Triple arthrodesis is a surgical procedure aimed at correcting severe foot deformities, specifically those affecting the hindfoot, where multiple joints are fused together. Originally designed to treat deformities due to neuromuscular diseases, this procedure has evolved into a powerful tool to address various forms of foot deformities, such as flatfoot, arthritis, and other structural issues.
While it remains a common and effective solution, it requires precision and experience for the best outcomes. Below is a detailed explanation of the procedure, its indications, techniques, and results, presented in layman’s terms for better understanding.
What is Triple Arthrodesis?
Triple arthrodesis involves the fusion of three main joints in the foot: the subtalar joint (between the talus and calcaneus), the talonavicular joint (between the talus and navicular), and the calcaneocuboid joint (between the calcaneus and cuboid). The goal of this surgery is to create a stable, pain-free foot that can better absorb the stresses of walking and standing. This procedure is particularly useful for patients suffering from deformities like flatfoot, arthritis, and certain types of tendon dysfunctions.
Indications for Triple Arthrodesis
Triple arthrodesis is generally recommended for patients with severe, rigid foot deformities that do not respond to other treatments, such as physical therapy or braces. The most common conditions that may lead to the need for triple arthrodesis include:
Adult-Acquired Flatfoot (Planovalgus Deformity): This occurs when the arch of the foot collapses, causing the foot to flatten and turn outward, making walking difficult.
Arthritis: Degenerative joint diseases, like rheumatoid arthritis or post-traumatic arthritis, can cause pain and stiffness in the joints of the foot.
Tendon Dysfunction: Conditions like posterior tibial tendon dysfunction, where the tendon that helps support the arch weakens or tears, may require surgical intervention.
Neurological Disorders: In patients with conditions like polio, where muscle weakness leads to abnormal foot positioning, triple arthrodesis can help restore foot function.
Preoperative Planning
Before undergoing triple arthrodesis, a detailed assessment is necessary. This includes:
Medical History and Examination: Understanding the patient’s symptoms, functional goals, and overall health.
Radiographs: X-rays of the foot and ankle are taken to evaluate the deformity, joint degeneration, and overall bone health. A Saltzman hindfoot view, which shows the alignment of the hindfoot, is particularly important.
Evaluating Risk Factors: Certain health conditions, such as smoking, diabetes, or poor nutrition, may increase the risk of complications, including nonunion (failure of bones to fuse) or infection.
Surgical Technique
Triple arthrodesis is performed through either a medial (inner side) and lateral (outer side) incision or sometimes through a single medial incision for specific cases.
The choice of technique depends on the patient’s specific deformity and the surgeon’s preference.
Incision and Joint Preparation: The surgeon makes an incision to access the foot’s three main joints: the subtalar joint, talonavicular joint, and calcaneocuboid joint. Cartilage is removed from the joints to expose the bone surfaces.
Fusion of the Joints: Once the joints are prepared, they are positioned in a corrected alignment and fixed using screws or other hardware. This process helps ensure that the joints heal in the correct position.
Additional Procedures: In some cases, additional procedures may be necessary, such as tendon lengthening or osteotomies (cutting and repositioning bones) to correct other deformities like tight tendons or excessive foot abduction.
Results and Outcomes
The main goal of triple arthrodesis is to create a stable, pain-free foot. The results can vary based on the patient’s age, health condition, and the extent of deformity.
Pain Relief: Most patients experience significant pain relief after surgery, especially in cases where arthritis or tendon dysfunction is causing chronic discomfort.
Improved Function: Many patients regain the ability to walk more comfortably, although the fusion of joints limits the foot’s flexibility. This is not a problem for many patients, as they are often relieved from the pain caused by the deformity.
Complications: While triple arthrodesis is generally successful, some risks remain. These include nonunion (where the bones fail to fuse), malunion (incorrect fusion), wound infections, and adjacent joint degeneration. Proper postoperative care is essential to minimize these risks.
Postoperative Care
After surgery, patients are typically placed in a cast or boot to protect the foot while it heals. Weight-bearing is usually avoided for several weeks, and physical therapy may be recommended to regain strength and mobility. Regular follow-up visits are important to monitor the healing process through X-rays and to ensure that the bones are fusing correctly.
