Hindfoot fusion is a surgical procedure that involves joining together the joints in the hindfoot. It can be a very successful surgery to treat severe arthritis and deformities of the hindfoot. Bony fusion restricts the movement of the fused joints, which can help relieve pain in that area. Depending on the specific injury or condition, different joints may be fused. The fusion can involve a single joint or multiple joints, depending on the patient’s needs. Subtalar joint fusion, talonavicular fusion, and triple fusion are all variations of hindfoot fusion surgery. Triple fusion specifically involves fusing three joints: the calcaneocuboid, subtalar, and talonavicular joints.

During the surgery, one or two incisions are made on the top and side of the foot. Any arthritic matter is removed, and the damaged cartilage is shaved off. The joint is then fused using screws and sometimes plates and staple devices.

Following a successful hindfoot fusion, there are generally no restrictions on activities and exercise. The screws and plates used in the fusion are typically intended to be permanent, but they can be removed if they cause discomfort or other issues. Hindfoot fusion surgery is typically performed on an inpatient basis, and patients are often discharged from the hospital within one to two days. General anesthesia is frequently used for this procedure, and many surgeons also recommend a nerve block to numb the foot, which helps alleviate pain after the surgery.

Length of surgery

The duration of hindfoot fusion surgery is influenced by factors such as the condition of the joints, the number of joints being fused, and other variables. On average, the procedure generally takes about two hours to complete.

Risks of surgery

All surgical procedures, including orthopedic surgery, carry inherent risks. It is the responsibility of the surgeon to provide patients with comprehensive information about these risks. At Flint Foot & Ankle, our team will thoroughly explain all the risks associated with your specific surgery. Some risks are common across different types of surgery, while others are unique to the specific procedure being performed.

Standard risks associated with surgery include the possibility of infection, skin healing issues, numbness or nerve issues, and the development of blood clots. Infections can occur at the surgical wound site, although deep infections are rare. Nerve damage or sensations of “pins and needles” can be experienced at the incision site. These sensations often subside over time as the nerves heal. Blood clots are another infrequent complication, and precautionary measures are taken to minimize this risk. Blood thinners are frequently prescribed to help prevent blood clots from forming.

Nonunion is a specific complication that can occur in hindfoot fusion surgery, where the joints fail to fuse properly. In some cases, nonunion may occur without causing any pain, and in such situations, no intervention is typically required. However, if the patient continues to experience persistent pain, it may be necessary to consider a repeat hindfoot fusion surgery. Surgeons generally advise allowing at least a year to pass before determining the success of the fusion, as it takes time for the bones to properly fuse together. Nonunions can be prevented by following your surgeon’s postoperative protocol and not weight bearing on your foot too soon.

Recovery

After the hindfoot fusion surgery, the foot will be wrapped in a bulky dressing to provide immobilization and support. It is crucial for patients to refrain from putting weight on the operated foot for six to twelve weeks–depending on the exact procedure performed. In the hospital, the medical staff will guide and assist the patient in learning to walk with crutches and provide necessary post-surgical care. Following discharge, pain medication is typically prescribed to help patients manage any discomfort.

During the initial week after surgery, it is recommended that the patient elevate their leg to alleviate pain and reduce swelling. Pain medication should be taken as needed, following the prescribed dosage instructions.

Your surgical team and Flint Foot and Ankle Institute will follow you closely after your surgery. Within the first three weeks after the hindfoot fusion surgery, most patients have a follow-up appointment scheduled with their surgeon. During this visit, X-rays may be taken to assess the progress of the fusion. Any non-absorbable sutures will be removed, and the surgical wound will be carefully inspected to ensure proper healing. The bulky bandages will be replaced with a supportive boot, providing better mobility and protection.

At the six-week mark following surgery, additional X-rays are often taken to evaluate the healing process. Some patients are allowed to start walking with the assistance of the boot at this stage of the post-operative period. By around 12 weeks after the surgery, the swelling typically begins to subside, and patients can transition back to wearing normal footwear. However, it’s important to note that the timeline for recovery may vary depending on individual circumstances, and it is best to follow the specific guidance and recommendations provided by the surgeon. Physical therapy can also be helpful in maintaining control of your swelling and helping the patient return to walking more smoothly.

Hindfoot fusion surgery has the potential to greatly enhance a patient’s quality of life by reducing or even eliminating daily pain. However, it is important to note that this surgery does require a significant healing period. The recovery process following fusion surgery may feel slow, and there can be discomfort associated with the healing process. Nevertheless, the long-term benefit of being free from daily pain outweighs the temporary discomfort. If you are considering hindfoot fusion surgery, the experienced team at Flint Foot & Ankle can provide a comprehensive evaluation to determine if this surgery is the right choice for you.