Recent Triple Arthrodesis

[cjt1...@gmail.com]

Experience: I had a right ankle triple arthrodesis (same day surgery under a general anesthetic + nerve block)  two weeks ago using five screws, one main 6" incision on the outside of the foot  & a smaller one on the heel where some of the screws were inserted. I came home in a large, heavy cast/dressing (some oozing through the dressing for first couple of days) which was removed after the first week & am now in a boot 24 hours a day only removed for showering & PT. 

The nerve block wore off after 12 hours & I then used Oxycodone for about only 36 hours (being very aware of the side effects!) I am still taking Ibuprofen but with no pain, just the occasional ache, probably don't need it & will taper off. The staples were removed yesterday, the incision is healing nicely with no drainage, the 'black' bruising of my toes is fading & the foot swelling going down, still a bit puffy around the ankle. The worst part is having to wear the boot at night for another 3 weeks. No weight bearing for three months. The foot still feels a bit stiff but is loosening up & more flexible now. Some calf tenderness which was concerning but no redness or other symptoms of DVT. Back on baby aspirin just in case. I do get tired probably because I'm not sleeping soundly.

History: I am 76, in pretty good shape apart from rampant osteoarthritis-arthritis necessitating earlier shoulder & hip replacements. The ankle had been getting progressively worse over the past 3 years despite cortisone injections, a brace & disastrous experience with a boot (& no compensation for leg length difference) which precipitated the hip surgery. I had kept up stretching/yoga exercises especially balance which has come in very useful having to stand now on my good leg. I have started exercising on the bed while I wait for in home physio as I don't want the rest of me to stiffen up. 

Recommendations: I am using a knee walker (with a basket that we attached) downstairs with a walker to help me get out of a recliner & a wheeled stool from Amazon upstairs which work well so I can be pretty independent. I have an invaluable partner if I need extra help. I use a fanny pack to carry extra stuff. No problems going up (easier on my knees than hoisting myself backwards) & down stairs. I can negotiate the 7 steps from the front door to the path & car the same way. I have a bath tub stool, non slip mat, safety bars & hand held shower. I wrap the boot in a plastic bag + elastic band at night which prevents it from sticking to the sheets & making it hard to turn over. I wear a sock on my good foot which I find makes it easier to wiggle that foot while I'm balancing on it to move around very slowly & carefully. Rubber soles don't allow that. Bare foot also works. No alcohol which I am fearful might mess up balance & concentration. Our Golden Retriever is staying with a neighbor for the 12 weeks as there is no way I could care for her. I am trying to eat less to compensate for the lack of walking/real exercise. Long, elastic waist skirts are easier than pants which won't go over the boot. 

Results: I had an excellent surgeon & I think I have been fortunate this far.  I am patient, resigned to not being able to keep up my usual busy schedule & planned the surgery during the winter months so that as an avid gardener, I would not miss being in the garden. I have a cosy spot in front of our gas logs a view out of the window. I am surprised that I am enjoying daily, time consuming crossword puzzles, listening to NPR & reading that I never used to make time for. I am very fortunate that my partner is a good cook! And I enjoy friends dropping in for short visits.     

Hope this is helpful.

[Caroline Levine]

Did you have a bulky foot dressing called a robert jones dressing? I have double arthrodesis recently and have this fat soft cast on. Will look for a skirt to wear or order a pair of palazzo pants online. Caroline-

[Mark Rafuse]

I don't know what the name of it was, but yes bulky.  Then had two more casts after that.  This first one was by far the most uncomfortable.

On Mon, Jan 29, 2018 at 8:45 PM, Caroline Levine <carolin...@gmail.com> wrote:

Did you have  a bulky foot dressing called a robert jones dressing?  I have double arthrodesis  recently and have this fat soft cast on.  Will look for a skirt to  wear or order a pair of palazzo pants online. Caroline-

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Mark Rafuse
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Home Repair | Remodeling

[cjt1...@gmail.com]

Hi Caroline
Happy to talk you you about my experience. I’m now coming up to 9 weeks post op & progressing well. I don’t know what the very bulky dressing was called (a split plaster cast & loads of padding & stretchy bandage) but that came off after a week & I have been in a boot 24/7 ever since. Couldn’t get pants on over dressing so used wide shorts then found long elastic waist skirts best. I remove boot to get elastic waist pants on/off now or same skirts easier too of course.
Clips out after 2nd week, incision oozed for a while probably because the steri strips kept it damp after showering. Healing nicely now.
I’ve been using a knee walker till last week, now allowed to progressively bear weight & using regular walker. Feels strange to have 2 feet on the ground!
Important to wear clog or shoe with higher heel on good leg to equal height of boot.
Lots of physio throughout.
Let me know how you progress - happy to share more of mine.
Caroline


Sent from my iPhone

> On Jan 29, 2018, at 9:45 PM, Caroline Levine <carolin...@gmail.com> wrote:
>
> Did you have a bulky foot dressing called a robert jones dressing? I have double arthrodesis recently and have this fat soft cast on. Will look for a skirt to wear or order a pair of palazzo pants online. Caroline-
>

