LONDON FOOT & ANKLE SURGERY
Mr Andy Roche MSc FRCS (Tr & Orth) Consultant Orthopaedic and Trauma Surgeon specialising
in Foot and Ankle Surgery and Reconstruction

Foot Fusion Surgery

Why do I need a fusion procedure?

The surgeon will have explained that in joints in your foot, i.e. where the bones meet one another, the bone is normally covered by a smooth cartilage lining allowing you to move normally. In people who have, for example, severe osteoarthritis, rheumatoid arthritis or possibly a previous injury the cartilage gets damaged and gradually the joint stiffens and develops arthritis and pain.

What is a fusion?

This is a permanent joining or stiffening between arthritic bones of your foot. The bones are held together with metal screws/plates that act to stabilise the bones tightly together while your body naturally allows the bones to combine and fuse together.

Does it matter that the bones are being fused together?

No. The reason for this is because they bones are already stiff together anyway because of the wear and tear and arthritis between them. In fact the operation is really designed to convert an already stiff but painful joint into a stiff (with screws) but painless joint.

How the surgery is carried out?

Generally 1 night hospital stay is required. The operation is done under a general anaesthesia and an added injection in the leg to numb the foot for after surgery. The operation in general will involve 1-2 incisions on the foot, depending on the exact joints to fuse together. The procedure involves removing the painful damaged joints and then stiffening the bones together with screws or plates that stay in long term. Occasionally extra bone is needed to help the bones to fuse. This can be taken from your own hip area or knee area or even from sterile supplies of donor bone in the hospital. Your Consultant will discuss this as required. Dissolvable skin stitches are used.

Foot Fusion Xrays

What to expect immediately after surgery

Your foot will be in a plaster cast to the knee, numb and pain free. You will see a physiotherapist who will advise on walking non-weight bearing. You will be discharged only when comfortable with an appointment and pain-killers as required.

Recovery in the first few weeks after surgery

  • Elevate you foot as often and as much as possible to reduce swelling.
  • Mobilise as instructed, but only for necessity indoors and outdoors.
  • Some blood ooze can be expected in the bandage, if worried contact the Consultants clinic.
  • Take pain-killers as prescribed.
  • Avoid smoking and anti-inflammatory medications such as Ibuprofen or Voltarol as they can potentially halt bone healing.

Post-operative clinic schedule

  • 2 weeks - Wound check, X-Ray and new cast
  • 6 weeks - X-Ray, new cast/boot at Consultants discretion
  • 12 weeks - X-Ray, put on normal shoes
  • 6 months - X-Ray, discharge

When can I start to walk?

  • 0-2 weeks - Plaster cast, non-weight bear with crutches
  • 2-6 weeks - Lightweight cast non-weight bear with crutches
  • 6-12 weeks - Weight bear in boot/cast with crutches at Consultant discretion
  • >12 weeks - Full weight bear in normal shoes

Physiotherapy and Rehabilitation

Your physiotherapist will guide you through the stages of rehabilitation including gait re-education, swelling reduction and reducing muscle tightness. It is important to adhere to advice given. 

How do I wash and shower?

Keep the plaster cast totally dry. You may shower with a waterproof cover over the plaster. Once the plaster is removed you may shower if the wound is healed by carefully removing the boot and gently dab the wound dry.

How can I look after the incision wound?

Once out of cast, do not pull at scabs but let them fall away naturally. If your wound becomes red, swollen or sore you need to see your Consultant to ensure there is no infection present. Your physiotherapist may advise on wound massage when its healed.

When can I start to drive again?

DVLA states it is the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car in an emergency stop. This will take at least 12 weeks. Click here to read DVLA guidance.

When can I work?

This is very individual and job-dependent. Below is a guide:

  • Sedentary 3 weeks
  • Manual labour 12-16 weeks

What long-term outcome can I expect after surgery?

Excellent pain relief quite quickly and improving as the joints fuse, which can take 3 months. Good level of activity and sports by 6 months to continue to improve up to 12 months. Fusion operations have excellent outcomes in over 90%. Mild swelling can persist in the foot for up to a year.

What are the risks?

Any operation carries a risk. Below is a guide to some risks potentially encountered. It is the surgeons duty to fully inform you of possible risks. Mr Roche will ensure this is always done so patients can make safe and informed choices about their operation.

Infection

If this happens, it is usually simply treated with antibiotics. The risk is around 1%. Significant consequences from infection are very rare but can be dealt with.

Nerve damage

Nerves that supply sensation to the skin are near the incision site. Damage is rare but if your toe stays numb after surgery, the nerve may be bruised. If so it usually recovers. Risk is 5-10%.

Non-union

This means the bones fail to biologically fuse. Occasionally it can be “painless” and intervention may not be needed. If painful, then treatment options will be discussed. The risk is 5-10%.

Prominent metalwork

Sometimes the metal can be prominent and once the bones have fused, usually after 6 months the metal can easily be removed with a small day-case operation.

Deep Vein Thrombosis

Symptomatic clot formation in the leg is unusual after foot and ankle surgery (<3%). Whether treatment to prevent clot is needed can be discussed with your surgeon. There is no consensus amongst UK Orthopaedic surgeons as to whether preventative medicine is needed.

PLEASE REMEMBER…

Certain things may delay or even prevent the bones from fusing together. You must try to avoid them. This includes:

  • Non-steroidal Anti-Inflammatory tablets (NSAIDS)
  • Smoking
  • Failure to follow medical instructions (especially weight-bearing instructions) 

Important last note

This document is only meant to be a guideline to help you understand your treatment and what to expect. Every person is different and your rehabilitation may be quicker and slower. This will be advised and guided by your doctor and physiotherapist.

  • Chelsea & Westminster Hospital NHS
  • The Lister Hospital, Chelsea
  • Fortius Clinic
  • Bupa Cromwell Road