Triple Arthrodesis for Foot Arthritis


 

What Is Foot Arthritis?

Arthritis of the foot is condition where the certain joints in the foot becomes degenerated.  The cartilage, a smooth gliding surface, erodes and becomes coarse and stiff.  The affected joint can become enlarged and full of bone spurs.  Arthritis of the foot is commonly associated with flat feet.

 

What Are The Symptoms Of Arthritis in the Foot

Patients with arthritis of the foot have varying degrees of symptoms, which are strongly dependent on the joints that are involved and the extent of the arthritic degeneration.  Typically the symptoms involve pain, swelling and stiffness.   Arthritis can result in pain after periods of inactivity (such as getting out of bed in the morning, or after a standing up after a sitting for a while).  As the joints loosen the pain may decrease as the day moves on.   The pain may be deep and intense to topical and achy.

 

Movement of the affected joint can result in a clicking feeling, medically known as crepitus.  In more advanced cases, the joints develop bone spurs (aka arthritic bone spurs) – which is the body’s mechanism for limiting the motion.  Irritation from shoes can induce redness and swelling.

 

Causes of Arthritis Of Foot

Foot arthritis is most commonly caused by biomechanical problems or traumatic injuries.  Inflammatory arthritis (ie rheumatoid) can occur as well.  Gouty arthritis tends to affect the big toe joint.  Arthritis of the back part of the foot or midfoot can occur from flat feet, due to the improper position of the foot for many years.   Arthritis usually develops gradually over time, with somewhat frequent flare ups until a defining point is reached resulting in ongoing pain and discomfort.

 

When to Seek Treatment

Patients seek treatment for some of the following reasons: pain, interfering with simple walking, affecting activities, difficulty fitting shoes, grinding sensation in foot, swelling, and/or a change in the architecture of the foot and/or toe(s).

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Treatment

Depending on your overall health, symptoms and severity of the foot arthritis, treatment can be conservative and/or with surgery.

 

Non-operative Treatments For Foot Arthritis

Non-surgical methods for foot arthritis are focused at decreasing and/or alleviating symptoms (pain).

Simple Treatments Patients Can Do:

  • Wear supportive shoes
  • Use an arch support
  • Wear shoes with a wide toe box
  • Change your activities
  • Shed pounds.
  • Wear shoes with cushion

Non-surgical treatments Dr. Blitz can add:

  • Prescribe an oral anti-inflammatory medication
    Anti-inflammatory medication is useful to significantly reduce pain and inflammation.
  •  Prescribe physical therapy
    A physical therapist may perform ultrasound and other techniques to reduce inflammation.  You will also be instructed how to stretch your foot and leg properly.  Keeping the joint mobile may preserve function.
  • Prescribe protective pads
    Padding and/or cushioning of when bone spurs are present on the top of the foot is an effective method of preventing mechanical irritation with shoes.  Pads with cutouts say off-weight specific areas of concern.
  • Prescribe custom foot orthotics
    A custom foot orthotic is a doctor prescribed arch support that is made directly from a casting (mold) of your feet, and theoretically should provide superior support compared to shoe insert that you would purchase from a pharmacy.   In the case of the foot arthritis with a flat foot, the orthotic may be able to improve the position of the foot.
  • Give cortisone injection
    An intra-articular cortisone injection is a powerful anti-inflammatory medication that is used to rapidly reduce the pain associated with an arthritic joint.  The pain relief that you may experience from the injection(s) is often temporary.

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Foot Arthritis Surgery

Surgery for arthritis of the foot varies depending on the location of arthritis, severity of arthritis, and the presence of flat feet.  But, in general, the procedures are separated in two kinds: Joint sparring (preserves the joints) or Joint destructive that fuses the joints.

  •  Joint Sparing Procedure
    These procedures involve “surgical cleaning” the arthritic components of the joint(s) to alleviate pain and increase motion.
  • Joint Destructive Procedure
    Destructive procedures involves locking the joints in place by a fusion or bone mending procedure.  Joint replacements are also considered joint destructive procedures.The extent of the arthritis determines whether or not the joint(s) could be “saved”.  Dr. Blitz evaluates each joint carefully, and takes significant measures to prevent joint destructive procedures while still preserving motion and decreasing/eliminating pain.
  • Rearfoot Procedures
    The rearfoot is made up of three joints, they are called the talonavicular joint, subtalar joint, and the calcaneal cuboid joint.   These three joints work in conjunction with the ankle to provide the side to side motion of the foot while the ankle performs the up and down motion.  
  • Bone Spur Removal (Exostectomy)
    The term exostectomy describes a procedure to remove bone spurs.  The rearfoot joint that controls 90% of the side to side motion of the foot, is called the talonavicular joint.  This joint, the talonavicuclar joint, is located directly in front of the ankle joint, and large bone arthritic bone spurs can interfere with ankle range of motion.  In some cases removal of these bone spurs can reduce pain and increase range of motion, however, removing the bone spurs does nothing to manage the underlying arthritis.

 

  • Rearfoot Bone Mending or Fusion Procedures
    When a rearfoot joint is arthritic, a fusion may be a great option.  Depending on the extent of the arthritis and joints involved, the fusion can be a single joint or a double joint or a triple joint arthrodesis.  The fusion will lock-up any rearfoot motion (taking away the pain) and also allows for proper positioning of the foot.  In many cases a flatfoot occurs in conjunction with rearfoot arthritis.  With a rearfoot fusion surgical hardware is inserted into the bones, traversing the joint(s) to allow the bones to mend.  The hardware is most often screws, thought plates may also be used.

 

Arthritis Surgery Recovery

Recovery depends on which joint(s) are involved and the surgical repair.  Arthritic bone spur removal is much less invasive, and patients can usually ambulate after surgery.  Rearfoot fusion protocols typically involve non-weightbearing with cast and crutches until bone mends – a process that can take 6 weeks to 12 weeks.

 

What Anesthesia Is Needed For Arthritis Surgery

Depending on the surgery, it can be performed as an outpatient or an inpatient.  Major rearfoot fusions may require a hospital stay.  Rearfoot fusions (ie triple arthrodesis) is performed under regional, spinal or general.  Local anesthesia is less effective for these surgeries.

 

What Are The Risks Of Arthritis Surgery

There are general risks associated with foot surgery (or any surgery) and the use of anesthesia. Complications may occur and are not necessarily your fault, or the fault of your surgeon. Nonetheless, you should understand the risks.

Triple Arthrodesis complications include, but are not limited to: infection, pain (temporary or permanent), swelling, hematoma, bleeding, blood clot, poor wound healing, incision breakdown, poor bone healing (delayed union, nonunion), malunion, nerve injury, neuroma, pain syndrome, RSD, disability, recurrence, hardware problems, metatarsalgia, unsightly scar, stiffness, weakness, loss of toe to purchase ground, hardware problems, need for revisional surgery, and/or catastrophic loss.

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