Are there any bad things that could happen if I decide to postpone subtalar fusion surgery for post-traumatic arthritis in my foot? It was a badly shattered calcaneus courtesy of an illegal, unlicensed, uninsured driver in an unregistered van smacking into my sedan. After it was almost healed, the ignored open surgical incision erupted with infection, nearly killing me, and requiring several more surgeries.
For the severe pain, I begged and begged and begged the docs for a cortisone shot in the joint. They finally relented and gave only lidocaine, which lasted for 4 weeks, not just 4 hours. It took a month and a half to get scheduled for the surgery because of all the extra stuff they have to do to work around the muscle transplant and so on.
Now, surgery is a week away, and I don't want it. Just another shot to stop the pain, more when I need them, and let me work a new job (really freaking hard to find in this economy), get new health insurance, get an income coming in, and otherwise not end up homeless. Egads this is hard.
There are no real long term consequences of avoiding a subtalar joint fusion besides continued pain. The end result of severe arthritis of that joint is a fusion. Since you are already there, you aren't doing any extra damage that would ultimately change the type of surgery performed or the outcome.
If your subtalar joint is at the end stage of arthritis, there is nothing wrong with multiple cortisone injections per year. This joint, like all other joints, is surrounded by a soft tissue capsule and the injection stays localized to that area. The long term consequences of multiple cortisone injections into a joint is further deterioration of the joint. Just remember, this type of surgery is an elective surgery.....you elect to have it done not the physician. If you do not want to undergo the procedure, you shouldn't go through with it. That being said, I am very certain you would find it very helpful for your current pain since it has very good success with arthritis secondary to calcaneal fractures.
If you truly do not want the fusion at this point, my recommendation is to find a physician that is willing to give you a cortisone injection to make you more comfortable instead of insisting you have the fusion. Believe it or not, physicians like that are out there. Other things that you may want to look into is bracing. An "Arizona brace" is specifically designed to support excessive inversion/eversion motion of the subtalar joint. It is more commonly used for painful flatfoot pathology, but you may have very good success with it as well. It is the motion of the arthritic subtalar joint that is causing you pain and the goal of the brace is to limit that motion. Hope this helps.
The Following User Says Thank You to j9879 For This Useful Post: amarillokid (02-14-2012)
Maria...if you're still checking these boards would you mind updating and letting me know if you went ahead with the surgery or not.
I'm in the same position and am trying to decide what to do. My initial thought is to wait, but my biggest fear is causing other problems from walking (limping) improperly. I have one good foot and I hate to cause problems with my hips, knees, good foot or back. It may not even be worth considering, but that is what is really pushing me towards doing the fusion right now.
I had a subtalar fusion last year and I too tried to put it off but it was the best decision I've made to date with this ankle. Those take your breath away pains are gone!
I did put it off a bit and the Arizona brace was absolutely a life saver for that but the brace wasn't intended to solve the problem, just helped me not be in pain or make things worse before surgery.
If you are in that much pain, odds are you don't have much motion in that joint now so you won't miss the motion. This joint isn't like your tibiotalar talar where it's going to effect your hips, knees, etc. so don't let that be a deciding factor in your decision. Also compared to other surgeries I've had, pain from surgery/recovery wasn't too bad either - always a plus.
Cortisone shots are great for short term pain relief but unfortunately they wear off and you are back where you started. Not sure the rationale for putting off fixing it, unfortunately it most likely is not going to heal. Time to get your life back!
I'm so happy to hear that you've had a good outcome. I know that the longer I wait the worse it is going to get. I currently have a subtalar implant and it is causing the arthritis in the joint so it will only continue. So I don't have a huge range of motion right now and still can't run because the implant causes stress fractures every time I try. It was supposed to be the 'fix' to my problems and I think that it has made it worse.
I hate to go through this surgery, but I'm young and feel like the sooner I get it done the faster the recovery will be. Your post has helped me significantly. Have you had any isses with the screw they put in? I've read that about 20% of patients experience pain from the screw and have to have it removed.
