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Old 11-27-2008, 04:59 PM   #1
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Subtalar fusion

I am scheduled for a subtalar fusion Monday. This will be my 9th surgery on this foot. I've had post traumatic arthritis in my ankle and subtalar joint following a pilon fracture 8 years ago.

For the past couple of weeks my pain has escalated and spread. I think it is now also in my calcaneal cuboid joint. It is very sensitive to the touch and extremely painful when I walk. I have to admit, I am concerned we are missing something. What if there is advanced post traumatic arthritis there too? I called my surgeon and he said he would review the x-rays before Monday to make sure, but he doesn't recall anything standing out last time I was x-rayed (which was at least 9 months ago). I had a CT scan a few months ago, but it was focused on my st joint.

I guess I am just scared because 2 years ago I had my ankle fused thinking it would be the end of my pain. Now, here I am 5 surgeries later facing another. I really hope this is the end of the road for me.

Also, I have noticed I walk clear on the outside of my foot and I stand that way too. The inside of my foot and the big toe don't even touch the floor. I am beginning to think maybe my ankle was fused at the wrong angle. If I want the inside of my foot to touch the floor I have to bend my knee a little. The Dr. said he may be able to fix this Monday.

I have a few questions, and I am really hoping someone can help ease my fears:

1. Can an OS, or is it normal for an OS to add a procedure or revise the plan the day of surgery? Will I get there expecting one thing and end up having another?

2. Is there alot of pain after a subtalar fusion? I know my dr said I will have the popliteal block and spend the night in the hospital to ensure my pain is under control before they send me home. I am afraid I will feel good, get released with no pain meds, get home, and then have horrible pain when the block wears off. I live pretty far from the hosp. and I have had bad experiences with pain management. I am afraid the past will repeat itself.

3. What can I expect from the recovery? Is it long?

Any assistance that can be provided or if you have an experience you can share, I would really appreciate it.

Maybe this is all just a case of the pre-op jitters. You would think after all of these surgeries, I would be over it.

Step

 
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Old 11-27-2008, 08:30 PM   #2
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Re: Subtalar fusion

Step, so sorry to hear you are having another surgery. You've really been through it with that foot. I had PTT/Osteotomy so I'm sure my experience won't quite be the same but my surgeon did not make the decision to do the osteotomy until the day of surgery. What he did was have me go early that morning for an MRI and bring the disk to the hospital with me. He wanted to make sure that he wasn't missing anything. He had told me that the osteotomy was a possibility so it wasn't a shock. He reviewed the MRI and I was in pre-op and he came in and said that he was adding the osteotomy to my tendon transfer procedure.

Also, I was scheduled for one night for pain management and they ended up keeping me two. If you aren't under control they shouldn't let you go home. Once you are in there if you are really concerned you can ask to stay another night. I'm sure your doctor would go along with it if warranted.

Pre-op jitters are the worst thing. Especially when you have multiple surgeries. I've only had three and the thought of another one sends me over the edge so I can't imagine what you must be feeling.

Hang in there and remember that you do have some control over things. If you are really worried about this other joint ask that he do another x-ray the morning of surgery and review it with you. You have every right to request all the tests and/or information you need until you feel comfortable.

Best of luck to you and let us know how you are doing.

emmie

 
Old 11-29-2008, 06:54 AM   #3
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Re: Subtalar fusion

Emmie,

Thank you so much for the reply. I am feeling a little better about things today.

The most comforting portion of your post is pointing out that I do have control and that if the pain is bad enough, they will keep me another night. My dr was so kind on the phone and tried to give me some comfort by saying they weren't going to send me home if my pain wasn't managed.

My dr also seems 100% confident that the popliteal block will work on my pain. He said they can even come around and do a second block if necessary the next day. I have faith in my dr and trust that this will work, but my fear is that I will go home with no meds in hand and when the block wears off I will be in excruciating pain.

I am trying to find information on subtalar joint recovery, so I can see how long people actually need narcotics following surgery. I have been on meds of varying potency for the last 8 years and am currently taking vicodin, so I know I will probably need something stronger.

I do feel better knowing the surgeon can change the procedure or even add something at the last minute. I guess in my mind, I thought since the dr always has to get approval from ins co, there is no way he could just change his mind. I believe my os knows what is best. I will go in Monday morning and talk with him about ALL of my symptoms/problems and let him decide.

Thanks again Emmie!

Step

 
Old 11-29-2008, 09:42 AM   #4
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Re: Subtalar fusion

You are welcome! I also had the block and it does work well. wished I could have had it for about a month! I was put on Percocet post-op. The trick is to start taking it before the block wears off. I found I had to stay ahead of the pain with medication. Once I got behind it I was miserable and it took me a whole day to get back ahead of it. I had PTT/tendon transfer with a calcaneal osteotomy. Any time they cut your bones it is sooooo painful, as I'm sure you already know.

