor bone) which is used to help the bones heal correctly.
You can help improve the outcome of surgery by attending a pre-assessment screening where you’ll have blood tests to check for levels of Vitamin D and swabs to rule out infection or other problems. You’ll also be weighed and have an opportunity to discuss your medical history. This is important so that any anaesthetics problems can be identified.
Please note: it’s important to stop smoking at least eight weeks before your procedure; this is because smoking can affect the body’s ability to heal and causes health problems including an increased risk of blood clots forming in the lungs (pulmonary embolism) or calf (deep vein thrombosis).
What happens after surgery?
Your foot will be numb and pain-free (from a local anaesthetic injection around the affected area). A member of our physiotherapy team will help you to stand, supported by crutches, and will give you a tailored programme of exercises to help you walk correctly in your plaster cast. In most cases, you’ll be given painkillers to take for a few days and offered a follow-up appointment with Mr Heidari.
What can I do to speed up my recovery?
Raising your foot above the level of your heart and keeping weight off the foot as much as possible during the first few days can help with recovery. Make sure you follow any advice about keeping the wound clean and dry, and carry out the exercises advised by your physiotherapist as these will help you to return to your normal activities as quickly as possible.
Please note: it’s important to avoid smoking or taking anti-inflammatory painkillers as these can slow the healing process down.
When can I drive again?
The DVLA states that it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is when you can stamp down hard with the foot to stop the car during an emergency stop. How long this takes will vary, depending on how quickly you recover, but can be around 12 weeks.
Although Mr Heidari will advise you about when it’s safe to start driving again, it is your own responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.
When can I return to work?
This varies, depending on the type of work you do and the speed of your recovery. In most cases, if you have a sedentary job (sitting down most of the time), you should be able to return after around three weeks. If your job involves manual work, you may need up to four months off.
What is the long term outcome of surgery?
Most people experience excellent pain relief as a result of the procedure and, in many cases, can return to their normal activities – including sport – within six months and continue to improve for up to a year.
What are the risks of surgery?
- All surgery carries risks. With this type of surgery, risks include a small chance of infection which can be treated with antibiotics
- There is a small chance of deep vein thrombosis (DVT) following any surgery, although this is unusual following this type of surgery. However, you may be given blood-thinning medication after surgery as a precaution or if you are at higher risk. You will also be given support socks and exercises to reduce the chances of DVT
- There is also a small chance of nerve damage which can cause temporary or permanent numbness around the toe
- In a few cases (rarely) the bones may not joint together correctly as they heal and, although this may not be painful, you may need to have further surgery
- The metal that’s used to fuse the joint can stick out. However, this can easily be removed later on, once the joint has healed
You can find more information about recovering from foot fusion surgery in our patient information leaflet, which can be downloaded from this website.