I had a cortisone shot into the joint instead of surgery. Doing so, with repeated cortisone shots about every three months, allowed me to get a real job, get health insurance, and if I can keep postponing the surgery, might even have some savings available to keep me out of the poorhouse. I think it's a good reason to postpone the surgery. The alternative was too terrible to consider.
I'm also pursuing a nerve specialist who can deal with the damaged and trapped nerves. Maybe they can fix everything in one surgery, instead of several treatments.
I am postponing the surgery, for as long as I can. Between cortisone, a mix of OTC painkillers (doc approved combo), and lidocaine patches, I can keep walking and doing my job.
Absolutely! If the reason for postponing are those you mentioned it makes absolute sense. Get everything in order, feel comfortable about your situation and then make the decision.
Just know there will be a time however when they will stop the injections. I am surprised they would do one every three months...I was getting one per year in my other (good) ankle and after three they said no more because it will start to cause more damage.
Good luck, hope things workout for you...keep us posted!
kimberp...if you don't mind me asking another question...how long has your recovery taken? I know that initially I'll be in a cast and non-weight bearing for 8 weeks and then 4 weeks in a boot, but how did you feel once you got out of the boot? I realize everyone is different, but trying to judge (prepare) myself for the recovery.
I will keep you updated on what I decide. Still on the fence and still have some questions I would lke to have answered by the doc, but since my right (good) foot has started to ache a bit (from what I'm assuming is me favoring my left too much) it is definitely swaying my decision into the do the surgery now category. Agree...being younger does help with healing. I'm 35, don't smoke, work out 5-6 days a week and don't take any medications...so I think they are all going to work in my favor to help provide a favorable outcome.
Maria80386...thank you for your reply! I'm glad to hear that the combo you have (cortisone, OTC meds and pain patch) are keeping you mobile for now while you wait. I've had a couple cortisone shots and they would work for a little bit, but eventually it would go back to the same thing. It sounds like you have a plan on how to move forward and that is great! I feel very fortunate aobut my job. I'm a research scientist so while I do spend some time on my feet in the lab it can be modified to fit what I need and I have plenty of people who can help. Plus, there is always stuff I can do on the computer if need be...so luckily I won't have to be out of work too long. I think I'd go crazy otherwise! But, thank goodness for short term disability. I would have no idea how people would have to tackle something like this without it.
Hope you can continue to control your pain and I hope that when you do have the surgery it works out well for you!!
That's actually a difficult question for me to answer because I didn't just have the subtalar fusion during that surgery...but I'll try.
I had an external fixator put on for ankle distraction at the same time as the ST fusion. (they were supposed to use the ex fix for fusion so I wouldn't have screws but ended up using screws) so the first 6 months of my ST fusion which would normally be casted during the first 2 or so, I had the metal cage through my foot (and believe it or not, still not too bad).
When the ex fix was removed and I was put in the boot, I went from nwb to fwb in less than one week. Yes I still used crutches for awhile for support, and yes, those first steps were quite unpleasant, but it was doable.
To date, as I mentioned the stabbing, take your breath away pain and deep ache after spending any time on it are gone...thank goodness!
Now I am deciding what to do with my ankle joint. Both it and my ST always had arthritis but now that ST joint is good, makes that pain more pronounced.
To replace now or to fuse with replacement later...that is the question.
Oh my goodness...that sounds pretty extreme, but it sounds like you feel like you definitely made the right decision.
I know exactly what you mean about that deep take your breathe away pain after being on your foot for a long time. I know days that I'm in the lab for a long time and being on my feet I have that pain and that is probably what is the worst.
Good luck with your decision about the ankle. I wish they had a way to replace the subtalar joint becuase I would definitely choose that first. I think I'm having a hard time because fusing a bone just doesn't seem like the best of ideas, but I know in the end my pain will be substanitally reduced. Whichever you choose you know that your pain will be better so either way it will be better than what you have now.
Thank you for all of your answers. I appreciate you taking the time to answer them. It's so nice to know that someone else has had a similar decision and it worked out well. Have a GREAT weekend