Midfoot Arthrodesis

Diagnosis:

Midfoot arthritis

Surgery:

Midfoot arthrodesis/fusion

Post operative orders:

Plaster backslab 2 weeks – this is applied in the OR. Leave intact – do not remove. Keep clean and dry at all times.
Elevate: as much as possible
Ice: at least 3 times per day 20 mins on, 20 mins off (ice should not be directly contacting skin or dampen the plaster)

Wounds:

Please keep the wounds with any dressings applied at the time of surgery clean and dry and intact.
The dressings will be changed at the time of first review in the office, 10-14 days post surgery.
Signs of infection: increased redness, swelling, malodorous discharge or persistent wound ooze, feeling unwell, fever. If these occur please contact the office straight away.

Weight bearing Status:

NON weight bearing for 6 weeks after surgery
6 -12 weeks – May be permitted to commence gradual, progressive weight bearing in boot. This will be confirmed at time of review.
12 weeks – Transition normal shoe wear. Gradually increase walking, light exercise

Driving:

Casts and boots and strong pain medications can interfere with your ability to drive.
You must be able to safely operate the vehicle including the accelerator, brake and clutch pedals at all times and respond appropriately in the event of an emergency.

When safely weight bearing without crutches; Minimum 12 weeks if the driving foot was operated on

Exercises:

First 6 weeks: No exercises of foot/ankle whilst in plaster/Boot. May do knee ROM, quadriceps and core strengthening, upper limb strengthening and toe stretches.
6-12 weeks: Gentle ROM ankle, stationery bike, swimming, non impact cardio 12 weeks: continue non impact cardio e.g. elliptical, stationery bike, swimming
Once the fusion is deemed united or healed, then gradual progressive reintroduction of activities will be permitted.

Pain Medication:

Strong pain medication may be prescribed on discharge from hospital. In general this will not be required for >1 week. It is important to take pain relief as required to stay comfortable post surgery.
Change to simple pain medication when the pain has reduced e.g. panadol/ panadeine
No Alcohol or driving whilst taking strong pain medication Narcotics eg Endone are not prescribed in the office.

Physiotherapy:

12 weeks: Non impact exercise e.g. swimming, stationery bike. May progress with gait retraining, generalised stretching/strengthening fitness program and progressive increase in Lower limb weight bearing exercises,

DVT (Deep Venous Thrombosis or blood clots) prophylaxis:

100mg aspirin daily whilst NWB 6 weeks OR other anticoagulation as prescribed

Return to Sports:

Generally after 3 months depending on progress and sport

Swelling:

Expected to decrease when elevated and gradually decrease over time
May have persistent swelling for up to 2 years post surgery

Travel:

It is usually safe to travel short distances on a plane or car 1 week after surgery.
You may experience increased swelling therefore try and keep the limb elevated.
It is more difficult to get around the airport and plane. You will need assistance.
If there is any concern regarding DVT then air travel or long car travel is not advised. In general long haul flights should be avoided for at least 3 months post surgery.

Please take usual precautions for healthy travel such as elevation of the limb, regular movements of the limb and moving around the cabin, stay well hydrated and avoiding alcohol. Additional DVT prophylaxis may be required.
Please discuss any travel plans prior to your surgery

Follow up:

2 weeks – Office for wound review. Continue Non weight bearing in CAM Boot, including when sleeping.
6 weeks – Xray and decision as to weight bearing status in Cam Boot.
12 weeks and 6 months– Xray.

Concerns:

Please contact the office (during working hours) or attend your nearest Emergency Department with any concerns e.g. increased leg swelling despite elevation for 30 mins, pain in calf, chest pain, shortness of breath, wound ooze, increasing pain despite pain relief.