Composed of two of the seven tarsal bones, the talus and the calcaneus make up the hindfoot. The hindfoot connects the midfoot to the ankle and sits directly inferior to the ankle joint. Patients suffering from pain and stiffness due to arthritis, deformity or repetitive injury may consider undergoing a hindfoot fusion. When seeking a physician to perform a hindfoot fusion, patients should look for board-certified foot and ankle orthopedic specialists.
Surgeons utilize subtalar fusion to stabilize and reduce pain in cases of hindfoot deformity due to trauma, arthritic damage or physiological defect. Subtalar fusion, or arthrodesis, involves fusing the heel bone, or calcaneus, to the talus bone stabilizing the heel and mid-hindfoot. The surgeon removes and fuses the subtalar joint with one or more screws inserted through the heelbone and into the talus.
Your Guide to Subtalar Fusion
Arthritis of the Subtalar Joint
Arthritis gradually destroys the cartilage in joints causing painful bone on bone rubbing that leads to bone spur formation. Arthritis most commonly occurs from natural wear and tear as we age but can also form after a fracture or from an autoimmune issue such as rheumatoid arthritis. Treating subtalar arthritis can end up leading to a subtalar fusion or to eliminate the source of instability and pain.
Trauma to the Subtalar Joint
Fractures involving the subtalar joint, talus or calcaneus can destabilize the hindfoot and can require an open fixation that may include subtalar fusion. Other cases that are non-operative can form post injury arthritis that may eventually require fusion to eliminate the pain and instability.
Deformity of the Subtalar Joint
Some people have developmental risks acquired in their hindfeet that may be either unstable or breakdown with arthritic damage quicker leading to eventual subtalar fusion. Others may have conditions that affect the entire foot and may lead to a breakdown of the subtalar joint and the surrounding structures. A portion of their treatment may involve a subtalar fusion.
How Do Foot and Ankle Surgeons Perform a Hindfoot Fusion?
During hindfoot fusion, the anesthesiologist places the patient under general anesthesia. With a patient under general anesthesia the patient remains asleep throughout the entire procedure and does not awaken until the end of the procedure. The surgeon first cleans the surgical area with an anti-microbial wash. Next, the surgeon makes an incision into the lateral aspect of the foot and compresses the affected joints with specialized hindfoot fusion screws. Typically, only the subtalar joint needs fusing; however, if the patient has widespread arthritis or excess poor foot alignment, the calcaneocuboid joint and the talonavicular joint may also need fusing. To fuse those two joints, the surgeon makes an incision on the medial aspect of the foot. If a surgeon fuses all three joints, surgeons call it a “triple arthrodesis.” A hindfoot fusion screw allows the joints to fuse together creating one solid bone. With one solid bone, the joint no longer moves, which diminishes the patient’s pain of the moving arthritic joint rubbing together. When an arthritic joint rubs together with movement, it creates painful friction. Once the foot and ankle surgeon completes their work, they close the wound and that completes the procedure.
The hindfoot fusion screw must stay in for a minimum of six months, but surgeons can remove a hindfoot fusion screw in a relatively quick procedure if the screw causes the patient too much pain or discomfort.
Subtalar Fusion Procedure
Patients that end up needing a subtalar fusion can expect to go home the same day as the surgery. We often perform a subtalar fusion with an arthroscope on an out-patient basis, but may have to perform the case traditionally if needed. The patient undergoes anesthesia and the surgeon removes the cartilage from portions of the calcaneus and talus in the subtalar joint. The surgeon fills bone graft material into the created void and fixates the two bones together with one or more screws driven through the heelbone and into the talus.
Potential Risks and Complications Associated With Hindfoot Fusion
Potential risks may arise any time something punctures the skin. During a hindfoot fusion, potential risks include those associated with anesthesia, infection, excessive bleeding, blood clots and nerve damage. Surgery-specific potential risks include the failure of the bones to fuse, over- or undercorrection of deformity, or issues with the screws used. If a patient suspects they may have any of these previously listed risks, they must let their provider know immediately.
Subtalar Fusion Recovery
The patient can bear no weight for at least six weeks as the bone fusion site heals. After six weeks the patient will wear a boot or cast for another six weeks. Subtalar fusion has a high success rate and most patients return to full capacity between 6 to 12 months. Subtalar fusion has a low rate of non-union with risk factors that include patient non-compliance, diabetes, smoking and obesity. Non-union healing results in additional surgical correction. Walking and running will feel different for the patient due to the fusion, but most patients can walk without a limp and learn to have a new normal with the slight loss of foot flexibility.
F.A.Q.
What Is Hindfoot Fusion, and How Does It Help With Orthopedic Conditions?
Hindfoot fusion is a surgical procedure designed to treat various orthopedic conditions affecting the hindfoot region of the foot and ankle. This procedure involves the fusion of bones in the hindfoot to improve stability, alleviate pain and correct deformities. By eliminating motion between specific bones, hindfoot fusion can effectively address conditions such as arthritis, deformities and severe injuries in the hindfoot.
Who Is a Candidate for Hindfoot Fusion?
The eligibility for hindfoot fusion surgery depends on the individual’s specific condition and its severity. Typically, candidates for hindfoot fusion may include patients with severe hindfoot arthritis, hindfoot deformities, fractures that disrupt the stability of the hindfoot or failed previous surgeries. It is essential to consult with our experienced orthopedic specialists at OrthoTexas for a thorough evaluation and personalized assessment to determine if hindfoot fusion is the right treatment option for you.
What Is the Recovery Process After Hindfoot Fusion Surgery?
The recovery process after hindfoot fusion surgery varies depending on the extent of the procedure and the patient’s overall health. Generally, patients can expect a period of immobilization with the use of a cast or brace to support the healing process. Physical therapy may also be recommended to aid in rehabilitation and regain strength and mobility. It’s crucial to follow the postoperative instructions provided by our orthopedic team at OrthoTexas diligently. The complete recovery timeline can vary but usually ranges from several weeks to several months, and our experts will monitor your progress to ensure the best possible outcome.