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Subtalar fusion now or later?

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Old 09-20-2011, 09:52 PM   #1
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Subtalar fusion now or later?

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.

Any opinions?

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Old 09-21-2011, 08:25 AM   #2
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Re: Subtalar fusion now or later?

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 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.

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Old 04-21-2012, 08:17 AM   #3
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Re: Subtalar fusion now or later?

My update, I shattered my heel in November 2010, thanks to an illegal alien drunk driver, then due to the poor care I received, got an infection which required several more surgeries, a week in ICU, a muscle transplant, and a skin graft.

I started a new job in November 2011, then switched to a new company in January 2012. My work requires a lot of walking, yesterday was over a mile. The heel doesn't like that much as the cartilage between the sub-talar joint and the calcaneus is gone. The docs want to do a joint fusion, but I need the motion in my foot as we have dual function foot pedals in what we drive. So far I'm surviving on a combination of OTC painkillers and cortisone shots into the joint.

I guess my story is a request for any ideas on the joint fusion, and to let others know one doesn't have to completely give up on a future life. Find an alternative to what you were doing before. It's okay to not be happy about the injury, but focus on what you can do, not what you've lost.

Last edited by Mod-S4; 08-04-2013 at 09:14 PM.

Old 05-18-2012, 08:50 PM   #4
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Re: Subtalar fusion now or later?

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.

Old 05-19-2012, 04:40 AM   #5
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Re: Subtalar fusion now or later?


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!
Microfracture, OATS, Distraction arthroplasty x2, Subtalar fusion, Achilles lengthening, Tarsal Tunnel release x3, Total Ankle Replacement, Peroneal Tear/Subluxation Repair/Groove Deepening

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