Midfoot Arthrodesis, Midfoot Fusion
Midfoot arthrodesis is the procedure where one or more of the metatarsal cuneiform joints or intercuneiform joints are fused. This is a surgical technique used to treat some types of midfoot arthritis. Surgery to make two or more different bones grow together is called Arthrodesis, or Fusion. It is sometimes used for patients who have previously had a fracture or dislocation, and have chronic pain. Some patients with rheumatoid arthritis or osteoarthritis will benefit from this surgery.
This surgery can be done as an outpatient. You will need a General anesthetic or Spinal anesthetic.
During the surgery one or more parallel 3 inch long incisions are made on the top of the midfoot. The bone ends are prepared by removing any remaining cartilage. They are held together with one or more screws.
A Bone Graft is occasionally used to fill any gaps in the bones, and improve the chances of solid fusion. This is routinely taken from the iliac crest, above the hip. That will be taken from the same side as the foot. If I anticipate that a bone graft will be needed, I will ask that you spend one night in the hospital after the surgery.
Look here for things to watch for after Outpatient surgery, or after Inpatient Surgery.
Day of Surgery
At the end of the surgical procedure the wounds are covered and a short leg plaster splint is applied. That dressing gives support to the foot, holding it securely. That should be left in place until I change it at the first post-operative office visit.
You should try to keep your foot elevated a much as possible to minimize swelling.
You will be given crutches or a walker at the surgery center, and I want you to not put any weight on that leg during the first 6 weeks. Do not walk on the splint.
Dealing with post-operative pain will be your major concern for the first few days.
The first post-operative visit is usually 7 – 10 days after surgery. At that time I will remove the splint and dressings, wash your foot, and take out the Skin Stitches.
I will then put your leg into a short leg cast. This is not a walking cast, so you will still need to use the crutches or walker. You will wear this until 6 weeks after the surgery. Do not walk on the cast.
The second post-operative visit is usually at the 6 week point. At that time I will remove the cast, and check to make sure that everything is healing satisfactorily. I will then have you go into a CAM Walker, and you will wear that for protected weightbearing for an additional 6 weeks. You must wear it when you do any walking.
I will ask to see you next after an additional 6 weeks, the 3 months point after surgery. I will have you get an Xray then to make sure that the arthrodesis is healing satisfactorily, and there are no problems with the metal implants. I will allow you to go into a regular shoe then.
Most people “wean” off the CAM Walker and back into a regular shoe. This takes a variable amount of time, and depends on how comfortable the regular shoe feels. It may take a few days, or up to a month.
Most patients have swelling about the surgical area that lasts for about 4 months after surgery. It generally takes 9 – 12 months for complete healing to occur.
The goal of the surgery is to leave you with a painless foot that will allow normal walking. How successful that will be is variable. It is usually possible to make the foot pain-free for daily activities. Some patients will have some mild soreness still. Most patients will notice discomfort when the weather changes.
There is usually not a significant loss of foot motion after this surgery. Most people can ultimately wear shoes without restrictions.
Complications can occur with any surgery. Go here for a general discussion of Surgical Complications.
Specific risks of this surgery include the possibility of the bone not healing, or non-union, and implant problems. It would be rare for midfoot arthrodesis to cause problems in any other joints in the future.