Subtalar Arthrodesis - an overview (2023)

Subtalar Arthrodesis•Make an incision centered over the sinus tarsi from tip of fibula to fourth metatarsal•Identify the peroneal tendon sheath and fat in the sinus tarsi•Locate fascia of the extensor digitorum brevis and incise along lines of skin incision•Dissect off the extensor digitorum brevis as a distally based flap off the calcaneus and sharply•Incise the sinus tarsi fat pad to expose the tarsal canal, taking care to preserve talus blood supply.

From: Case Competencies in Orthopaedic Surgery, 2017

Fractures and Dislocations of the Foot

Frederick M. Azar MD, in Campbell's Operative Orthopaedics, 2021

Subtalar Arthrodesis

With the realization that symptoms should improve for at least 2 years, and as long as a patient is progressing in activity level and work capability, arthrodesis may be avoided, although the psychosocial complications of prolonged disability are profound. If a patient fails to progress with conservative treatment (e.g., bracing, antiinflammatory medications), arthrodesis should be considered. It has been shown that the longer the interval between the injury and the salvage procedure, the longer the interval until the patient returns to full activity or work.

In patients who are candidates for subtalar arthrodesis, bilateral standing radiographs should be scrutinized carefully. The talar angle of declination should be evaluated because it measures excursion of the tibiotalar joint in extension (Fig. 89.27). For patients with a depressed talar angle of declination, Carr etal. modified a procedure originally described by Gallie, the subtalar distraction bone block arthrodesis (Fig. 89.28).

Although the procedure is technically demanding, resulting postoperative appearance of the foot and improved ankle dorsiflexion may be impressive. A number of studies have demonstrated the usefulness of subtalar distraction bone block arthrodesis for the late complications of calcaneal fractures. Failures occurred in patients with transverse tarsal joint arthritis, malunions, and nerve problems. Functional outcomes were better in patients who had a late subtalar arthrodesis after ORIF than in those who were initially treated nonoperatively.

If calcaneal height is normal or minimally depressed and there are no anterior ankle joint impingement symptoms, we prefer in situ subtalar arthrodesis. Lateral wall decompression can be added if widening of the calcaneus is causing subfibular impingement, and use of this local graft for distraction has been shown to have outcomes similar to iliac crest bone grafting. This procedure can be helpful for patients with subtalar arthrosis after calcaneal fractures. No correlation has been identified between final outcome and talar angle declination, talar height, or calcaneal width. Peroneal tendon and subfibular impingement, ankle tenderness, sural nerve injury, and patient smoking all were statistically associated with lower scores.

Distraction Subtalar Fusion

Beat Hintermann, Roxa Ruiz, in Operative Techniques: Foot and Ankle Surgery (Second Edition), 2018

Positioning

Subtalar arthrodesis may be performed in the lateral or prone position.

We favor a full lateral decubitus position with the patient’s torso safely secured within a beanbag and the operative extremity supported on a well-padded bump of folded sheets or towels.

The knee is flexed, and the heel of the patient rests at the posterior corner of the operating table.

A tourniquet is placed thigh high.

The iliac crest is also draped if the use of iliac crest is considered.

Positioning Pearls

The use of a radiolucent table will facilitate intraoperative fluoroscopy.

An axillary roll is recommended and helps to prevent compression of neurovascular structures at risk.

Positioning Equipment

Beanbag

Protective padding below contralateral limb and axilla to protect the peroneal nerve and brachial plexus, respectively

Positioning Controversies

The patient may be positioned supine if other surgical procedures on the medial ankle and foot are considered during the same surgery; in this case, elevation of the ipsilateral back will allow internal rotation of the foot.

(Video) Subtalar Arthrodesis

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Paralytic Disorders

Frederick M. Azar MD, in Campbell's Operative Orthopaedics, 2021

Subtalar Arthrodesis

Paralytic equinovalgus deformity results from paralysis of the anterior tibial and posterior tibial and the unopposed action of the peroneals and gastrocnemius-soleus. The calcaneus is everted and displaced laterally and posteriorly. The sustentaculum tali no longer functions as the calcaneal buttress for the talar head, which shifts medially and into equinus. Hindfoot and forefoot equinovalgus deformities develop rapidly and, with growth, become fixed and require bony correction.

