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Old 06-20-2011, 09:53 AM   #1
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Problem Subtalar Revision Arthrodesis

I broke my calcanius 6.19.2010, The Doctors first treatment was cast followed by physical therapy.
In sept 2010 My level of pain was unbearable.
So a subtalar arthrodesis was performed on Oct 18.2010, with 1 screw inserted through the heel for fixation and allograft.
After following all doctors orders non weight bearing 12 weeks at the end of january 2011, I was allowed full weight bearing after about a week I was able to walk to the bathroom or refridgerator and then my recovery quickly deteriorated. A ct scan revealed a non union and a subsequent subtalar arthrodesis surgery was performed 3.28.2011, at 10 weeks (06.08.2011) xray showed no cracks or lines at the subtalar joint and I was ordered partial weight bearing with physical therapy my first attempts at bearing weight were unsuccessful
with great pain. after 1 wk of PT I was still unable to put any weight on my foot and was very concerned so I scheduled an emergency appt with my orthopedic surgeon on 06.17.2011,
He did an xray which looks great to the naked eye. but when he blew it up on the computer he could see what appears to be a hairline crack through the subtalar joint.
He thanked me for being proactive in sensing some thing was wrong cancelled my pt an ordered a ct scan. which I am waiting for now. he says that my joint is still alligned and fixated with two screws and may still be fused or may be a delayed fusion. I still use a bone stimulator.
my concerns are with the first procedure the screw was countersunk into the calcaneal bone.
with the second procedure both screws are protruding and look like they may impinge the heel pad. my question are

1)has anyone had pain from screws impinging the heel pad after subtalar fusion that was relieved with removal of hardware?

2)has anyone undergone this procedure twice and had non unions.what would be the next step?

Last edited by unclmikl; 06-20-2011 at 11:01 PM. Reason: grammar

 
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Old 09-21-2011, 03:03 PM   #2
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Re: Problem Subtalar Revision Arthrodesis

To answer your questions:

1) When a screw is used for a subtalar joint fusion and inserted from the heel, the pain associated with the screw is almost always directly at the heel pad. This is resolved when the screw is removed, which is usually a simple procedure. There is no reason to remove them other than if they become painful.

2) When you have a failed fusion within the subtalar joint, whether once or multiple times, your options are limited. Most often this would involve a change in surgical procedure including bone graft from your hip or lower leg, an internal bone stimulator, platlet rich plasma at the surgical site, and more extensive non-weight bearing post-operatively. Other things to consider are diet, cessation or smoking, etc.

Reasons for a non-union are the patients health status (healing potential), improper immobilization (not allowing the fusion site to heal), vascular deficiency, or infection. You physician should absolutely consider all of these factors if a fusion site does not heal especially after multiple procedures.

 
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Old 09-21-2011, 04:34 PM   #3
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Re: Problem Subtalar Revision Arthrodesis

thanks J9879
I went to the doctors this week and i am now at just over 50% fused .and am now allowed to walk on my foot with continued used of external bone stimulator.I am a non smoker so at least I have that going for me.I have pain walking but it seems from a different source right now.more peroneal tendon strain,I am attributing this to not walking for over a yr and it will take some time to strengthen this up. when i am standing for longer periods of time i seem to have some pain from the heel pad. most of the pain seems to subside when i get off my feet and lay down for the night. I am refreshed by morning and depending how much i am up on my feet determines how long i will last that day.I know im trying to do too much too soon. I try to take it slow, but theres so much to be done after a yr of letting alot of things go around the house and my rental unit. I have to get things done. when my foot tells me it had enough I know its time to quit. hopefully in the next yr my pain will diminish to a level that is more tolerable with out the use of pain killers.I try to refrain from using them unless it is necessary. somedays are better than others.

 
Old 11-21-2012, 12:52 AM   #4
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Re: Problem Subtalar Revision Arthrodesis

I know it has been quite some time since you've posted to this thread but I am hoping that you will get this message. Has your subtalar arthrodesis fused since you last posted?

I had a subtalar arthrodesis, talonavicular arthrodesis, and achilles lengthening in April of this year. In July, i began physical therapy. In August, I was in a shoe and walking. I came to one of my appointments and was surprised to find i was going to be working with a student in her clinicals. She told me she was going to test my strength to hold my foot up and not let her push down. Instead of applying a steady gentle pressure, she stood up and quickly jammed my foot down. My foot snapped down (like to point my toes). I jumped up off the table cursing and crying (the first time crying). I told the girl if she did it again I would kick her in the face. I am not a violent person but it hurt BAD. It ended breaking the union in my subtalar fusion. My screw is loose (yes I can officially say I have a screw loose). After four months of taking excessive amounts of calcium and vitamin D and two treatments per day of a bone growth stimulator, my fusion still remains unfused and not progressing I was even put back into a cast and non weight bearing. As of now I have surgery scheduled for January 16th. He is going to go back in, remove all current hardware and clean out the subtalar joint. He will then insert a bone graft and some sort of grafting putty that contains live bone cultures. I am praying this works. I am only 33 years old and living like im 65.

I hope you're doing well. I guess I am fishing to hear a success story after non union.

Thank you!
~Kimberly
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April 2012
Double Arthrodesis
Achilles Tendon Lengthening
January 2013
Subtalar Arthrodesis Revision
Talonavicular Fusion Hardware Removal

December 2013
Screw Removal

 
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Old 12-07-2012, 12:53 PM   #5
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Re: Problem Subtalar Revision Arthrodesis

Lady K
I am sorry to report that my last procedure has not fused. with this type of procedure the success rate goes down with ea procedure. i can say i asked the doctor is their any personal health reasons my my fusion is so difficult. he said that their is nothing in my profile that puts me at risk and then he stated unless you are vitamin d deficient. so we did a vitamin d level. and my vitamin d level was well below the normal range. so i was put on a high dose of vit d 50,000 mg program for 6 months. I know take 5000 mg vit d weekly. which is also to help with my fibromyalgia.
i can walk. but each step is painful. i only use pain pills when i absolutely have to. my physiacal activity is minimal. my primary exercise is swimming during the summer. A 3rd surgery is imminent according to my doctor. at this point i have elected to not have the next procedure until i can no longer walk.
wish i had better news to report.
michael

 
Old 12-07-2012, 01:48 PM   #6
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Re: Problem Subtalar Revision Arthrodesis

I was almost completely fused when she broke it. Since that break we have been unable to get it to fuse any further. We went through the list of conditions that would cause problems too and I have no deficiencies. They commented when I had my surgery that I had the hardest bones they've worked on in the 14 years they've been in practice. They struggled getting the hardware into my bones but got the job done. I have been taking 1250 mg of calcium + vitamin D daily. I drink milk daily as well as eat plenty of yogurt. Calcium and vitamin D deficiency is definitely not a problem. I am not a smoker either. I am typically pretty healthy. I have surgery scheduled January 16 where he is going to revise things and add bone grafts. Sooo dreading it!
__________________
April 2012
Double Arthrodesis
Achilles Tendon Lengthening
January 2013
Subtalar Arthrodesis Revision
Talonavicular Fusion Hardware Removal

December 2013
Screw Removal

 
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Old 12-07-2012, 02:16 PM   #7
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Re: Problem Subtalar Revision Arthrodesis

wish you the best of luck. do you use crutches after surgery. I would suggest a knee walker it is the greatest thing since sliced bread. they have come way down in price around $200 there are several options. consider it

Last edited by moderator2; 12-07-2012 at 02:46 PM. Reason: please do not post a commercial website for any reason

 
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