The operation can be performed either under general anaesthesia or regional anaesthesia. This decision can be made after discussion with the anaesthetist. The procedure involves making an incision over the affected area, inspecting the two joint surfaces, removing the cartilage and compressing the joint together in an appropriate position with screws.
You may be given a local anaesthetic nerve block to ensure immediate post-operative pain relief. Whilst you are in hospital you will be monitored and the medical staff will give you painkillers as required and prescribed. When you are at home you may find Paracetamol and/or anti-inflammatories useful for controlling any pain. Instructions on the management of pain will be given by the nursing staff before you leave the hospital.
Most patients who have a fusion will stay in hospital for one night. The majority of patients have only a padded dressing and bandage to the wound but rarely you may require the use of a plaster cast to the forefoot after surgery.
You will be given a special shoe, which helps to off load the forefoot. The physiotherapist will give instructions on how to wear the shoe as well as the use of elbow crutches if necessary.
For the first two weeks you are advised to restrict your walking distance to within the house and garden and to elevate the foot as much as possible. Swelling is quite common after foot surgery and this is best managed by elevating the foot on a pillow every night and during the day on at least three different occasions e.g 11am, 3pm and 6pm for about one hour each time. This will help to reduce swelling of the foot and speed wound healing.
Your wound dressing will be changed at 7-14 days and the stitches removed or trimmed. You are advised to keep the dressing clean and dry until the stitches are removed. You will need to wear the special shoe for about six weeks to allow the bones to fuse, after which time you will need to wear loose-fitting shoes (eg Ecco, Hotter or sports shoes). Normal footwear (which is well fitting) can be worn about three months after the operation.
People vary in how quickly the swelling disappears after surgery and three to six months is not unusual. Provided you are not having undue pain or inflammation there is probably nothing to worry about and you can afford to give it time.
Patients having had only the left foot operated on will be able to drive an automatic car within two weeks. Those who have had an operation on the right side will be able to drive after about 6-8 weeks. You are advised not to fly after surgery for about 6 weeks. Swimming will be possible once the sutures are removed and the wound is healing satisfactorily.
You may be able to return to work after 2-4 weeks with a desk job, if you are able to elevate your foot whilst sitting. If you do manual work and there would be a lot of pressure on the foot, then you may need 8-10 weeks off work.