PLEASE KEEP YOUR FOOT ELEVATED ABOVE YOUR HEART AS MUCH AS POSSIBLE FOR THE FIRST FEW WEEKS AFTER YOUR SURGERY
This is an operation to fuse or stiffen the ankle joint. It is done for 2 reasons:
1. Arthritis of the joint - joint wear and tear
2. Severe deformity of the rear part of the foot. Sometimes if you have an ankle problem as a result of a significant foot deformity it can be treated by procedures involving reshaping the foot bones or fusing the other foot joints. In other cases it is best to fuse the joint into an optimal position, particularly if the joint is already stiff or the foot is weak.
The only extra operation, which will be discussed here, is the combination of a fusion of the ankle and the joint below the ankle – the subtalar joint. This operation is called a tibiotalocalcaneal fusion as it fuses the shinbone to the main bones in the back of the foot – tibia, talus and calcaneum. It is included here because it changes the way the ankle operation is done.
Once the joint has been fused, it cannot later be changed to the ankle replacement. This is because the foot becomes too stiff for an ankle replacement to work.
What does it involve?
You will have a general anaesthetic. An incision is made on each side of the ankle and the joint is opened up. The joint surfaces are removed and if necessary, reshaped to correct a deformity. The joint is then put in the correct place and fixed with 2/3 screws.
Less frequently, the shinbone – tibia and 2 ankle bones may be fused with a large metal rod, which is inserted through a cut in the bottom of the heel. This procedure will be discussed in more detail with you if it is required.
How long will I be in hospital?
An ankle fusion usually requires you to stay in hospital for 2-5 days.
After surgery your foot is at risk of swelling, so you will have to rest with your foot raised to help the swelling to go down. This may take anything from 2-7 days. If you don’t elevate enough, this may cause problems with the healing of your foot. A resting plaster slab will be applied.
Once the swelling goes down and the incisions on your foot are healing, your foot will be put in a light weight plaster and you can get up with crutches and go home. The physiotherapist will teach you how to walk with crutches.
Will I have a plaster on afterwards?
You will need to wear a plaster from below the knee to your toes until the ankle has fused – usually 8-10 weeks.
For the first 3-4 weeks you should not put any weight on your foot as it may disturb the healing joint. Occasionally touching your foot to the ground for balance is ok, but no more.
What will happen after I go home?
By the time you go home you will have mastered walking on crutches without putting weight on your foot. You should remain non weight bearing for 3-4 weeks.
10-14 Days after surgery
You will be seen again in the clinic. Your plaster will be removed and the wounds and swelling will be checked. If all is well you will be put back in plaster. You should continue walking with your crutches and not putting weight through the foot.
4 Weeks after surgery
You will return to the clinic for a follow up appointment. An X-ray will be taken and if this shows the joint is healing in a good position you can start putting about half your weight through the plaster.
Mr Williams will guide you as to when you can start taking your full weight through the plaster. When you commence weight bearing you will be given a special shoe that can be worn over the plaster.
You will have further x-rays over the next few weeks – exactly when and how often will be determined by how well your foot is healing. When the x-rays show that the joint is fused enough to take your weight, the plaster will be removed and you can start walking with out it.
Once your plaster has been removed, you will be allowed to have a proper bath/shower!
You will be given an Aircast boot to wear. This is usually worn for about a month for walking only.
Why do I need physiotherapy?
It is important that you regain as much function as possible from your whole leg after the ankle joint has been fused as the joint may be swollen and somewhat uncomfortable in the early stages post operatively. Other joints will have to compensate for the loss of ankle movement. In order to avoid any future problems with related joints, your physiotherapist will assess your mechanics carefully and may make recommendations regarding how to optimise the effect of the operation. This may be with specific exercises and/or the use of Orthotics – specifically designed insoles for your feet.
Your physiotherapist will let you know how and when you can return to normal activities including sport.
Returning to normal activities / work
If your foot is comfortable and you can keep your foot up and work with your foot in a special shoe, you can go back to work within 2-3 weeks of surgery. On the other hand, in a manual job with a lot of dirt or dust around and a lot of pressure on your foot, you many need to take anything up to 6 months off work. How long you are off will depend on where your job fits between these two extremes.
If you have only your left foot operated on and have an automatic car, you can drive within a few weeks of the operation, when your foot is comfortable enough and you can bear weight through it. Most people prefer to wait until the plaster is removed and they can wear a shoe.
After your plaster is removed you can start taking increasing exercise.
Start with walking or cycling, building up to more vigorous exercise as comfort and flexibility permit. Obviously, the foot will be stiffer after surgery and you may not be able to do all you could before. However, many people find that because the foot is more comfortable than before surgery they can do more than they could before the operation. Most people can walk a reasonable distance on the flat, slopes and stairs, drive and cycle. Walking on rough ground is more difficult after an ankle fusion because the foot is stiffer. It is rare to be able to play vigorous sports such as squash or football after the ankle fusion, however golf and doubles tennis should be fine.
What can go wrong?
The main problem is late swelling of the foot i.e. after your plaster has been removed. This may take several months to go down completely so you may find that only trainers are comfortable in the initial stages. It is not uncommon for the foot to remain slightly swollen for the first nine months post operatively.
Elevating your foot, applying ice and wearing elastic stockings help to keep the swelling down.
Swelling is part of your body’s response to surgery rather than the operation going wrong but it is a nuisance to many people who may be concerned that something has indeed gone wrong. If you are worried about the swelling of your foot, ask Mr Williams or your physiotherapist whether the amount of swelling you have is reasonable for your stage of recovery.
The most serious thing that can go wrong is infection in the bones of the ankle. This only happens in about 1% of people, but if does it is serious, as further surgery to drain and remove the infected bone and any infected screws or pins will be necessary.
About 5% of ankle fusions do not heal – non-union – and need a further operation to get the bones to fuse – basically another ankle fusion.
Minor infections in the wounds are slightly more common and normally settle after a short course of antibiotics.
If you develop a fever associated with an increase in pain and a discharge from the wound please call Mr Williams’ secretary. If you have any questions please call Mr Williams’ secretary.