The hindfoot is the rear section of the foot which incorporates the following:
There are many causes for arthritis in the hindfoot:
- Post traumatic
- Related to a flat foot deformity
- Rheumatoid arthritis
- Primary arthritis
The arthritis may involve one joint, two joints or all three.
It can be associated with deformity.
Symptoms are dependent on severity of the arthritis and can range from bony spurs to widespread arthritis and deformity.
The aim of treatment of arthritis in the hindfoot is to provide a pain free, well aligned foot which functions well
What is the non-surgical treatment?
- Pre-emptive pain relief
- Anti inflammatories if tolerated
- Weight loss
- Activity modification- avoid impact exercise
- Trial of chondroitin, glucosamine and fish oil
- Supportive shoes
- Orthotics are very important
- Medial arch supports and heel wedges can help to realign mild deformity and offload arthritis
- An ankle brace can provide some support to the hindfoot
- More rigid custom made splints can also be used to limit motion and help with pain relief
- Steroid injections can be useful
What is the surgical treatment?
Surgery is reserved for when non operative treatment fails.
Surgery is individualised and is dependent which joints are affected, the severity of the arthritis and on the presence of deformity.
Mild arthritis with spurs
- Excision of bone spurs and joint debridement
- Day surgery
- Elevation of the foot for 2 weeks
- Full weightbearing with crutches
- Back to most activities at 6 weeks
- Ongoing use of orthotics required
- Does not ‘cure’ arthritis
Joint fusion and bone grafting with deformity correction is the most commonly performed surgery.
Fusion stops all movement of the joint and provides a stiff, well aligned painless joint with no arthritis.
The surfaces of the joints are removed. Bone graft is taken from the heel bone through a small incision and packed into the joint to aid in the healing.
The deformity is corrected. The joints are then compressed with screws or plates to allow the bones to join together ( fuse ).
Additional soft tissue procedures may be required.
What procedures are commonly performed?
- Achilles tendon lengthening
- Subtalar fusion
- Talonavicular fusion
- Calcaneoucuboid fusion
- Double or Triple fusion
- Tendon transfer procedures
What does the rehabilitation involve?
Rehabilitation is similar for all fusions
- 2 nights in hospital.
- 2 weeks elevation of the foot as much as possible in a cast
- 4 weeks in a boot non weightbearing
- 6 weeks in a boot progressively weightbearing
- Physiotherapy to maintain ankle motion and strength starting from 6 weeks
- By 3 months managing most daily activities in a shoe with an arch support
- By 6 months back to most recreational activities
- When swelling resolves at 6-9 months a permanent custom orthotic is often required.
- 1 year for final result
Will the operation be painful?
Your operation will usually be done under general anaesthetic.
To provide ongoing pain relief your anaesthetist will perform a nerve block whilst you are asleep which numbs the foot for 8-16 hours. So when you wake up you will have minimal pain.
As the block wears off you will be given oral pain relief.
How long will I be off work?
This is dependent upon your occupation
- Seated job 3-4 weeks
- Standing job 8-12 weeks
- Heavy lifting job 4-6 months
When can I drive?
- If you have a manual car you will be unable to drive for 12 weeks
- If you have an automatic car
- you can drive after 2 weeks if you have your left foot corrected
- you can drive after 12 weeks if you have your right foot corrected
What are the risks of the procedure?
General risks of surgery
- Wound healing problems
- Nerve injury and scar sensitivity
- Incomplete symptom resolution
- Blood clots to the leg
- Anaesthetic problems
Specific risks for joint fusion
- Non union of the fusion (bones not joining). This may require repeat surgery.
- Incomplete correction of deformity
- Development of arthritis in adjacent joints. The movement that has been lost is transferred to adjacent joints.
- Metalware irritation requiring removal
If you have any questions please contact Mr Curry’s rooms on (03) 99286560