Foot and Ankle Fusion
At Mater Health Services we understand that being in hospital can be a very stressful experience. This booklet aims to alleviate some of your concerns in keeping with our Mission to offer compassionate, quality care that promotes dignity while responding to patients’ needs. It explains briefly the events that may occur during your visit and the things to expect when you are discharged from the hospital.
It is, however, only a guideline as each person may require differing treatments.
If you have any questions about your treatment please ask your doctor or nurse.
Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have.
Foot and ankle fusion
Foot and ankle surgery is a specialised area of surgery. The surgery can be quite challenging and every patient is different with unique needs and goals.
Fusion is a surgical technique which can be used for most joints in the foot and ankle where a joint becomes worn out and painful—a condition called degenerative arthritis.
This operation is undertaken to create a permanent joining of the bones. The damaged cartilage is removed to create a level bone surface. The next step is to position the bones correctly for the fusion. Metal screws are used to hold the bones in the correct position. With the correct positioning, the patient will not feel the screws and there is no need for them to be removed in the future.
What are the risks involved with ankle and foot fusion surgery?
All patients are at risk of complications following surgery, but complications do not occur frequently. The following are the main complications to be aware of:
- Anaesthetic complications occur when the anaesthesia given during surgery causes a reaction with other drugs the patient is taking or a patient may have a problem with anaesthesia itself.
- Nerve and blood vessel damage: it is possible that the nerves of the foot or the blood vessels around the ankle can be injured. This may result in numbness in the foot. Severe injuries of the blood vessels of the foot could lead to the need for an amputation.
- Infection: following surgery, it is possible that the surgical incision can become infected. This will require antibiotics and may require another surgical procedure to drain the infection.
- Non-union: this is when the bone fails to unite, although it is very rare, as the bone in this area has a good blood supply. If this does happen further procedures, including bone grafting, may be necessary.
- Malunion: this is where the bones may heal in the wrong position. If the malunion is too extreme and causes problems with walking, another operation may be required to try to achieve a better position of healing.
After your operation
You will stay in the recovery room within theatre suite after the operation. When you wake up fully from the anaesthetic you will be transferred on your bed to your room.
You will have a drip (IV). This is necessary to maintain your fluid intake. This will be removed when you are tolerating adequate amounts of oral fluids.
- Pain relief: a local anaesthetic block may be given to you during surgery. This will produce numbness around the nerves in the region of your surgical procedure. It will provide you with pain relief for approximately eight to 12 hours postoperatively, enabling you to be comfortable and allow you to sleep after your surgery.
- you may have either a Patient Controlled Analgesia (PCA) or an epidural
- A PCA allows you to manage your own pain. PCA involves specialised equipment which is connected to a drip (IV). You will have a button to push which allows a small amount of pain relieving medication to be delivered directly into your vein via the drip. The equipment has a specialised safety programme to reduce the risk of you receiving too much medication. You will remain on PCA until you are able to eat and drink. Your pain will then be managed with tablets. There is no risk of becoming addicted to strong pain relieving medication when it’s used appropriately.
- An epidural delivers pain-relieving medication into the space in your spine where the nerves carry pain signals from your operation site to your spinal cord and brain. The epidural usually remains in for one to two days depending on your type of surgery. Some patients will experience little or no pain with an epidural and may feel numb around the operation site. This is quite normal as this is its intended effect and means that the epidural is working, however if pain is moderate or severe you must notify the nurses straight away. You must also notify the nurses if you have any feeling of numbness or tingling around your mouth or upper limbs.
- If you have a PCA or epidural, you will more than likely be prescribed paracetamol (Panadol®) four times a day. Paracetamol works well when used on a regular basis and helps to reduce the amount of stronger pain-relieving medication you require which therefore reduces their side effects.
You will also be on medication to reduce the risk of blood clots. This will be in the form of an injection. It will be necessary to continue this treatment at home.
Your nurse will take frequent observations of your vital signs (e.g. temperature, pulse, blood pressure etc), wound, drains and limb (colour, warmth, sensation and movement) for several hours after the surgery. As you become fully recovered, these observations become less frequent but remain regular until you leave hospital.
About four hours after you return to the ward, your nurse will assist you to have a wash. Your drain will be removed anytime from 24 hours after your surgery when your doctor orders its removal.
