Name of the Procedure:

Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy (e.g., flatfoot correction)

Summary

Arthrodesis of the midtarsal or tarsometatarsal joints involves the surgical fusion of multiple joints in the midfoot or where the foot bones connect to the toes. This procedure often includes an osteotomy, which is the surgical cutting and realignment of bone to correct deformities such as flatfoot.

Purpose

Arthrodesis is used to treat severe pain and instability in the foot due to various conditions like arthritis or flatfoot deformity. The primary goal is to relieve pain, improve foot alignment, and restore function.

Indications

• Severe arthritis in the midfoot or tarsometatarsal joints
• Flatfoot deformity causing pain and functional impairment
• Traumatic injury leading to joint instability
• Failure of conservative treatments like orthotics, medications, and physical therapy

Preparation

• Fast for at least 8 hours before the procedure.
• Adjust medications as advised by the healthcare provider.
• Undergo preoperative tests such as blood work, imaging studies (X-rays, MRI), and a pre-surgical physical exam.

Procedure Description

1. Anesthesia: The patient is given general anesthesia or a regional block.
2. Incision: A surgical incision is made over the affected joints.
3. Joint Preparation: Damaged cartilage is removed from the joint surfaces.
4. Osteotomy: If applicable, bones are cut and realigned to correct deformity.
5. Fixation: Screws, plates, or rods are used to hold the bones in place, allowing them to fuse together.
6. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

Approximately 2 to 4 hours, depending on the complexity of the surgery.

Setting

The procedure is typically performed in a hospital or surgical center.

Personnel

• Orthopedic surgeon or podiatric surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technologist

Risks and Complications

• Infection
• Blood clots
• Nonunion or delayed union of the fused bones
• Nerve damage
• Postoperative stiffness or continued pain in the foot
• Need for additional surgery

Benefits

• Relief from chronic pain
• Improved foot stability and function
• Enhanced ability to walk and perform daily activities
• Correction of deformity and better alignment of the foot

Recovery

• Use of crutches or a walker to avoid weight-bearing on the affected foot for several weeks.
• Follow-up appointments to monitor healing, including X-rays.
• Gradual reintroduction of weight-bearing activities as directed by the surgeon.
• Physical therapy to restore strength and mobility.
• Full recovery can take 6 to 12 months.

Alternatives

• Conservative treatments: orthotics, physical therapy, pain medications
• Joint-preserving surgeries like tendon transfers or osteotomies without fusion
• Pros: Less invasive, shorter recovery time
• Cons: May not provide long-term pain relief, may require further treatment

Patient Experience

• During the procedure: No sensation in the surgical area due to anesthesia.
• After the procedure: Postoperative pain, managed with pain medications.
• Recovery involves a period of restricted movement and use of assistive devices.
• Physical therapy helps in regaining strength and mobility.