Tibiotalocalcaneal Fusion

Surgery:

TibioTaloCalcaneal Fusion

Post operative orders:

Plaster backslab: 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:

0-6 weeks: Non weight bearing with crutches/knee scooter/CAM Boot
6-12 weeks: May be permitted progressive Partial weight bearing in CAM Boot OR will be instructed to remain NonWB
3 months – If gradual WB has begun – 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/boot. Minimum 12 weeks if the driving foot was operated on.

Exercises:

Toe stretches, Knee exercises, Upper body and core work.

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:

After 12 weeks: may progress with gait retraining, generalised stretching/ strengthening fitness program and progressive increase in Lower limb weight bearing exercises and Low impact exercise: stationery bike, swimming, elliptical machine etc.
Once the fusion is deemed united or healed, then gradual progressive reintroduction of activities will be permitted.

Swelling:

Expected to decrease when elevated.
May have persistent swelling for up to 2 years post surgery.

DVT (Deep Venous Thrombosis or blood clots) prophylaxis:

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

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, removal of sutures. Continue Non weight bearing. CAM Boot.
6 weeks – Xray, transition to partial weight bearing in Boot
12 weeks – Xray – transition to shoe 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.