Grice and Green developed an extraarticular subtalar fusion to restore the height of the medial longitudinal arch in patients 3 to 8 years old. Ideally, this procedure is performed when the valgus deformity is localized to the subtalar joint and when the calcaneus can be manipulated into its normal position beneath the talus. Careful clinical and radiographic examinations should determine whether the valgus deformity is located primarily in the subtalar joint or the ankle joint. If the forefoot is not mobile enough to be made plantigrade when the hindfoot is corrected, the procedure is contraindicated. The most common complications of the Grice and Green arthrodesis are varus deformity and increased ankle joint valgus because of overcorrection. Bone infection, pseudarthrosis, graft resorption, and degenerative arthritis of the metatarsal joints also have been reported.

Dennyson and Fulford described a technique for subtalar arthrodesis in which a screw is inserted across the subtalar joint for internal fixation and an iliac crest graft is placed in the sinus tarsi. Because the screw provides internal fixation, maintenance of the correct position does not depend on the bone graft.

Arthroscopic Subtalar Arthrodesis

James P. Tasto, in Textbook of Arthoscopy, 2004

ARTHROSCOPIC SUBTALAR ARTHRODESIS IN A NUTSHELL

History, Physical Examination, and Imaging:

Pain laterally over subtalar joint, limitation of motion, response to subtalar injections, radiographic evidence of arthritis

Indications:

Intractable subtalar pain secondary to rheumatoid arthritis, osteoarthritis, or post-traumatic arthritis, as well as posterior tibial tendon dysfunction

Surgical Technique:

Lateral decubitus position with high thigh tourniquet and two- or three-portal technique; nick and spread technique used to establish all portals; diagnostic arthroscopy carried out through anterior portal; posterolateral portal used for majority of debridement, accessory anterior portal for some debridement; small shaver and bur used to remove all articular cartilage and decorticate 1 to 2 mm below subchondral plate; spot-weld vascular channels established; subtalar joint thoroughly irrigated; fixation accomplished with one 7.3-mm cannulated screw from anteromedial to posterolateral

Postoperative Management:

Immobilization in bivalve cast; full weight bearing in ankle-foot orthosis 1 week postoperatively; orthosis removed when clinical and radiographic fusion accomplished

Results:

Decreased morbidity and increased fusion rate, as well as reduced time until fusion

Complications:

(Video) Subtalar Arthrodesis for Post-Traumatic Subtalar Arthritis

Minimal

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Malunited Fractures

Frederick M. Azar MD, in Campbell's Operative Orthopaedics, 2021

Posterior Subtalar Arthrodesis

Gallie advised arthrodesis of the subtalar joint from the posterior aspect because the procedure is simpler than the one usually employed (Fig. 58.4); however, it does not allow correction of varus or valgus position of the calcaneus or of any other deformity of the foot. According to Gallie, a mild valgus position of the heel usually can be disregarded. His operation is not suitable if the primary deformity is one of varus because excessive weight would be borne on the head of the fifth metatarsal and cause a painful callus.

Technique 58.3

(GALLIE)

With the patient prone, make a longitudinal incision along the lateral border of the Achilles tendon for 6 to8 cm and incise transversely the posterior capsule of the ankle and of the subtalar joint.

Locate the subtalar joint by medial and lateral motions of the calcaneus.

Probe the subtalar joint to determine its general direction and cut a mortise in the calcaneus and talus approximately 1.3 cm wide, 0.6 cm deep, and as far distally as the sinus tarsi.

Flex the knee and remove a graft 6.2 cm long × 1.3 cm wide from the anteromedial surface of the proximal tibia. Divide the graft into two parts and bevel one end of each.

Pack cancellous bone into the depth of the mortise. With their cortical surfaces apposed, drive the two grafts into the mortise. If the grafts are of the proper size, their cancellous surfaces press snugly against the lateral walls of the mortise. Strips of cancellous bone from the ilium probably are preferable to the tibial grafts used by Gallie; they are packed tightly into the cavity.

Close only the subcutaneous and skin layers over a suction drain.

Apply a bulky dressing followed by a short leg cast.

Total Ankle Replacement

Mark S. Myerson M.D., in Reconstructive Foot and Ankle Surgery (Second Edition), 2010

ADDITIONAL PROCEDURES

When a subtalar arthrodesis is required, I use long small screws inserted from the dorsal aspect of the tarsal neck directed in multiple projections into the calcaneus (Figure 24-32). Large screws should not be inserted into the talus from bottom to top, because the direction of the screws is unpredictable. Insertion of the correct length of screw also is difficult, because it may abut the undersurface of the talar component, causing displacement. The head of the screw must not abut the anterior edge of the talar component, because movement of the screw can lift it up off the talus.