In some cases, additional interventions such as bone stimulators (which promote healing) may be used if healing is delayed.
Conclusion
Triple arthrodesis is a highly effective procedure for treating severe foot deformities, providing relief from pain and restoring functionality. Whether used to address arthritis, tendon dysfunction, or deformities like flatfoot, it offers a solution for individuals who have not found relief through conservative measures. As with any surgery, proper preoperative planning, skilled execution, and diligent postoperative care are crucial for optimal results. While there are potential risks and complications, when performed correctly, triple arthrodesis can lead to improved quality of life and foot function for many patients.
Do you have more questions?
Q. What is Triple Arthrodesis?
A. Triple Arthrodesis is a surgical procedure that fuses three joints in the hindfoot (the subtalar, talonavicular, and calcaneocuboid joints) to treat severe foot deformities like flatfoot, arthritis, or tendon dysfunction.
Q. What conditions are treated with Triple Arthrodesis?
A. It is commonly used to treat conditions such as adult-acquired flatfoot, arthritis, tendon dysfunction (e.g., posterior tibial tendon dysfunction), and foot deformities due to neurological disorders.
Q. How is Triple Arthrodesis performed?
A. The surgeon makes incisions to access the three joints in the hindfoot, removes damaged cartilage, aligns the joints, and fuses them using screws or other hardware to ensure proper healing in the correct position.
Q. What are the benefits of Triple Arthrodesis?
A. The procedure provides pain relief, restores foot stability, and improves mobility by correcting deformities, particularly in patients with severe foot deformities that don’t respond to conservative treatments.
Q. What are the risks of Triple Arthrodesis?
A. Risks include nonunion (failure of the bones to fuse), malunion (incorrect alignment of the fused joints), infection, adjacent joint degeneration, and nerve damage, although these complications are relatively rare.
Q. What is the recovery time after Triple Arthrodesis?
A. Recovery typically involves 6 to 12 weeks of non-weight bearing with a boot or cast, followed by gradual weight-bearing and physical therapy. Full recovery can take up to 6 months.
Q. Can Triple Arthrodesis be performed on both feet at the same time?
A. While it is technically possible to perform the procedure on both feet, it is typically done one foot at a time to allow for proper healing and reduce the risk of complications.
Q. Is physical therapy required after Triple Arthrodesis surgery?
A. Yes, physical therapy is crucial after Triple Arthrodesis to help restore strength, flexibility, and range of motion in the foot, as well as to improve walking and prevent stiffness.
Q. Will I experience any loss of motion after Triple Arthrodesis?
A. Yes, the procedure involves fusing three joints, which will result in a loss of some foot motion. However, the trade-off is increased foot stability and pain relief, which improves overall function.
Q. How long does the Triple Arthrodesis procedure take?
A. The surgery usually takes about 2 to 3 hours, depending on the complexity of the deformity and whether additional procedures are needed.
Q. Will I be able to walk immediately after Triple Arthrodesis?
A. No, you will need to avoid putting weight on the foot for several weeks to allow the joints to heal. Crutches or a walking boot will be used to protect the foot during recovery.
Q. Can Triple Arthrodesis be done on children?
A. Triple Arthrodesis is generally not recommended for children, as their bones are still developing. The procedure is more commonly performed in adults with severe foot deformities or arthritis.
Q. How effective is Triple Arthrodesis for correcting foot deformities?
A. Triple Arthrodesis is highly effective for correcting severe foot deformities, especially those caused by arthritis or tendon dysfunction. Most patients experience significant pain relief and improved foot stability.
Q. Are there any long-term complications of Triple Arthrodesis?
A. Potential long-term complications include arthritis in adjacent joints due to altered foot mechanics, as well as a risk of further deformities or instability in the ankle or midfoot.
Q. Can Triple Arthrodesis be combined with other foot surgeries?
A. Yes, in some cases, Triple Arthrodesis can be combined with other procedures, such as tendon transfers or soft tissue releases, depending on the patient’s needs and the severity of the deformity.
