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Guide to Triple Arthrodesis

written by: R. Elizabeth C. Kitchen • edited by: Leigh A. Zaykoski • updated: 8/25/2009

This article discusses a triple arthrodesis and its elements.

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    A triple arthrodesis is a surgical procedure used to relieve foot pain and other associated problems. This procedure surgically fuses the talonavicular joint, talocalcaneal joint and calcaneocuboid joint. This surgical is most often performed after all other non-surgical methods have been exhausted. Most patients who undergo this procedure will have had little to no relief with bracing, physical therapy, steroid injections, non-steroidal anti-inflammatory drugs, and strapping and tapping.

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    Purpose of This Procedure

    The primary purpose of this surgical procedure is to alleviate pain from deformed, arthritic or unstable joints. Other important objectives include creation of a balanced and stable plantigrade foot and deformity correction. This procedure is generally indicated for chronic pain, valgus foot deformities that are unable to be braced, post-traumatic arthritis, collapsing pes planovalgus deformity, degenerative arthritis, tarsal coalition, dysfunction of the tibialis posterior tendon, neuromuscular disease, varus foot deformities that are unable to be braced, joint instability, talipes equinovarus, and cavovarus and cavus.

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    Procedure Description

    The way the procedure is performed depends entirely on the issue it is correcting. All patients will be anesthetized. All patients will have incisions made into their foot and certain tendons and ligaments or cartilage will be dissected in order for the surgeon to get to what he or she needs to get to. An imaging device called a fluoroscope will be used so that the surgeon can make the proper dissections. This imaging device will also allow the surgeon to see where he or she needs to place any necessary screws or pins. Patients will spend the night in the hospital for pain control, observation and IV antibiotics. Any sutures will be removed after two weeks when the patient's foot is placed in a removable boot.

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    Possible Complications

    A triple arthrodesis is a complicated surgical procedure so it is inevitable that some patients may experience complications. Nonunion is a complication that may occur and is a fairly common complication. This complication occurs when a fusion does not stay fused. Degenerative joint disease can occur after this procedure. This complication is a condition in which the joints of the foot degenerate, or gradually “waste away”. Some patients, particularly the elderly, may experience wound healing problems. This most often occurs at the edges of any incisions that were made and edema may cause delayed wound healing as well. Because the foot is delicate and many incisions have to be made close to nerves, a nerve injury could result. Though rare, avascular necrosis may occur due to a disruption in blood flow after surgery. Some patients may experience lateral instability or a still foot. As with all surgeries, infection and anesthesia complications may also occur.

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    Outcome

    This is a very delicate procedure and it is not uncommon for delayed union to occur. This may cause the patient to need further immobilization. Patients will need to stay off the the foot that was operated on for six to eight weeks before they are reevaluated. If x-rays are clear the patient will be given permission to put weight on that foot again and in another four to six weeks another set of x-rays will be taken to check the patients progress. If everything is okay after the twelve weeks the patient will be permitted to remove the boot and wear a regular shoe. At this time patients will also be referred to physical therapy to increase strength and improve range of motion.

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    Resources

    Schroeder, S.M., DPM. (2008). Triple Arthrodesis. Retrieved on August 23, 2009 from Website: http://emedicine.medscape.com/article/1234042-overview