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Subtalar Fusion

What is the subtalar joint?

The subtalar joint is located just below the ankle joint between the talus bone and the calcaneus bone (heel bone). The main job of the subtalar joint is to allow for side‐to‐side movement of the foot and ankle. This movement aids walking, especially on uneven surfaces.

What is a subtalar fusion?

A fusion surgery causes two bones that normally move against each other through a joint to heal together. Fusion is appropriate for diseased joints when replacement of the joint is not an option. Once the area heals together, it acts as one unit but can restore function and provide significant pain relief. Generally speaking, fusion is also very durable.

Subtalar fusion is performed to either correct rigid deformity or instability of the subtalar joint or to remove painful arthritis of this joint. During surgery, this joint between the talus bone above and calcaneus bone below is removed as the joint surfaces are fixed together. The aim of subtalar fusion is to decrease symptoms and allow improved function with less pain. You will still feel unbalanced on rough ground and boots help with this.

How long will I have to stay in hospital?

You will come into hospital on the day of your plaster cast. operation and usually stay in for one night.

What happens after surgery?

After surgery, pain medication will be required for a period of time. Some people may require medication only for a day or two and others for longer. In the first few weeks after surgery you must rest and elevate the operative leg to control swelling and allow the skin incisions to heal. When upright, you may experience throbbing and discoloration in the toes as the blood rushes back to the foot, but typically this resolves with elevation. It is important to keep weight off the foot.
Once stitches are removed, there will be fewer restrictions. A boot or cast is usually placed after the initial surgical bandages are removed. The boot or cast will be in place for 12 weeks, sometimes longer for certain patients. You will be in a cast for 8 weeks, non weight bearing. Then a boot for 6 weeks during which you will be allowed to start weight baring.X‐rays will be taken at 6 and 12 weeks to help guide this.

What are the complications for this operation?

A potential complication of any fusion procedure is a failure of the fusion to heal, which is called a non‐union(10%). Healing in a
bad position can also occur, but this is not common(5%). Other complications include infection (1%), nerve damge (2%) and removal of metal (1%). Following your surgeon’s instructions is very important to avoid complications

There is a small risk of a clot forming in the leg veins (Deep Venous Thrombosis or DVT) associated with any form of orthopaedic surgery. This is the same type of clot that passengers on long aeroplane flights may develop. A DVT may cause the leg to swell and
occasionally the clot may break loose and lodge in the lung (Pulmonary embolism or PE). Overall the risk of a DVT or PE is small and we will take active measures to minimise this risk to you.

A DVT is more likely if you are overweight or smoke. You can reduce the risk of developing a DVT by getting up and walking about as soon as possible after your operation.
A DVT may only be obvious after you have gone home. If you notice any swelling of the calf or more rarely the thigh, or you experience pain or tenderness in the calf, or notice that your leg is shiny or discoloured you should seek medical advice quickly. You should also contact a doctor immediately if you develop shortness of breath or pain on breathing following surgery.

What happens before the operation?

Prior to admission you will need to have a pre‐ operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. The pre‐operative assessment nurses are there to help you with any worries or concerns that you have, and can give you advice on any preparation needed for your surgery.
Before the date of your admission, please read very closely the instructions given to you.
If you are undergoing a general anaesthetic you will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose an anaesthetic risk and we may have to cancel your surgery.

What does the operation involve?

Patients are positioned on their back or side to allow exposure of the operative leg. Subtalar fusion is most often performed through an incision on the outer side of the foot. The joint surfaces are prepared by removing all cartilage and correcting all deformity. The bone surfaces are roughened to stimulate bleeding. This bleeding allows the two bones to heal together after the joint is fixed with hardware. X‐ray will be used during the surgery to ensure proper alignment and hardware position. Sometimes bone graft is added to help the healing. Once surgery is finished, the foot and ankle are placed in a plaster cast.

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