Conversion of ankle arthrodesis to a prosthesis is technically possible but is a complex procedure. Regardless of what has been described in the literature to date, this is a salvage procedure performed as an alternative to amputation. Candidates for this procedure should have severe pain in the hindfoot, with no possibility of conversion to a pan-talar arthrodesis. If the ankle fusion has been successful, as an isolated procedure and subtalar and or transverse tarsal joint arthritis is the preferable if not the required procedure. The ideal patient for this procedure is someone who presents with a painful nonunion of the arthrodesis, with avascular sclerotic bone margins, and for whom a revision arthrodesis poses further potential for failure (Figure 24-33).

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(Video) Isolated Subtalar Arthrodesis

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Subtalar Arthrodesis

Mark S. Myerson MD, Anish R. Kadakia MD, in Reconstructive Foot and Ankle Surgery: Management of Complications (Third Edition), 2019

Abstract

The indications for subtalar arthrodesis are broad and include arthritis and deformities. Specific problems amenable to management by this method are calcaneus fracture, isolated traumatic subtalar arthritis, middle facet tarsal coalition, and calcaneovalgus deformity, among others. The surgical approach that we use for subtalar arthrodesis depends to some extent on the underlying pathology. Many of these procedures are performed for posttraumatic arthritis secondary to a calcaneus fracture. We generally use a standard incision across the sinus tarsi. In some cases, the patient has undergone multiple surgeries, and the incision is prone to dehiscence unless care is taken with the approach. In cases of a bone block fusion, the use of a vertical posterior incision is preferred to minimize risk of wound complication from distraction of a transverse incision.

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Subtalar Arthrodesis

Mark S. Myerson M.D., in Reconstructive Foot and Ankle Surgery (Second Edition), 2010

OVERVIEW: APPROACH AND INCISIONS

The indications for subtalar arthrodesis are broad and include arthritis and deformities. Specific problems amenable to management by this method are calcaneus fracture, isolated traumatic subtalar arthritis, middle facet tarsal coalition, and calcaneovalgus deformity, among others.

The surgical approach that I use for the subtalar arthrodesis depends to some extent on the underlying pathology. Many of these procedures are performed for posttraumatic arthritis secondary to a calcaneus fracture. I generally use a standard incision across the sinus tarsi. In some cases, the patient has undergone multiple surgeries, and the incision is prone to dehiscence unless care is taken with the approach (Figure 35-1). If previous surgery has been performed, I prefer not to reopen the original incision for the open reduction with internal fixation (ORIF) procedure. Although use of the original incision is an option, considerable scarring will be encountered over the lateral calcaneus and peroneal tendons, and it is not as easy to reach the sinus tarsi and the more medial aspect of the subtalar joint through this route (Figure 35-2). The more limited incision over the sinus tarsi heals well, with no risk for compromise of the intervening skin bridge between the sinus tarsi incision and the original more extensile lateral incision (Figure 35-3).

Subtalar arthrodesis procedures are of two basic types: (1) fusion performed in situ, without changing the orientation of the hindfoot and (2) a bone block arthrodesis with structural grafting to restore the height of the hindfoot. In addition to these two basic procedures, osteotomies of the calcaneus may be added to correct additional deformity. Beyond correction of the calcaneus and subtalar joint problems, other essential considerations include the condition of the peroneal tendons, which frequently are torn or dislocated, as well as the flexor hallucis longus and the soft tissues on the medial ankle, including the tibial nerve and its branches.

Complete exposure of the peroneal tendons and adequate subfibular decompression in patients with subtalar arthrodesis after calcaneus fracture are essential. Impingement in the subfibular recess is common, and the bone must always be removed regardless of the type of arthrodesis performed (Figure 35-4). The easiest way to determine that an adequate decompression has been performed is to make sure that the lateral wall of the calcaneus is slightly medial to the undersurface of the overhanging talus. After completion of the procedure, I palpate the subfibular recess percutaneously to detect any persistent bone underneath the tip of the fibula.

