Orthopaedic Surgery - Hindfoot Fusion (Arthrodesis)

What is a hindfoot fusion?

The foot is made of many small bones. This means there are many joints where these bones come together. The hindfoot are the areas in the back of the foot. A hindfoot fusion involves one or more of the joints being permanently stiffened in that area of the foot.

Why do I need this operation?

The main reason the operation is performed is due to arthritis causing pain and stiffness. Arthritis results in the soft protective cartilage layer around the end of the bones becoming worn away. This can occur through wear and tear of the joint as well as due to other conditions such as rheumatoid arthritis and fractures.

Deformities of the foot, such as flat foot (pes planus), can cause the joints to wear out and collapse. By removing the joints and fusing the bones together the operation will improve pain and correct any deformities.

How is a diagnosis made?

You will firstly have a clinical examination by a foot and ankle specialist, and x-rays will be taken of your foot. A diagnosis will be made as there may be other reasons for the pain in your mid-foot area.

Are there any alternative treatments?

Non-surgical treatment may be offered initially if appropriate. This depends on the severity of the pain and stiffness in your foot along with any other medical conditions you may have, such as diabetes or circulatory problems.

The alternative treatments may include painkillers, insoles and splints provided by an orthotist. Adapting footwear to provide more support to your foot can often help. Stiff sole shoes, ankle boots and calipers may be recommended.

Steroid injections are often given as this can also help your specialist determine which and how many of the joints to fuse. Once these options have been explored a fusion may be offered to relieve pain and correct deformity.

What does the operation involve?

The operation usually involves a general anaesthetic (asleep) with a local anaesthetic block to provide good pain relief following surgery.

An incision (cut) is made over the joint. Often more than one incision is made depending on which and how many of the joints are to be fused.

The surfaces of the joint are removed to create the edges of the 2 bones. Sometimes there is a small gap between the edges of the bones which may be filled using bone graft taken from the heel bone.

The edges are then held together and positioned carefully to correct any deformity. Screws will then permanently fix the bones in the correct position, allowing them to heal and fuse together.

Subtalar Fusion

What are the risks?

There are general risks relating to all surgery of the foot which includes infection, scarring, swelling, numbness and blood clots.

The main specific risk is failure of the bones to fuse. This risk is increased in patients who are diabetic, have rheumatoid arthritis and in those who smoke. It is therefore important to stop smoking prior to the operation and during recovery.

You will be given medication to reduce the risk of developing blood clots for the whole time that your leg is in a plaster cast.

What happens after the operation?

Following the procedure a dry dressing will be applied to the wound with a plaster backslap.

It is important that this remains intact, clean and dry until you are seen in clinic in about 2 weeks, where the dressing and stitches are removed.

You will be placed in a full below knee plaster and remain non- weight bearing for another 4 weeks.

At the 6 weeks point you will be put in to a boot and you will be able to partially weight through the leg for a further 6 weeks. It is imperative that you keep your foot elevated above the level of you heart to control the swelling in your foot.

After 12 weeks you will be able to gradually increase the amount of weight you put through your leg.

Will I be able to wear normal shoes?

Once your foot has fully healed and the bones have fused you will be able to wear normal shoes. It is recommended that you wear stiff soled shoes for support.

Further information

Please inform staff of any concerns or questions you may have. We will do our best to answer your queries quickly.