I wouldn't worry about taking the meds as long as you need them. What happened with me was at six weeks when I was put in a boot I was switched to Lortab, which is the same as Vicodin. I was then able to just take it as needed. I know someone who had a subtalar fusion and she pretty much followed my recovery schedule to the "T"....6 weeks in cast then six weeks in boot working to FWB by about 8-9 weeks.

Glad you are feeling a little better about things. Let us know how you are doing. Good luck and I know you will be happy when you are on "the other side".

emmie :=)

Last edited by emmie54; 11-29-2008 at 09:44 AM.

 
Old 11-29-2008, 09:55 AM   #5
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Re: Subtalar fusion

Hello Again Emmie

I think my dr has told me to expect about the same time span for NWB with the cast and then with the boot.

I understand what you are saying about taking the medication before the block wears off. When I had my TT fusion, I did not do that very well, and therefore woke up in horrible pain. It took 2 days just to catch up. It was awful!

Were you in the hospital following your surgery? If so, did they do the popliteal block more than once?

I guess I should trust my os. Even though he is not comfortable prescribing much, I am sure he will make sure I do not get left with inadequate care. My pain management doctor/clinic is not proactive at all. It drives me nuts!

Thanks again for your help! You are really helping to ease my fears and anxieties.

Step

 
Old 11-29-2008, 08:59 PM   #6
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Re: Subtalar fusion

I was scheduled to stay one night and ended up staying two due to extreme nausea. I was in the hospital when it wore off and WOW!! They worked to get my pain under control and stop the nausea and wouldn't let me go home until they did. It wasn't too pleasant.

I hesitated answering you because I don't want you afraid this will happen to you! I often react to anesthesia that way which is why I chose to get a block and stay awake for hardware removal, peroneal repair, and the arthroscopy I had last February.

 
Old 11-30-2008, 12:48 PM   #7
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Re: Subtalar fusion

I undestand, and you are not telling me anything I didn't already know. I've had the same kind of experience.

Thank you for helping calm my nerves. I feel a lot better today.

Step

 
Old 12-01-2008, 07:45 PM   #8
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Re: Subtalar fusion

Well, I had the surgery this morning. So far so good.

My os said the arthritis was much worse than the MRI showed! No wonder my pain had escalated. His tone changed from "we can do this whenever you are ready" which he stated about 6 weeks ago to "this operation NEEDED to be done" today. I am so glad I scheduled it when I did and did not put it off any longer.

The best part of the whole experience today is the os and the staff at this specialty hospital is totally responsive to my needs and proactively treating my pain. I'm not sure I'm a big fan of the block as I still woke up in really bad pain, but I didn't even have to ask for anything in recovery. I think I uttered a noise and I was crying. The nurse just looked at me and said, "I'll be right back with some morphine." This happened several times during my recovery room time. I was impressed!

Now, I am sitting here in my room feeling comfortable and secure in our pain management plan. I have the pump in, but we have already started oral meds, so I am prepared if he releases me tomorrow. I am very pleased with the way this has turned out.

Thank you for listening to my worries and pre-op jitters. It turns out the additional pains were just from the amount of arthritis in the STJ. I didn't know it could spread or radiate so far. Not to mention the problems and stress the inflamation causes in nearby joints.

Well, I am going to take advantage of these warm blankets and peaceful atmosphere and spend some time thanking God. This experience has actually been a blessing, believe it or not.

Step

 
Old 12-01-2008, 07:55 PM   #9
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Re: Subtalar fusion

Good to hear from you! I actually thought about you this morning and said a little prayer that things would go well. Glad you are able to report and I hope things continue going well. Let's hope you get home tomorrow.

emmie

 
Old 12-02-2008, 01:05 PM   #10
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Re: Subtalar fusion

Emmie,
You are sooo kind!

I am getting ready to get out of here. The block wore off very early this morning, and man did that hurt! I couldn't believe how bad the pain was.

I suffered for a little bit before I had another on put in. It took a little work, but once it was in, it was worth it

My pump is out now, so I am using the prescriptions to stay on top of the pain. The new block will wear off overnight, and I am scared that I will have that horrendous pain again. This time, instead of being here in the hospital where I can receive treatment, I will be at home - far away from the pain mgmt clinic.

I will need to create a plan with my husband regarding what we will do if it escalates out of control. I trust my os, and he says it won't be nearly as bad when this block wears off, but i understand pain can be difficult to predict. I just hope it goes ok. I will be taking my meds as prescribed just to stay ahead of the pain.

Thank you for listening!

Step

 
Old 12-04-2008, 05:59 PM   #11
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Re: Subtalar fusion

just take the meds when you are supposed to, even if you aren't feeling pain. that way you won't get behind. hang in there, day by day gets so much better.

shelley

 
Old 12-05-2008, 06:49 PM   #12
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Re: Subtalar fusion

Well, I ended up back in the er and then was admitted for 3 days to try and control the pain better. Over-all, it just was not a good experience.

I don't really have the energy to write about it right now, but I can say there is a reason I did not want to go back to this particular large hospital. I am not the least bit impressed with their care and caliber of their nursing staff. They have a lot to learn!

Anway, I just got home and had to make a mad dash to the side of the front steps to avoid throwing up on my husband. I am sure I took a couple of steps on my bad foot, but I really couldn't imagine doing it any other way.

I called the on-call service just to make sure my foot would be ok. They assured me that a couple of steps would be alright, especially since I did not have an increase in pain or pressure.

It has only been five days, but I am absolutely ready for this to be over!

Step

 
Old 12-05-2008, 10:16 PM   #13
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Re: Subtalar fusion

Step. I am sooo sorry you are having a tough time. Just wanted to mention that I always had to take Phenergan with my pain meds. I told the nurse that most pain medication makes me sick so from day one I was prescribed phenergan along with it. Maybe you can try this? If you are throwing up then the oral meds certainly won't stay in your system and you will be hurting big time.

Please let us know how you are doing. Hope it gets better soon.

emmie

 
Old 12-06-2008, 09:20 AM   #14
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Re: Subtalar fusion

Emmie,

Thank you for your suggestion on nausea control.

Last night I started eating 2-3 saltine crackers before every dose of pain medicine. This seems to help. However, I only took half of my allowed dose every 4 hours through the night to avoid letting the pan get out of control.

I am about to take my full dose of meds this morning, so we will see how it goes.

My cast is feeling pretty tight this morning. I'm getting my polar ice machine hooked up as I type. Hopefully this will help. Some of the issues I had the other night seemed to come from a very tight cast.

I'm doing what I can, but still on the verge of depression. That hospital stay was pretty hard on me emotionally!

Thanks!
Amy

 
Old 12-07-2008, 08:02 AM   #15
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Re: Subtalar fusion

Hello Step and Emmi -

I recently had what was supposed to be subtalar fusion and tendon lengthening on the 18th of November. I have severe flat foot deformity and I was experiencing pain from it in my ankle. Anywho, my surgeon had several x-rays of my ankle and thought it would be a simple procedure. Oh! I also had an implant in my ankle that was inserted when I was three, this was done to prevent my fee from turning in so much. Okay, so my surgery ended up lasting 4 hours. My surgeon said when he opened my ankle and removed the insert there was no joint. My ankle bone and heel bone had already fused, incorrectly! this was a part of my pain! He said he had never seen anything like it! He had to break that fusion and reset my bones to the correct position. Once that was done there was about an inch of bone missing. He put a bone graft in and set the bones in that position. Now, I usually have a very high tolerance for pain and things like this but when I woke up in recovery and realized I would have to stay overnight I cried. I don't like hospitals and that meant I wouldn't be comfortable in my own bed. Needless to say the morphine would not work, it was only good for making me sleepy. Then they went on to Lortab, which did not work either. After about 5 hours of no sleep and severe pain, they gave me torodal. That did the trick! I was pain free for about three hours.
I was not happy! I told the resident I would need something more than percocet for my home pain meds. He said I would have to spend the night if I wanted more. I went home
Well I doubled up on the percocet and was a sleeping zombie for the first few days.
The pain started to ease a little but then my cast started feeling tight and like it was sticking me. Once again not a happy camper.
I went to my first post op appointment the following Monday. My surgeon told me all there was to tell me about my deformed ankle. He took the cast off and I saw the damage. It was a mess.
Let me tell you, the pain I experienced when I stood up on my crutches to take the x-rays was terrible! Once he recast me it was little better, but not much. They told me it would be like this because there wasn't any pressure on my foot anymore. That is the type of pain that made me sit down for as long as I could with my foot elevated, minimizing the number of times I went to the restroom and everything. My husband and I slept on the floor downstairs because whenever I stood up on my crutches the pain was too intense. He felt so bad for me and didn't want me to suffer.

Anyway, all I can say is this pain was more intense than when I gave birth to my children.
Now, I have a question. Does anyone know how to prevent this burn from the crutches? My skin is really getting torn up from it.

Step stay on top of your pain meds. Do not get behind on them or the pain will creep up on you.

I would like to keep in touch with you on here to see how your recovery is doing and vice versa.

Hopefully you will be feeling a little better in the next couple of days.

 
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