The incision is made from the tip of the fibula extending distally down over the sinus tarsi toward the calcaneocuboid joint. On the inferior surface of the incision the peroneal tendon sheath is identified, and more distally in the incision the terminal branch of the sural nerve should be looked for. The nerve usually lies inferior to the peroneal tendons, but if the dissection extends more distally, the nerve can be at risk for injury.

What incision should be used after a failed ORIF of a calcaneus fracture? Reuse of these extensile incisions for a subsequent elective arthrodesis procedure typically is problematic, and visualization of the entire joint can be limited because of scarring. I do not recommend using the original incision. Provided that 6 months has elapsed since the initial ORIF procedure, a standard sinus tarsi approach is far easier. With fractures treated initially with ORIF for which the hardware is still in place, two outcomes are possible: (1) either failure of the ORIF with widening and collapse of the subtalar joint or (2) normal hindfoot anatomy with arthritis. In the first case, the hindfoot widens with collapse of the subtalar joint, and the hardware needs to be removed before the lateral wall ostectomy and arthrodesis are performed. In the second case, despite the arthritis, the overall architecture of the hindfoot has been maintained, and the hardware can be left in place. Fixation of the subtalar fusion can be a little more difficult here, but the larger screws for the arthrodesis can be inserted around the plate and original screws, as is done for a primary arthrodesis of the subtalar joint combined with ORIF for an acute fracture.

When the hardware removal is planned as a simultaneous procedure, the plate and screws should be removed percutaneously assisted by fluoroscopic imaging. Each screw can be marked with a needle, and then a 2-mm puncture incision is made directly on top of the screw through the skin and then deepened through subcutaneous tissue with a hemostat, to avoid injury to the sural nerve. The plate can then be grasped with needle-nose pliers and then twisted out the front of the incision.

The retinaculum of the undersurface of the peroneal tendon sheath is stripped and elevated off the lateral wall of the calcaneus. Depending on the nature of the underlying disease, the peroneal tendons may be left in position or completely retracted if the lateral calcaneus has widened. After a calcaneus fracture, bone builds up laterally and squeezes the peroneal tendons into the fibula. To address this problem, the lateral wall of the calcaneus is completely exposed proximally toward and then posterior to the fibula, until the impingement against the lateral wall of the calcaneus is visible. A retractor is inserted into the soft tissue to pull the peroneal tendon sheath inferiorly and expose the entire lateral wall of the calcaneus.

For the lateral wall ostectomy, I use a 2-cm curved osteotome to remove a generous amount of bone to achieve complete exposure of the lateral aspect of the posterior facet of the subtalar joint and also remove the lateral impingement under the tip of the fibula. Slight irregularities often are present in the lateral wall of the calcaneus after this ostectomy, and the surface should be palpated through the skin to identify residual bone, which may be the source of pain. After completion of the ostectomy, the lateral margin of the posterior facet of the calcaneus should be slightly medial to the undersurface of the lateral margin of the talus. I preserve the resected bone and cut it up with a bone cutter into 5-mm fragments for later use as graft material (Figure 35-5).

The contents of the sinus tarsi are elevated off the floor of the sinus tarsi until the anterior aspect of the posterior facet of the subtalar joint is well visualized. A rongeur can be inserted directly into the posterior facet of the subtalar joint and then twisted around to loosen up the joint. The rongeur can then be pushed more medially to first open up and then debride the interosseous scar, opening up the middle facet. Once the debridement has been performed with the rongeur, a toothed laminar spreader is inserted into the sinus tarsi. With the spreader placed on stretch, the remnant of the interosseous ligament is visualized and is debrided to gain access to the posterior aspect of the subtalar joint and the middle facet. I use a flexible chisel to denude the articular surface of the posterior facet, but minimal bone is removed. The posterior facet is debrided down to bleeding healthy subchondral bone. All of the chondral fragments are removed with the rongeur. Final debridement using a flexible chisel is performed again on the more medial aspect of the subtalar joint, with entry into the middle facet and complete denudation of the articular surface and the undersurface of the talus, as well as the dorsal surface of the middle facet. It is important to debride the medial aspect of the joint, including the middle facet; otherwise, a gap will be present, which may not close, or the heel will tilt into valgus as the posterior and lateral aspect of the joint is compressed. Once I have removed all of the cartilage and chondral fragments, the joint is aggressively punctured or “fish-scaled” using an 8-mm curved osteotome and then perforated with a 2-mm drill bit.

The bone graft harvested earlier from the lateral wall of the calcaneus is used to augment the arthrodesis (Figure 35-6). The graft is now inserted into the sinus tarsi and the recesses in the subtalar joint and packed into place with a bone tamp. It is essential to ensure that no graft spills into the soft tissues, particularly under the peroneal recess laterally and then more posteriorly into the retrocalcaneal space. Over the past few years I have been routinely adding a spun-down concentrate from an iliac crest aspirate to the cancellous bone graft. In patients who are considered to be at higher risk for nonunion, I include use of bone morphogenic protein or an implantable bone stimulator in addition to the arthrodesis.

If I anticipate that copious amounts of bone graft will be needed, the surgical plan includes obtaining either autograft or allograft supplemented with mesenchymal cell aspirate from the iliac crest. If I anticipate that a defect will be present or that elevation of the height of the hindfoot is necessary, then I use a vertical incision. If, however, I have used the standard sinus tarsi incision, then before I complete the procedure, I make sure that the skin can be closed without tension. Removing some of the bulk of the bone graft may be necessary to achieve a tension-free closure. A defect is inevitable if avascular necrosis of the posterior facet is present: As debridement is performed, more bone loss will result. This defect can be filled with either a bulk structural graft or cancellous chips. Before the graft is inserted, a laminar spreader is placed into the sinus tarsi to check the required height, and the tension on the skin is evaluated.

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(Video) SUBTALAR ARTHROEREISIS (ENG)

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Fractures of the Calcaneus

Michael P. Clare MD, in Core Knowledge in Orthopaedics: Trauma, 2008

Open Reduction and Internal Fixation with Primary Subtalar Arthrodesis

ORIF with primary subtalar arthrodesis is indicated for Sanders type IV highly comminuted intraarticular fractures, whereby the articular surface is unsalvageable.8,15 By restoring calcaneal morphology and the so-called talocalcaneal relationship, both ankle range of motion and complex hindfoot motion in the transverse tarsal joints are optimized.15

Technique

The identical technique as for a displaced intraarticular calcaneal fracture is used.

Once the provisional reduction has been obtained as described previously, including restoration of calcaneal height and length, the posterior facet articular surface is then assessed.

If the posterior facet is confirmed to be unsalvageable, the remaining articular surface is removed while preserving the underlying subchondral bone. The subchondral surface is drilled with a 2.5-mm drill bit for vascular in-growth and supplemental allograft material is placed.

A low-profile neutralization plate and associated screws are then placed as described previously. Fixation of the arthrodesis is completed with two 6.5- to 8-mm cannulated screws from posterior to anterior in diverging fashion into the talar dome and neck. The screws are placed perpendicular to the plane of the posterior facet, and care is taken to avoid violation of the talofibular joint. One or more of the 3.5-mm screws may need to be removed or redirected to facilitate placement of the larger screws.

The patient is kept nonweightbearing in serial short leg casts for 12 weeks, until healing of the fracture and arthrodesis is confirmed radiographically.

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Revision Total Ankle Replacement

Mark S. Myerson MD, Anish R. Kadakia MD, in Reconstructive Foot and Ankle Surgery: Management of Complications (Third Edition), 2019

Subtalar Arthrodesis

If a talonavicular or subtalar arthrodesis is to be performed simultaneously, then the incisions are planned accordingly, to allow an adequate skin bridge on the lateral foot. Typically, the anterior central incision is used, and then as wide a skin bridge as possible is planned to include exposure of the subtalar joint. A short incision over the posterior facet of the joint is sufficient immediately below the tip of the fibula to expose only the posterior facet of the subtalar joint. This will maintain as much vascularity of the talus as possible, and an extensile exposure on the joint with extension into the sinus tarsi should be avoided if possible. Debridement of the cartilage is performed with a curved osteotome, but the remaining talar and calcaneal subchondral bone must be preserved and is perforated with a 2-mm drill. Once the arthroplasty components are inserted, screws are inserted to stabilize the subtalar joint from the neck of the talus, just distal to the talar component, aiming inferiorly into the calcaneus. We use two 5.5-mm screws for fixation. We do not like the idea of inserting the screw from “bottom to top.” This method of placement is not precise, and repeated insertion of guide pins or drilling may compromise the talus further. It is far safer and more accurate to insert from the dorsal surface of the neck of the talus, making sure that the screw head is not impinged against the anterior aspect of the talar component.

