The aim of foot fusion surgery is the permanent fusion of separate bones in the foot. This procedure is used to treat flat feet, arthritis, including rheumatoid arthritis, and fractures that haven’t healed of their own accord, or that are caused by wear-and-tear of cartilage and bones over time.
When midfoot fusion is carried out, it can involve one or two bones being joined together, or all the midfoot joints that comprise the foot’s arch. The midfoot’s bones are stiff by their nature, functioning to strengthen and support the foot. Therefore, when they are fused, it doesn’t usually affect movement adversely.
Hindfoot fusion can necessitate the permanent fixation of the Chopart joint, comprised of the talonavicular and calcaneocuboid joints, to address hindfoot arthritis. These two joints form an ‘S’- shaped joint that transverses the foot, separating the hindfoot from the midfoot and forefoot. This joint doesn’t usually move so permanent fusion doesn’t impact movement.
An overnight stay in hospital is normally necessary and surgery is performed under a general anaesthetic. A post-operative local anaesthetic is administered in the foot to minimise pain.
The surgery may involve the removal of the damaged joint and the permanent stiffening of the bones via plates fixed by screws to facilitate bone fusion as healing occurs. The outcome should be less pain and greater joint stability. It may be necessary for a bone graft to be performed utilising bone from a different part of your body, or donor bone, to promote correct healing of the bones.
If you are suffering from flat feet, arthritis/rheumatoid arthritis and other conditions including fractures resulting from wear and tear to cartilage and bones you may need to undergo foot fusion surgery.
Following foot fusion surgery, your foot will be placed in a plaster cast for around twelve weeks, although at some point during weeks two to six your initial cast will be replaced with a more lightweight version. Whilst still in hospital, you will be shown how to walk using crutches and advised on some exercises you should complete to aid your recovery and maintain flexibility and the strength in your muscles.
For the first two weeks, you should keep your weight off your foot, keeping it elevated as much as possible. It is important to perform the stretching and stability exercises demonstrated to you by your physiotherapist in this period. During the second week after your operation, you should be able to walk short distances using your crutches, but it is crucial to remember to refrain from putting any weight on your foot.
After six weeks and once an X-ray confirms that your bones are healing correctly, you can start to put weight on your foot. To do this, you should use the surgical sandal you are provided with. You should also begin to massage around the scar as much as you can. Although this can be painful, it is important to desensitise the scar and ensure the tissues don’t stick to each other.
You may be able to return to work 6-12 weeks after your operation. However, if your job involves heavy manual labour, it can be up to six months before you can return to work. If surgery was on your left foot, you can usually start driving if you drive an automatic car at this point, if advised by your consultant. However, you should also check with your car insurance provider.
After twelve weeks, your joints will have fused completely and you should be able to return to driving a manual car.
Six months after your operation you can return to your normal sports. The amount you can do will steadily increase over time. After a year, your foot should be fully healed and all swelling subsided.
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