The hindfoot consists of the talus bone or ankle bone and the calcaneus bone or heel bone. The talus bone is the highest bone in the foot while the calcaneus bone is the largest bone in the foot. The calcaneus joins the talus bone at the subtalar joint enabling the foot to rotate at the ankle.
Hindfoot deformities can often be painful and debilitating. These deformities reduce your ability to walk and hinder your activities of daily living. The deformities arise secondary to congenital birth defects, fractures/trauma of the hindfoot bones (talus and calcaneus), or acquired from degenerative diseases.
Conservative treatments usually in the form of orthotics, braces, anti-inflammatory medications, and steroid shots are the primary mode of treatments to relieve pain and discomfort. Surgery to reconstruct the deformity is considered the last treatment resort when the deformities fail to respond to the above conservative treatment options. Arthrodesis (fusion) is the most common type of hindfoot fusion surgery. The aim of the procedure is to reconstruct the normal bony structure of the foot, and alleviate pain while walking. The surgery is usually performed under general anesthesia on an outpatient basis as a day surgery.
During the procedure, incisions are made on the inner or the outer surface of the foot based on the number and type of joints to be fused. Your surgeon removes the damaged cartilage from the affected joint surfaces, and fuses one or more of the three joints that form the hindfoot. Internal fixation devices such as metal screws are used to hold the bones in appropriate alignment while they heal. Certain deformities require an additional procedure performed to transplant small pieces of bone and tissue with a viable blood supply to the operated site to promote healing.
A non–weight-bearing, short leg cast can be used for the first 3 months after surgery. You will be placed in a rocker bottom brace with protected weight-bearing for another 2-3 months. Finally, you will be placed in a custom orthotic/brace which provides ultimate stability and protection for the hindfoot. Activities can then be gradually resumed.
Some of the potential complications include infection, unresolved pain, non-union and mal-union of the bones. Early identification and prompt intervention are the key factors to avoid any complications. Worsening of the symptoms may necessitate a revision surgery.
Discuss your concerns with your surgeon prior to hindfoot fusion surgery.