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FAQs

Subtalar Arthrodesis - an overview? ›

The primary goals of a subtalar arthrodesis are pain relief, and restoration of hindfoot alignment, which should ultimately lead to increased mobility (Fig. 2). Pain relief is achieved by bony fusion which will prevent shear forces in the joint, and restoration of malalignment will diminish intra-articular peak forces.

What is subtalar arthrodesis? ›

Subtalar arthrodesis entails surgical fusion of the posterior aspect of the subtalar joint to alleviate pain in patients with conditions such as post-traumatic arthritis after calcaneal fractures or adult-acquired flatfoot deformity due to posterior tibial tendon dysfunction, as well as other disorders.

How long does it take to recover from subtalar fusion? ›

You should plan on at least 10 to 12 weeks of recovery before returning to normal activities. Be sure and discuss any return to work with your surgeon. It can take up to one year to feel the full benefits of subtalar fusion. Most patients make a good recovery from subtalar fusion.

How painful is a subtalar fusion? ›

Pain from this joint is often worst when walking over uneven ground. The surgery is usually performed through a 5 cm incision over the outer side of the ankle. The arthritic joint surfaces are removed and the joint surfaces fixed together with a screw(s) through the heel. The operation takes approximately 1 hour.

How long are you non weight bearing after subtalar fusion? ›

After surgery, your leg will be immobilised in a backslab (half plaster) for 2 weeks. Elevation of the foot (above the pelvis) for the first 10 days is vitally important to prevent infection. Naturally, small periods of walking and standing are necessary, but no weight must be taken through this leg for 6 weeks.

How long after ankle fusion can you walk? ›

It will be about six to 12 weeks before you can put weight on your ankle. When you're allowed to walk you'll have to wear a boot or cast that protects your ankle.

Is arthrodesis the same as a fusion? ›

Arthrodesis, also referred to as a joint fusion, the uniting of two bones at a joint, is typically completed through surgery. In simple terms, the orthopedic surgeon manually straightens out the damaged joint, removes the cartilage, and then stabilizes the bone so that they heal together.

Can you wear normal shoes after ankle fusion? ›

12 weeks - you will have an X-ray, and can start to wear normal shoes. Six months - final appointment and X-ray.

How successful is subtalar fusion? ›

Background: Isolated subtalar arthrodesis is generally successful, with reported fusion rates of 84% to 100%. However, alteration of subtalar joint mechanics and talar body vasculature after ankle fusion may negatively influence subsequent ipsilateral subtalar joint fusion.

How long does it take for a subtalar fusion to fuse? ›

You will need to wear a plaster or fracture boot from your knee to your toes until the joints have fused – usually 8-10 weeks.

Can you drive a car with a fused ankle? ›

If your fused ankle/foot is on the left and you have a car with an automatic transmission, you should be mechanically able to perform the functions associated with normal driving.

What motion is lost with subtalar fusion? ›

Isolated subtalar arthrodesis leads to significant loss of ankle movement in the sagittal plane, particularly in plantar flexion. Midfoot joints contribute to continued ankle mobility after a subtalar fusion, offsetting the loss of movement to some extent.

Is ankle fusion classed as a disability? ›

(In November 2005, ankle fusion was included as part of the right foot disability.

What happens at 8 weeks after ankle surgery? ›

Recovery from this surgery is lengthy. You will need to wear a cast or a boot for 3 to 4 weeks after surgery and be non-weight bearing. At 6-8 weeks, you will be in a walking boot with gradually increasing weight-bearing with guidance from your physical therapist.

What can you not do after ankle surgery? ›

In the days and weeks after surgery, you'll likely be told to avoid putting too much (if any) weight on your foot, avoid unnecessary physical labor, and rest as much as possible. You'll also, obviously, prefer to avoid any preventable accidents when moving around the house, or navigating up and down stairs.

Is ankle fusion a major surgery? ›

With the advent of improved arthroscopic (keyhole) equipment, an ankle fusion may now be performed as a minimally-invasive procedure in some patients. This improves wound healing and aids a quicker recovery.

What are the cons of ankle fusion? ›

The risks of ankle fusion include:
  • Infection.
  • Damage to nearby nerves.
  • Bleeding.
  • Blood clot.
  • The bones not joining together properly.
  • Misalignment of the bones.
  • New arthritis in nearby joints (very common)

What are the best shoes to wear after an ankle fusion? ›

Rocker bottom shoes are commonly recommended for patients who have undergone ankle arthrodesis.

Is arthrodesis surgery painful? ›

RECOVERY from ARTHRODESIS

Foot and ankle surgery can be painful. Pain relievers in the hospital and for a time period after being released from the hospital may help. It is important to keep your foot elevated above the level of your heart for one to two weeks following surgery.

Is arthrodesis major surgery? ›

Arthrodesis in the wrist stabilizes the joint. It fuses the long bone in your forearm to the smaller bones in your wrist. This is a major surgical procedure. Your doctor may only recommend it after trying conservative treatments first.

Can you bend your toe after fusion? ›

You may have to wear a special type of shoe or a walking cast during your recovery. After the surgery, you will not be able to bend the toe joint, and your toe may not touch the ground.

Can you wear heels after ankle fusion? ›

About 8-10 weeks after surgery, you can go back to wearing regular shoes. Rush says you can wear whatever type you like, even high heels or sandals.

What do you wear after ankle surgery? ›

You often will have a bulky dressing and/or plaster splint on your operated leg, ankle, and/or foot after surgery, and your clothes must fit around your dressing and/or splint. Examples of such clothes include shorts or sweat pants without elastic bottoms.

Can you wear boots after an ankle fusion? ›

Your Recovery

When you leave the hospital, you will wear a cast or walking boot. And you will use crutches or a walker to keep your weight off your ankle. After surgery, you can expect your ankle to feel stiff and sore around the area where your doctor made the cut (incision).

What happens if foot fusion fails? ›

A major potential complication after midfoot fusion is failure of the bones to fuse (nonunion). Other complications can include over-correction or under-correction of deformity (malunion). There can be problems with wound healing. Prominent plates and screws can be painful and may require removal of the hardware.

Can I run after subtalar joint fusion? ›

Can you run after subtalar fusion? It will be 1 1/2 to 4 months before you can put full weight on the leg. Full healing and resuming normal activities will take about a full year. Running after an ankle fusion is not advised.

What happens if ankle fusion fails? ›

A failed fusion can ultimately result in amputation. Risks for poor outcomes include smoking, noncompliance (walking on it early or removing your brace against your doctor's advice), poorly controlled diabetes, and poor bone density.

How long do you have to wear a cast after ankle surgery? ›

After two weeks, the splint/cast is changed and typically a non-removable walking cast is applied for an additional 4-6 weeks. Weight bearing is typically allowed on this second cast. The use of crutches or a walker is essential during this time.

How should I sleep after ankle fusion? ›

Sleep on your back with a pillow between your knees. Avoid crossing your surgical leg across the middle of your body. Sleep on your non-operative side with pillows between your legs. Avoid bending your knees.

When can I weight bear after ankle fusion? ›

You will have this on for 3 months. You are not allowed to weight-bear on your operated leg for the first 6 weeks, but you are likely to be able to put a little bit of weight through your leg (partial weight bearing) for the second 6 weeks. There is always a small risk that you may pick up an infection with surgery.

How long is physical therapy after ankle fusion? ›

After Surgery

This usually takes between eight and 12 weeks. You should keep your leg elevated above the level of your heart for several days to avoid swelling and throbbing.

Can you walk with a fused ankle? ›

You should anticipate at least a 12-week period of convalescence at home before you are able to resume your normal activities. You will need to use crutches when walking or climbing stairs as you will not be able to bear weight through the ankle.

Can a fused ankle get an ankle replacement? ›

Q. If I decide to have an ankle fusion, can I later have an ankle joint replacement (and vice versa)? Replacement to fusion: It is possible. It is more challenging because we have to use bone graft to fill in the space where the replacement once was, but it is very possible to have a fusion after a replacement.

What is the success rate of ankle fusion? ›

In studies ranging in size from 12 to 101 patients, rates of successful primary ankle fusion of 80–100% have been reported earlier. In other studies ranging from 5 to 62 patients, substantial pain relief ranging from 80 to 100% was reported after successful fusion.

Who is not a good candidate for ankle replacement? ›

In general, ankle replacement is recommended for people older than 60 who don't participate in high-impact activities, such as running, and who are not overweight. The surgery may not be a good option if you have weakened ankle ligaments, misaligned ankle bones or nerve damage from diabetes or other medical conditions.