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[cjt1...@gmail.com]

On Tuesday, January 30, 2018 at 8:15:41 AM UTC-5, cjt1...@gmail.com wrote:

Hi Caroline
Happy to talk you you about my experience. I’m now coming up to 9 weeks post op & progressing well. I don’t know what the very bulky dressing was called (a split plaster cast & loads of padding & stretchy bandage) but that came off after a week & I have been in a boot 24/7 ever since. Couldn’t get pants on over dressing so used wide shorts then found long elastic waist skirts best. I remove boot to get elastic waist pants on/off now or same skirts easier too of course.
Clips out after 2nd week, incision oozed for a while probably because the steri strips kept it damp after showering. Healing nicely now.
I’ve been using a knee walker till last week, now allowed to progressively bear weight & using regular walker. Feels strange to have 2 feet on the ground!
Important to wear clog or shoe with higher heel on good leg to equal height of boot.
Lots of physio throughout.
Let me know how you progress - happy to share more of mine.
Caroline


Sent from my iPhone

> On Jan 29, 2018, at 9:45 PM, Caroline Levine <carolin...@gmail.com> wrote:
>
> Did you have  a bulky foot dressing called a robert jones dressing?  I have double arthrodesis  recently and have this fat soft cast on.  Will look for a skirt to  wear or order a pair of palazzo pants online. Caroline-
>
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[Caroline Levine]

Hi, cj
I got the bulky dressing go yesterday and was given a st etch boot with plastic bottom. If I, m just in the bed I'd on, t have to wear it. My foot hurts too much unless it,s elevated on pillows. The soft cast is called a Jones, s compressive dressing invented in 1921 in England. I really liked it over the fiberglass one after last year,s fusion at a military hospital.

I have to non weight bear for 12 weeks total. This was a double fusion.

I,m glad you are doing well. Do you think you could travel in a few months? I,m hoping to so late summer.

Caroline

[Caroline Turner]

Caroline,

My boot comes up to my knee, has a plastic bottom & heavy fleece-like sides with lots of velcro - a big flap that goes over my shin, held with wide velcro straps & a smaller flap over my foot w/more straps. I can inflate some inner bag which could make it fit more snuggly but I don't need it tho it does inflate on its own & I have to deflate it. VERY heavy! Like a ski boot.

Don't have to wear it at night any more which is a blessing. 

I don't keep it up much except in recliner & watching evening TV - no swelling or bruising any more.

Initially I was told "No weight bearing for 12 weeks so that's what I expected hence the knee wheeler.

BUT when I saw Dr. at 8 weeks he said I could start with 25% weight with a walker & work up over the next month so that's where I am now. It's hard to gauge & I'm putting a fair bit of weight on the foot when I haul myself upstairs. Better than crawling! Weekly outpatient physio will be doing steps & heel raisers this week & I'm doing these at home with 5 lb weights. . 

It does get tired & a bit achy & the area under my heel where a couple of screws were inserted is a bit sore occasionally.  But no pain.

SO sorry you are in such pain - forgotten how many weeks you are post-op?? And did you have the other ankle fused last year?? What a bummer. 

Can get out to dinner with walker - thankfully I have a dear partner to help me & drive. Expect to be walking (in boot) next month & yes, could probably travel in the summer if we had plans to. As a gardener, my aim is to be able to work in our big sloping garden (with steps) as soon as it starts to warm up.

I'm taking Aleve or may go back to Meloxicam but that's for the hip which seriously needs replacing next! Phew! Family Osteoarthritis-arthritis.

Keep in touch & let me know how you're doing. Helps to compare notes. Good Luck & feel better very soon. 

Caroline T  

Caroline

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[Caroline Levine]

Caroline, I,m 2 weeks post double fusion. A different foot fusion was a year ago. The surgeon then didn't think I needed a triple one. Seeing that I was in constant pain and on a ro later a year later,had this next and hopefully last surgery. I,m able to keep from being down by keeping myself entertained so much of the day.

[Jack Shepard]

How are you doing now? Can you describe your ability to get around, to move your foot, whether there is pain, etc. Fusion is one of my options after a failing total ankle replacement. I'm 68, and up until the last year or so was pretty active with golf, walking, working out, etc. But I've been basically bed-bound since I acquired infection from a cyst removal procedure in December of '17. I would appreciate any insight you could provide. Thank you.

Jack

[cjt1...@gmail.com]

Sorry not to have checked in for so long.

I had my triple arthrodesis at the end of November, finished the 3 months of no weight bearing in early March, moved quickly through walking with boot to flat shoes/hiking boot (which gave me good support!) best bare foot! I have a light weight shoe insert & was discharged mid March.

I was told that the foot is going to be a bit swollen till Fall (which limits what shoes I can wear comfortably) but it is basically pain free apart from the occasional twinge. It feels stiff but I can now flex it when walking up stairs.

