What signs indicate surgery may be needed?

Triple arthrodesis is indicated for severe arthritis, instability or deformity that cannot be controlled with nonsurgical approaches. Other conditions, such as severe flatfoot, abnormal connections between bones, excessively high arches and joint instability due to neuromuscular disease, can also warrant treatment with fusion.

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When should I avoid surgery?

Patients who are still growing are not ideal candidates as they may develop additional deformities as they grow. Patients who use tobacco, have an active infection or have poor healing potential are at higher risk for complications. Nonsurgical measures such as bracing and anti-inflammatories should be attempted first. If another surgical procedure that leaves the joint intact can achieve the same goal, this is preferred over a fusion.

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General Details of Procedure?

Two incisions are generally required for this procedure. The traditional method involves one incision on each side of the foot. Within each joint cartilage is removed, bony surfaces roughened, and defects filled. Once all three joints have been prepared, they are put into place and hardware is placed to stabilize the reconstruction and promote healthy fusion.

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Specific Technique

The surgeon confirms the proper position of the bones with an X-ray while in the operating room. Then all incisions are closed and covered with bulky dry sterile dressings. To lessen post-operative pain, the nerves around the knee or ankle may be numbed with medication.

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What happens after surgery?

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 healing of the skin. Stitches may be removed two to three weeks after surgery.

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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.

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Potential Complications

Successful triple arthrodesis is appreciated by patients. 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.

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There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

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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.