Ankle fusion involves preparing both sides of the joint back to healthy and bleeding bone. The arthritic joint lining is removed and the ankle joint is placed in a functional position and held there until the bone has grown across the joint and the ankle is thus fused. The ankle is held in position whilst the fusion is occurring and this is most commonly done with large screws which are buried beneath the skin. Occasionally a large metal rod may need to be inserted through the heel to compress the ankle and sub-talar joints (known as a double fusion). In cases where infection is present a device known as an Ilizarov frame may be used to compress the ankle joint and hold it in position until fusion has occurred. On average it takes three months for bone to be fairly soundly fused but on occasion it can take significantly longer.
All joints are assessed for inflammation, deformities, and contractures. The patient's ability to perform activities of daily living (ADLs) is evaluated. The patient is assessed for fatigue. Vital signs are monitored, and weight changes, pain (location, quality, severity, inciting and relieving factors), and morning stiffness (esp. duration) are documented. Use of moist heat is encouraged to relieve stiffness and pain. Prescribed anti-inflammatory and analgesic drugs are administered and evaluated; the patient is taught about the use of these medications. Patient response to all medications is evaluated, esp. after a change in drug regimen, and the patient and family are taught to recognize the purpose, schedule, and side effects of each. Over-the-counter drugs and herbal remedies may interact with prescribed drugs and should not be taken unless approved by physicians or pharmacists. Inflamed joints are occasionally splinted in extension to prevent contractures. Pressure areas are noted, and range of motion is maintained with gentle, passive exercise if the patient cannot comfortably perform active movement. Once inflammation has subsided, the patient is instructed in active range-of-motion exercise for specific joints. Warm baths or soaks are encouraged before or during exercise. Cleansing lotions or oils should be used for dry skin. The patient is encouraged to perform ADLs, if possible, allowing extra time as needed. Assistive and safety devices may be recommended for some patients. The patient should pace activities, alternate sitting and standing, and take short rest periods. Referral to an occupational or physical therapist helps keep joints in optimal condition as well as teaching the patient methods for simplifying activities and protecting joints. The importance of keeping PT/OT appointments and following home-care instructions should be stressed to both the patient and the family. A well-balanced diet that controls weight is recommended (obesity further stresses joints). Both patient and family should be referred to local and national support and information groups. Desired outcomes include cooperation with prescribed medication and exercise regimens, ability to perform ADLs, slowed progression of debilitating effects, pain control, and proper use of assistive devices. For more information and support, patient and family should contact the Arthritis Foundation (404-872-7100) ().
I really appreciate this blog post about gout. I just had a second surgery on my foot in 3 months (the first was expected – Kidner procedure with flexor transfer). When I wasn’t progressing through PT as expected and severe pain developed, an MRI showed severe inflammation and coalition in the middle facet of the subtalar. The second surgery on Feb 6 for a subtalar fusion yielded a new surprise – gout crystals (and a subuquent uric acid blood test showing a ) AND an unexpected tear on the PTT hindfoot (ironically, not where the surgeon previously pinned the PTT for the first surgery). The concern is the gout. I’ve adjusted my diet (which wasn’t too bad to begin with), and my Primary Doc just put me on Allopurinol (which I understand can increase gout on a temporary basis). I want to do my best to ensure that this second surgery is successful, and my surgeon (who is a nice guy) is a bit hesitant to give me a straight answer. I’d really love to hear your insight on: 1) Gout affecting the PTT repair and subtalar fusion; 2) Is Allopurinol a bit premature at this stage since it can temporarily increase gout attacks; 3) The use of Indocin during this critical healing phase, if I THINK I have gout attacks. I’d like to use the information you provide to take back to my surgeon and Primary Doc. Thank you for your help!