I really don't think about it any more because I'm heading for a second hip replacement next week & the hip pain eclipses anything else! 

So it's hard for me to tell whether I could travel soon but I'm guessing without the hip issue, I'd be in good shape!

Good Luck.

Caroline Turner 

[Caroline Turner]

Jack,

What a dreadful outcome. I am so sorry.

I have just posted an update/answer on the support group page.

In case you can't access that........Following triple arthrodesis at the end of November, (I am 76 & in good physical shape apart from arthritis) I finished my 3 months of non weight bearing at the beginning of March. It was a very long winter but the orthopedic boot was comfortable & I had basically no pain. Continued with whole body physio throughout.

After I was allowed to weight bear in the boot first, then without, there was a short period basically of learning to walk again with some discomfort but it didn't take long. I found I did best barefoot. The foot will be slightly swollen till Fall, which means I have to wear a wide flat shoe. It feels stiff but apart from the occasional twinge, no pain & I can now flex the foot walking upstairs. 

Hard to tell really how I'm doing as the ankle has been totally eclipsed by a very arthritis hip (same side) which will be replaced next week.

I'm guessing that if I didn't have the hip problem, I'd be in very good shape.

I'm glad I finally decided to have the ankle done after many years of increasing pain which was limiting my gardening, Yoga & walking the dog. I'd been putting it off because of the long recovery but if it means no more ankle pain, then it was well worth it. 

I believe I've had such an excellent result because of my superb surgeon who I can't recommend too highly & adherence to regular physio. 

Dr. John Keeling with Montgomery Orthopedics in Chevy Chase, Md. 301-949-8100.

I do wish you the best of luck - let me know how you're faring.

Caroline Turner 

On Fri, Apr 13, 2018 at 5:28 PM, Jack Shepard <shep...@gmail.com> wrote:

How are you doing now? Can you describe your ability to get around, to move your foot, whether there is pain, etc. Fusion is one of my options after a failing total ankle replacement.  I'm 68, and up until the last year or so was pretty active with golf, walking, working out, etc. But I've been basically bed-bound since I acquired infection from a cyst removal procedure in December of '17. I would appreciate any insight you could provide. Thank you.

Jack

[Jack Shepard]

Thanks so much - I hope your hip surgery goes well!

Jack

BTW - I am able to read your posts so no need to send an email. 

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[Caroline Levine]

Hi,

I had the same surgery.  Dr. Keeling was the surgeon, but I stayed at Holy Cross, S. Spring for a couple of nights.  I'm now walking, mostly with the walker and cane, but sometimes without any device.  

Did your P.T. help you with gait training?  I just started PT and will begin the gait training this week.  I hope it helps with my limping.  When I limp, the un-operated leg and hip begin to hurt.  Is that your experience too?

Caroline

[Caroline Turner]

Caroline,

That report was written about 2 weeks post op. last December.

Don't know how long ago your surgery was but if you're now walking, I imagine that you've been in an orthopedic boot with no weight bearing for three months & are now allowed to walk with the boot or perhaps you're already out of it.

I did indeed have to totally learn how to walk properly again after I started walking with walker then cane sometime in March perhaps but with a pronounced limp which like you, screwed up all the other joints.  As I learned, the big problem with limping is putting abnormal stresses on the other knee & especially hip. By April, it was so painful that I had to have my second total hip replacement mid April so I am just 2 months post that surgery. The ankle got rather neglected while we concentrated on the hip - I worked with a great home physical therapist from Holy Cross who I'd had before for about 3 weeks then I went to the best outpatient physical therapist I have ever had close by in Kensington who quickly realized that my problem was not so much the hip but the still stiff & occasionally painful ankle. She worked for another month to loosen up the ankle & get me to walk normally. 

I am doing better without a cane & can finally walk the dog but still have to concentrate on walking "heel/toe" & remembering not to limp. The ankle still gives me pain coming down big steps - I can do shallow ones OK - but as Dr. Keeling told me that full recovery might take a year, I'm trying to be patient though I realize with 3 joints fused, there may always be stiffness & minor discomfort. Much better than pre-op however!

Hope you make good progress.

Let me know if you need contact info re my physical therapist. 

Caroline Turner

 

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[kimc...@gmail.com]

On Friday, December 15, 2017 at 2:29:10 PM UTC-5, cjt1...@gmail.com wrote:perience: I had a right ankle triple arthrodesis (same day surgery under a general anesthetic + nerve block)  two weeks ago using five screws, one main 6" incision on the outside of the foot  & a smaller one on the heel where some of the screws were inserted. I came home in a large, heavy cast/dressing (some oozing through the dressing for first couple of days) which was removed after the first week & am now in a boot 24 hours a day only removed for showering & PT. 

[kimc...@gmail.com]

On Friday, December 15, 2017 at 2:29:10 PM UTC-5, cjt1...@gmail.com wrote: