Foot fusion surgery

Foot fusion surgery is carried out to permanently join or stiffen the joint between arthritic bones. It is used to treat a wide range of conditions including arthritis, flat feet, rheumatoid arthritis and previous injuries such as fractures caused by wear and tear to bones and cartilage.

How is it carried out?

The operation, which usually involves staying overnight in hospital, is performed under a general anaesthetic with an added injection in the leg to numb the foot after surgery and reduce pain.

In most cases the surgeon makes one or two incisions (cuts) in the foot, depending on which joints are being fused together. The painful damaged joint is removed and the bones are stiffened with plates and screws that remain in the foot to increase stability and allow the bones to fuse (join) as they heal. If extra bone is needed to help the bones join, this can be taken from another area of your body or from donor bone; however, you will be able to discuss this with the surgeon before the procedure.

Will having my bones fused together cause me any problems?

No. The wear and tear that has caused arthritis has already caused the bones to be stiff and painful so, while the operation will not relieve the stiffness, it will relieve the pain in the joint and should not result in any other problems.

Recovery

Immediately after surgery:

• Your foot will be in a plaster cast to the knee. It will be numb and pain free
• You will see a physiotherapist who will advise on walking without bearing your weight
• You will be sent home only when you are comfortable, with a follow-up appointment and painkillers if required

During the first few weeks:

• Elevate your foot (raise it above the level of your heart) as much as possible to reduce the swelling
• Move around only when you need to, for example to wash or use the toilet. Don’t put weight on the operated leg
• Some blood ooze can be expected in the bandage. If you are worried, contact the Fortius Clinic
• Take painkillers as prescribed
• Avoid smoking and taking anti-inflammatory medications as this may delay or even prevent the bones from fusing together

Follow-up appointments:

Everyone is different, so healing and post-operative programmes vary from person to person. However, the schedule of follow-up appointments below is typical:

• Two weeks - your wound will be checked, you will have an X-ray and a new cast
• Six weeks - you will have an X-ray and may be given a new cast/boot
• 12 weeks - you will have an X-ray and should be able to wear your own shoes
• Six months - final appointment, X-ray and discharge

When can I start to walk?

Patients can respond differently to the surgery with some patients being able to cope better than others with walking, especially in the early stages post-operatively. However, below is a guide to what may be advised :

• 0-2 weeks - you will have a plaster cast and will be given crutches to keep the weight off your foot
• 2-6 weeks - you will be given a lightweight cast and continue to use crutches to keep the weight off your foot
• 6-12 weeks - you can start to bear your weight wearing a boot or cast with crutches if advised
• After 12 weeks - you should be able to fully bear your weight wearing your own shoes

Physiotherapy and rehabilitation

You will be referred to a physiotherapist who can design a personalised rehabilitation programme that includes gait re-education (walking correctly), and helping to reduce swelling and muscle tightness.

How do I wash and shower?

It’s important to keep the plaster cast totally dry. However, you will be able to shower with a waterproof cover over the plaster. Once the plaster is removed, it’s fine to shower without the cover if the wound is healed, but gently dab it dry.

How can I look after the wound?

Once out of cast, don’t pull at your scabs, let them fall away naturally. If your wound becomes red, swollen or sore you should contact the Fortius Clinic and arrange to see your consultant to check you don’t have an infection. Your physiotherapist may also be able to advise on wound massage when it has healed.

When can I start to drive again?

The DVLA states it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car in an emergency stop. This will take at least 12 weeks.

Although your specialist will advise you about when it’s safe to start driving again, it remains your responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.

When can I return to work?

This depends on the type of work you do and how quickly you recover. As a general guide, if your job involves sitting down for most of the time, you should be able to return to work after three weeks; if it involves manual work, you may need to have 12-16 weeks off.

What long-term outcome can I expect after surgery?

This is a very successful procedure, with excellent outcomes in over 90% of patients. You can expect:

• Excellent pain relief which improves as the joints fuse (join) at around three months
• good level of activity and sports by six months, continuing to improve for up to 12 months, although you may experience swelling in your foot for up to a year

What are the risks?

Below is a guide to the risks of this type of surgery. However, your surgeon will discuss these with you before your procedure, and answer any questions you may have:

Infection: The risk of infection is around 1% and this can usually be effectively treated with antibiotics. Serious problems caused by infection are very rare and can be treated

Nerve damage: Nerves that supply feeling to the skin are near the incision site. Permanent damage is rare (around 5%-10%) but if your toe stays numb after surgery, it may be because the nerve is bruised but it will usually recover

Non-union: This means the bones fail to join together as they heal (the risk of this is around 5-10%). Although non-union can be painless, in which case it may not need treatment, in some cases you may need further surgery

Prominent metalwork: Sometimes the metal used to fuse the joint can be prominent. However, once the bones have fused (usually after around six months) the metal can easily be removed during a minor day case procedure

Deep Vein Thrombosis (DVT): You may be given blood-thinning medication after the surgery if you are at a higher risk of DVT (where a blood clot forms in a deep vein in the leg). However, the risk of this is less than 3% and may be reduced if you keep your ankle moving and carry out the recommended exercises

Important:This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery