Name of the Procedure:

Arthrodesis with Tendon Lengthening and Advancement, Midtarsal, Tarsal Navicular-Cuneiform (Miller Type Procedure)

Summary

In layman's terms, this is a surgical procedure to fuse certain bones in the foot and lengthen or adjust the tendons. This operation is generally performed to treat severe foot deformities, relieve pain, and improve stability and function.

Purpose

This procedure addresses severe deformities in the foot, often caused by conditions such as arthritis, flatfoot, or traumatic injuries. The goal is to correct the deformity, alleviate pain, and enhance foot stability and function.

Indications

• Severe foot deformities not responsive to conservative treatments
• Chronic pain in the midfoot area
• Arthritis or degenerative joint disease affecting the midfoot
• Flatfoot deformity
• Previous injuries or fractures leading to instability

Preparation

• Patients may need to fast for at least 8 hours before surgery.
• Adjustments to regular medications as advised by the physician.
• Preoperative assessments, including X-rays, MRI, or CT scans to evaluate the structure of the foot.
• Blood tests and possibly a pre-anesthesia consultation.

Procedure Description

1. The patient is administered general anesthesia or regional anesthesia to numb the lower extremity.
2. An incision is made over the midfoot to expose the joints involved.
3. The surgeon removes any damaged cartilage and prepares the bone surfaces.
4. The bones are aligned correctly and fixed together using screws, plates, or other hardware.
5. Tendons may be lengthened or advanced to improve foot function and relieve tension.
6. The incision is closed with sutures, and the foot is placed in a splint or cast to immobilize it.

Duration

The procedure typically takes between 2 to 3 hours, depending on the complexity.

Setting

This surgery is usually performed in a hospital or specialized surgical center.

Personnel

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

Risks and Complications

• Infection at the surgical site
• Nonunion or improper fusion of the bones
• Nerve damage
• Prolonged pain or swelling
• Risks associated with anesthesia
• Blood clots

Benefits

• Relief from chronic pain
• Improved stability and alignment of the foot
• Enhanced ability to walk and perform daily activities
• Potential for long-term correction of foot deformities

Recovery

• Initial recovery period involves limited weight-bearing activities; crutches or a walker may be necessary.
• Follow-up appointments to monitor healing and remove sutures.
• Physical therapy may be recommended to regain strength and mobility.
• Full recovery can take several months, with some activity restrictions during this period.

Alternatives

• Conservative treatments like orthotics, physical therapy, or medications.
• Other surgical options, such as osteotomy or joint replacement.
• Pros and cons should be discussed with a healthcare provider to determine the best course of action.

Patient Experience

Patients may experience discomfort or pain post-operation, managed with prescribed pain medications. Swelling and bruising are common, and immobilization of the foot will be necessary. Proper post-operative care and adherence to the surgeon's instructions are crucial for a successful recovery.