Swelling can delay wound healing and cause the wound to break down. Swelling can be due to over activity and not keeping your foot elevated. This can also increase the risk of infection. Place your operated leg on two pillows or a bean bag so that it is above the level of your hip when you are lying down. The use of ice packs (or frozen peas, beans etc) can be a very effective way of reducing swelling. Place the icepack in a towel over the ankle or foot for 20 minutes three to four times per day.
You will be resting in bed on the day of surgery. It is important that you rest and keep your foot elevated as much as possible for the first seven to 10 days to encourage healing and discourage wound break down. While you are resting it is important for you to continue with deep breathing and circulation exercises.
The following exercises help prevent complications such as chest infections and blood clots in your legs. You should do these every hour that you are awake while resting in bed.
Breathing exercises: take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs.
Circulation exercises: firmly move your un-operated ankle up and down to stretch and contract your calf muscles. You will not be able to do this with your operated ankle.
The physiotherapist will instruct and practise mobilising with you on the day after your surgery. You will use crutches or a walking frame depending on your ability. Once you can demonstrate that you can mobilise safely, negotiate stairs if required and pain relief is adequate then you will be able to go home.
You will progress from clear fluids to light diet depending on what you can tolerate. You should be eating your usual diet by the time you leave the hospital.
You will be assisted with having a sponge or shower keeping your dressing or cast dry. You will be encouraged to manage your hygiene independently in preparation of going home. Wrapping your dressing or cast in a plastic bag and sealing the top of the bag above your dressings with tape helps to keep your dressing or cast dry while showering.
Your dressing or plaster will remain tact until your post-operative appointment or until your doctor orders. If you have sutures they will be removed at your outpatient appointment
The day you go home
You will receive specific instructions from your doctor, nursing staff and physiotherapist for when you go home and regarding follow-up appointments. Ensure you plan to rest after surgery to minimise bleeding and swelling
The following points will give you a guide for your recovering after you leave hospital. You may find variations as each person’s situation is different and doctor’s preferences also differ.
- you should leave your dressing in tact for 14 days
- your plaster should remain in tact for six weeks
- you should elevate your foot for seven days
- you should continue with the use of your walking aid for six weeks
- you should not drive for four to eight weeks
- you should be able to walk freely by about 12 weeks
- you can expect your foot to remain swollen for 16 weeks
- improvement and healing will continue for up to 12 to 18 months.
Safe use of crutches
Crutches are required and your physiotherapist will instruct you on their use. If you are not able to use crutches a walking frame may be required.
When standing: place your crutches forward and in a straight line, lean on your hands and your un-operated leg.
Non-weight bearing: with your crutches forward, lean on your hands and hop through, taking weight through your good leg.
Partial weight bearing: your doctor will let you know when to start taking some weight through your operated leg and when to increase the weight gain.
Move backward to the chair until it can be felt by your un-operated leg. Slide the crutches out and hold them in one hand. Hold the arm of the chair with your other hand and gently sit. Place your operated leg on a stool when sitting to prevent swelling.
When using stairs
Never vary this sequence:
Going up the stairs: un-operated leg—operated leg and crutches
Going down the stairs: crutches—operated leg—un-operated leg
Please contact Mater Hospital Brisbane Emergency Department on 07 3163 8111 or your general practitioner (GP) if any of the following occur after discharge:
- your wound feels hot and tender
- unusual discharge from your wound and dressings or an odour from your dressings
- fever may be present or a general feeling of unwell.
- swelling is not reduced with elevation of leg
- a change is colour of your toes or coldness
- the calf muscle in your leg of the treated foot swells or is painful.
- your dressings are showing excessive amount of fresh blood
- elevation and application of pressure dressings doesn’t stop the bleeding.
- the medication that has been prescribed for you is not helping control the pain while you have been resting with your limb elevated.
- you are experiencing ill effects due to the medication that has been prescribed for pain, e.g. nausea, vomiting, gastric discomfort.
Notes: If you have any questions, please ensure that you have them answered before you go home.
Mater Hospital Brisbane
Raymond Terrace, South Brisbane Q 4101
Telephone: 07 3163 8111
Staff of Mater Hospital Brisbane, Raymond Terrace, South Brisbane, Q 4101
© 2010 Mater Misericordiae Ltd. ACN 096 708 922
Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-420017
Last modified 13/11/2015.