Double or Triple Fusion
Fusion surgery may be needed in severe flat feet or high arched feet to correct deformity and reduce pain. A double fusion refers to joining the talus, navicular and calcaneus bones with two connections (hence the term double), whilst a triple fusion is that plus a connection with the cuboid bone with three connections (hence the term triple) in total.
Why have the surgery?
Deformity and pain from a stiff or rigid flat or high arched foot are the commonest reasons to perform either a double or triple fusion surgery.
How is surgery performed?
The operation is typically performed under a general anaesthetic. Incisions are usually made on both sides of the foot to access the joints which are removed. The foot is then put into its new position and held with metalwork such as screws, to allow the bones to heal.
What are the benefits?
The operation carries a high chance of improving deformity and pain in the appropriately selected patient. Improving the shape of the foot should make wearing shoes easier, whilst improving pain, should help standing and walking.
What are the risks?
All operations have risks, but the commonest and most concerning for this surgery are: - Non-union, meaning that the bone does not heal and the pain continues. - Arthritis occurring in the surrounding joints, since the stiffness at the ankle joint can place extra stress on the other mobile joints and leads to them wearing out over time. - Blood clots, which can form in the leg and travel up to the lung where they can be fatal. This list is not exhaustive and Mr Patel can talk you through them all in more detail during a consultation.
What recovery is involved?
All surgeons have different protocols after surgery. Mr Patel typically keeps a patient in a plaster cast for three months, although it is only in the first month that no weight-bearing activity is allowed. Progressive weight-bearing is allowed in the second month and full weight bearing is allowed in the third month. This protocol is tried and trusted and has consistently led to high rates of union for more than 10 years.
Any other considerations?
Many patients will think that once the hindfoot is fused, they will not be able to move the ankle. This is not the case unless the ankle is also being fused. Up and down motion occurs at the ankle joint, but fusing the hindfoot with a double or triple fusion limits the heel bone moving inwards or outwards. This means walking on flat ground is well tolerated but uneven ground where this compensation is typically needed, is still difficult.