Foot Fusion (Arthrodesis): Types, Indications, Recovery, and Life After Surgery

What is the name of the surgery for foot fusion?

The overarching medical term for a surgical procedure that permanently joins bones across a joint, thereby eliminating movement, is arthrodesis. When performed on the foot or ankle, it is specifically referred to as foot arthrodesis or ankle arthrodesis, depending on the precise joint(s) involved.

Understanding Foot Fusion (Arthrodesis)

Arthrodesis is a reconstructive surgical procedure designed to fuse two or more bones together across a joint. The primary goal is to create a single, solid bone structure, effectively eliminating motion at that specific joint. This procedure is typically reserved for cases where pain, instability, or severe deformity cannot be adequately managed by less invasive methods or other surgical interventions. By eliminating motion, the source of pain, often from degenerated or arthritic joint surfaces, is removed, and stability is significantly enhanced.

Common Types of Foot and Ankle Arthrodesis

While "foot fusion" is a general term, the specific name often depends on which joints are being fused. The foot and ankle comprise numerous small bones and joints, and fusion can target various areas:

• Ankle Arthrodesis (Tibiotalar Arthrodesis): This involves the fusion of the tibia (shin bone) with the talus (the primary bone of the ankle joint). It is commonly performed for severe ankle arthritis, instability, or deformity, leading to a rigid ankle that no longer moves up and down.
• Subtalar Arthrodesis: This procedure fuses the talus with the calcaneus (heel bone). The subtalar joint is crucial for inversion and eversion (side-to-side motion) of the foot. Fusion here addresses conditions like severe flatfoot, hindfoot arthritis, or instability.
• Triple Arthrodesis: As the name suggests, this is a more extensive procedure involving the fusion of three specific joints in the hindfoot:
  • The subtalar joint (talus and calcaneus).
  • The talonavicular joint (talus and navicular bone).
  • The calcaneocuboid joint (calcaneus and cuboid bone). This comprehensive fusion is often performed for severe, complex hindfoot deformities, neuromuscular conditions, or extensive arthritis affecting multiple joints.
• Midfoot Arthrodesis: This refers to the fusion of joints within the midfoot region, such as the tarsometatarsal (TMT) joints, naviculocuneiform joints, or cuneiform-cuboid joints. It's indicated for arthritis, instability, or deformity in the arch of the foot, often seen in conditions like Charcot foot or severe flatfoot.
• Forefoot Arthrodesis: Fusion can also occur in the forefoot, most commonly involving the metatarsophalangeal (MTP) joints (the joints at the base of the toes) or the interphalangeal (IP) joints (joints within the toes). A common example is first MTP joint arthrodesis for severe hallux rigidus (big toe arthritis) or severe bunion deformities, which aims to stabilize the great toe.

Why is Foot Fusion Performed? (Indications)

Foot and ankle arthrodesis is typically considered when non-surgical treatments have failed to alleviate symptoms or when the condition is too severe for conservative management. Key indications include:

• Severe Arthritis: This is the most common reason, including osteoarthritis (wear-and-tear arthritis), rheumatoid arthritis, and post-traumatic arthritis (arthritis developing after an injury). Fusion eliminates the painful bone-on-bone rubbing.
• Deformity: Significant structural deformities of the foot or ankle that cause pain, impaired function, or difficulty with shoe wear (e.g., severe flatfoot, high arch foot, Charcot neuroarthropathy).
• Instability: Chronic or severe instability of a joint that cannot be corrected by ligament repair or other stabilizing procedures.
• Neuromuscular Conditions: Certain conditions that cause muscle imbalance, weakness, or spasticity leading to severe foot deformities (e.g., cerebral palsy, stroke, Charcot-Marie-Tooth disease).
• Failed Previous Surgeries: In some cases, arthrodesis may be performed after other reconstructive surgeries have failed to achieve the desired outcome.

The Surgical Procedure and Recovery

The specific surgical technique varies depending on the joint(s) being fused, but the general principles remain consistent:

• Preparation: The patient is given general or regional anesthesia. An incision is made to access the affected joint.
• Joint Preparation: The damaged cartilage and underlying bone are meticulously removed from the joint surfaces, exposing healthy, bleeding bone. This promotes bone growth across the joint.
• Bone Grafting: In some cases, bone graft material (either from the patient's own body, a donor, or synthetic) may be packed into the joint space to encourage fusion.
• Fixation: The bones are then held together in their corrected position using internal fixation devices such as screws, plates, staples, or rods. These devices provide stability while the bones heal together.
• Closure: The incision is closed, and the foot is typically placed in a cast or splint.

Recovery is a lengthy process, as bone fusion takes time.

• Non-Weight-Bearing: Patients are usually non-weight-bearing for 6-12 weeks, requiring crutches, a walker, or a knee scooter.
• Immobilization: A cast or walking boot is worn for several months.
• Rehabilitation: Once initial healing occurs, physical therapy is crucial to regain strength, improve gait, and adapt to the altered mechanics of the fused foot.
• Full Recovery: Complete bone fusion and return to most activities can take 6-12 months, or even longer for complex fusions.

Potential Risks and Considerations

Like any surgical procedure, foot fusion carries potential risks, including:

• Non-Union: The most significant risk is that the bones fail to fuse together (non-union), which may require further surgery.
• Infection: As with any surgery, there is a risk of infection at the surgical site.
• Nerve Damage: Temporary or permanent nerve irritation or damage can occur.
• Adjacent Joint Arthritis: While fusion relieves pain in the targeted joint, it shifts stress to the surrounding joints, which may accelerate their degeneration over time.
• Limited Range of Motion: The primary goal of fusion is to eliminate motion, which means the patient will lose flexibility in the fused joint.
• Hardware Issues: Screws or plates can sometimes cause irritation and may need to be removed in a subsequent procedure.

Life After Foot Fusion

While foot fusion significantly limits movement in the fused joint, it often provides substantial pain relief and improved stability, which can greatly enhance a patient's quality of life. Patients typically experience:

• Reduced Pain: The primary benefit is often significant or complete elimination of pain originating from the fused joint.
• Improved Stability: The foot becomes more stable, making walking and standing easier and safer.
• Gait Adaptation: Patients learn to adapt their gait to accommodate the lack of motion. For ankle fusions, this might involve a slight rocking motion of the foot or increased motion at the knee and hip.
• Activity Modifications: While many patients return to daily activities, high-impact activities like running or jumping may be difficult or not recommended due to the increased stress on adjacent joints.
• Shoe Wear: Most patients can wear regular shoes, though custom orthotics or specific shoe types may be recommended to optimize comfort and support.

Foot fusion is a significant procedure, but for individuals suffering from severe, debilitating foot or ankle conditions, it can be a life-changing intervention that restores function and alleviates chronic pain.