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MIDFOOT AND HINDFOOT ARTHRITIS

Arthritis can affect any joint in the foot.  Arthritis of the big toe (hallux rigidis) and ankle arthritis are described elsewhere.  Treatment options for any arthritis through the foot begins with orthotics, shoe changes, anti inflammatory pain medications and physiotherapy. Should this fail, injections could be considered.  If you still have ongoing pain, then a fusion procedure can be performed to take away the movement of the joint which can predictably eliminate your arthritis pain.  Click below for more information on injection or surgical options. 

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FOOT FUSION POST OP INSTRUCTIONS

FOLLOW UP:

  • First appointment: approximately 2 weeks from surgery, usually at the Burnaby Hospital Fracture Clinic.

  • Prior to your surgery, you should have received dates for your 6 week and 3 months follow up visits. 

  • You will typically arrange a follow up one year from surgery as well for final xrays. 

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EXPECTED RECOVERY TIMELINE:

  • Swelling and pain is normal and expected in the first two weeks.  Rest, elevation and pain medication are important to help manage this. 

  • If your pain is severe and you aren't managing with the instructions and pain medication provided, call or go to the Burnaby Emergency Department.

  • Ideally by 3 months following surgery, you are walking not necessarily far, or fast but able to get back to your normal day to day in a more normal shoe.

  • Swelling is normal and not a concern and can last for up to 6-12 months.  Some swelling doesn't always resolve fully.

  • If all is healing well, you can progress your walking and other physical activity as your symptoms allow. 

  • You will not know full recovery (pain, swelling, strength) until 9-12 months following surgery.  

 

DRESSING:

  • After TMT Fusion, you will go home from surgery with a dressing/sandal.  This can remain on until your first follow up.  Or, if you prefer of the dressing is loose or uncomfortable it can be changed to something lighter typically after 5 days. 

  • After a triple fusion, subtalar, Talonavicular or Navicular cuneiform fusion, you will have a splint on your foot and ankle.  This can remain as is until your first 2 week appointment. After this appointment, once your wound has healed adequately, you will be placed in a post operative boot.

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WOUND:

  • Your wound(s) are closed with sutures or staples, some of which will need to be removed.  

  • Do not get the dressing or wound wet for the first 2 weeks.  To ensure this, a bag should be placed over the leg to avoid anything getting wet.  

  • The dressing/splint should remain on as per above recommendations. 

  • Sutures are removed typically at the 2 week mark. Its not uncommon given the high risk of wound troubles with ankle replacement, to have them removed at 3 weeks.  

  • After your sutures are removed, you can shower 2-3 days later and allow clean water to run over the wounds.  Pat this dry and reapply a dressing if it is your preference. It is not required.  The steristrip tapes on your wound can get wet.  Just pat them dry. 

  • Steristrips should stay on for about 10-14 days usually.  If they fall off prior to this, they do not need to be reapplied.  If they are still on after 14 days, ensure you please remove them yourself. 

  • Do not immerse the wound in a bath, hot tub or pool until the scar is fully healed with no scabs.  This is often 4 weeks. 

  • No lotions or creams should be used until the wound is fully healed, often 4-6 weeks. 

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WEIGHTBEARING 

  • You may not put any weight on your foot until 6-10 weeks from surgery.

  • At 6-10 weeks from surgery (depending on how your bone healing is progressing), you can begin walking in the boot as able and then gradually, transition to a shoe as able.  Keep in mind some people still have too much swelling at this point to be able to get into the shoes they want just yet.

 

PHYSIOTHERAPY:

  • At the 2-3 week mark, if you feel able, you may begin physiotherapy.  Prior to this due to swelling, wounds and dressings, possibly therapy will be limited.  

  • Dr. Roberts will provide you a custom physiotherapy prescription to help guide your therapist in your recovery. 

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DRIVING:

  • You are not able to drive if you are still taking Opioid (Narcotic) pain medication

  • Left foot surgery: beginning at least 2 weeks post op, once you are able to comfortably remove the sandal/boot while driving.  Contact your insurance for further recommendations.

  • Right foot surgery:  You can drive once you are walking fully in a shoe.

  • Try practicing in a parking lot first to ensure your reaction/strength/motion is adequate 

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FLYING:

  • If possible, you should consider avoiding long haul flights for the first 4-6 weeks from surgery.

  • If you must fly before this there is an increased risk of blood clot.  Try to keep moving on the flight, stay hydrated, avoid alcohol, consider compression socks.  Discuss with Dr. Roberts if you require a blood thinner to keep your risk as low as possible. 

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WORK:

  • You should arrange to be off of work for the first 2 weeks after surgery to allow for rest and recovery.

  • If you are working from home or can get to work safely and work in a flexible seated job, you could return to work after the first week if you so choose, provided you are off opiod (narcotic) pain medication.  You will need to elevate the foot and allow for more breaks. More commonly, most patients take 6 weeks off work. 

  • Any work should be sedentary for the first 8-12 weeks.

  • Typically a return to more physical duties can begin gradually at the 12 week mark from surgery. 

  • You may discuss your return to work plan with Dr. Roberts if you still have questions.

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