Is arthrodesis surgery painful? ›

RECOVERY from ARTHRODESIS

Foot and ankle surgery can be painful. Pain relievers in the hospital and for a time period after being released from the hospital may help. It is important to keep your foot elevated above the level of your heart for one to two weeks following surgery.

Do you walk with a limp after ankle fusion? ›

It's usually done to treat ankle arthritis. Ankle fusion surgery impacts ankle mobility and will probably limit activities like running and jumping. Walking after ankle fusion surgery becomes pain free, and most people eventually walk without a limp. Ankle fusion surgery is irreversible.

What is the subtalar joint responsible for? ›

The two bones that make up this joint are the talus bone, located in the curve of your ankle, and the calcaneous bone, which forms your heel. The subtalar joint's primary responsibility is to facilitate gait movements.

How long does it take for a foot bone fusion to heal? ›

Timeline: The recovery period for a foot fusion surgery can range from 2-3 months.

Is arthrodesis major surgery? ›

Arthrodesis in the wrist stabilizes the joint. It fuses the long bone in your forearm to the smaller bones in your wrist. This is a major surgical procedure. Your doctor may only recommend it after trying conservative treatments first.

Can you drive with fused ankle? ›

Arthroscopic Ankle Fusion

Driving is usally not possible until 3 months post surgery unless surgery to left foot only and automatic vehicle.

Can you bend your toe after fusion? ›

You may have to wear a special type of shoe or a walking cast during your recovery. After the surgery, you will not be able to bend the toe joint, and your toe may not touch the ground.

What are the best shoes to wear after an ankle fusion? ›

Rocker bottom shoes are commonly recommended for patients who have undergone ankle arthrodesis.

Is ankle fusion classed as a disability? ›

(In November 2005, ankle fusion was included as part of the right foot disability.

Is ankle fusion a major surgery? ›

With the advent of improved arthroscopic (keyhole) equipment, an ankle fusion may now be performed as a minimally-invasive procedure in some patients. This improves wound healing and aids a quicker recovery.

What does subtalar joint pain feel like? ›

The pain can be sharp and stabbing at times, but is often achy and deep. The pain generally grows worse throughout the day, as weight-bearing activities are performed. The source of the pain is the joint below the ankle joint, called the subtalar joint.

Can you run after subtalar fusion? ›

Can you run after subtalar fusion? It will be 1 1/2 to 4 months before you can put full weight on the leg. Full healing and resuming normal activities will take about a full year. Running after an ankle fusion is not advised.

What 6 movements can be made at the subtalar joint? ›

Subtalar joint
TypePlane synovial joint; three degrees of freedom
InnervationPlantar aspect - medial or lateral plantar nerve Dorsal aspect - deep fibular nerve
Blood supplyPosterior tibial artery, fibular artery
MovementsInversion/eversion, abduction/adduction, plantarflexion/dorsiflexion (gliding and rotation)
2 more rows

How long do I have to wear a boot after toe fusion surgery? ›

After surgery, you may need to wear a special type of shoe or boot for 3 to 6 weeks. It will help protect your foot and keep your bones in the right position. Your doctor will remove your stitches about 2 weeks after the surgery. Follow your doctor's instructions for putting weight on your foot.

How do you shower after foot fusion? ›

You can take a shower 3 days after your surgery. But you must cover your operated foot or dressing with a plastic waterproof cover or a plastic bag. Make sure you do NOT get your dressing wet. NO baths or swimming until your surgeon says it is safe to do so.

Can you wear high heels after toe Fusion? ›

Once fusion is successful, you will be able to wear most shoes (but not necessarily all types and generally not more than a 2 inch/5 cm high heel. There are no limits to the amount of type of exercise activities allowed subsequently.

Videos

1. Subtalar Arthrodesis for Post-Traumatic Subtalar Arthritis (Links to Full Procedure)
(JOMI - Journal of Medical Insight)
2. Subtalar fusion: what is it?
(Ettore Vulcano, M.D.)
3. Subtalar arthrodesis bone preparation
(Dr. Kinast TV)
4. Subtalar arthrodesis for post-traumatic Arthritis
(Docjoints)
5. Subtalar joint arthrodesis using Fixos 2
(Stryker)
6. ProStop® Subtalar Arthroereisis Implant
(What's New in Orthopedics)
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