Hi, everybody! It has been a while since I posted, but I am back and wanted to thank those of you who responded to me. I had a triple arthrodesis for Stage 4 PTTD on September 13, 2007.

I was quite concerned about it, but all went extremely well. The Dr. says that I do not yet have any observable arthritis in the ankle joint and so the fusion went great! I cannot believe how little pain I actually had! I even asked the doctor if something was wrong because it was easier that I expected!

My case is not typical, I suppose, but I am glad nervertheless.

Thanks again for your concern and support. Thank you, too, Dr Jeff, for encouraging me that I made the right decision. I will stay in touch as the cast comes off in about a month. The swelling is my main problem. I know I need to get that gone so it will heal properly. Anybody got any ideas besides just keeping it up?

PS, I found a fantastic alternative to crutches! It is called a Rollabout. It is like a little scooter that you put your knee on and then move about the house using your good foot. Check it out!! You can see what it looks like online!

Bye for now!

Magpie

Hi,

Thanks for dropping by. No pain with a triple? You are indeed very fortunate. That's a big project and usually is sore for the first week or two.

Glad things are going well. Let me know how you fare over time.

Jeff

Yeah, I have a pretty high pain tolerance. One thing I am curous about. My doctor didn't do a tendon transfer with the triple as he said he didn't think it would work for me. Does that make any sense to you, Dr Jeff, and if so can you explain it to me? Thank you so much for everything!

Yes. The two procedures are very different. A triple would be considered a structural change while a tendon transfer is called a functional change. Structural changes are much more stable and lasting. And a structural changes would work much better over time.

Jeff

Magpie,
So happy & lucky for you! Hope the healing continues on the positive side!
Katherine

Katherine:

Thanks so much for your encouragement. Yes, I too hope it contunues on the positive side. I will keep you posted. How are YOU doing?

Margaret

HI Guys:

Seven weeks post triple and still doing OK. I have a question for Dr Jeff and anyone else out there who has had this procedure done. A week ago, the cast came off (6 weeks post surgery). I was a bit horrified as my foot is still very swollen and a mottled red/blue color! Not bruised, exactly, but ugly nonetheless.

I saw the Dr's PA that week and I left with mixed messages. She stared at the Xrays of my foot for a long time and when I asked if bone was growing where it should be yet, she said "A little bit." She then commented that I still had a good bit of swelling and needed to get rid of it. By now, I am not filled with confidence that all is going according to plan!

However, she then said that she wasn't going to recast it and that I should start putting 50% weight on it. I was to stop and wait a week if it swelled or was painful. I asked her if I should wait until I had better control of the swelling before walking on it. She thought a bit and said well, yes, maybe I should wait the next day. Did I miss something?

Here's my dilemna: First off, I was sure I heard that no weight bearing for a longer time than 6 weeks with a triple. Also, what is 50% weight bearing? How can I tell if it is enough or too much?

Its a week later and I have not put much weight on it at all as the swelling is back immediately upon getting out of bed weight bearing or not. I am icing it 2-3 times a day and am beginning to panic that something is wrong. Is it OK to still have a fair amount of swelling? Dr Jeff: I promise not to quote you to my Doc, but how long do YOU recommend that your triple patients abstain from weight bearing? Is 6 weeks long enough? What is the cue that it is time to put weight on the foot?

Somebody please help clear up this mess!!?? Thank you all so much for all of your great information! I couldn't have made it through without you!

Hi,

One fusion is tough enough, but with a triple you're trying to get three major fusions to heal. There's no simple test that can really tell how well each of the individual fusion sites is healing. So the best test actually is guarded weight bearing. Guarded? It'll vary office to office, but in my practice I'd have you just on touch down pressure for the first couple of weeks in a walking cast. So you'd still be on crutches but would be able to touch down for rest. Also you could pivot to get on the commode or get in and out of the shower.

X-rays are going to be behind the healing of the fusion sites. So they're going to be unreliable in terms of gauging the healing. The only test at this stage is to try a little weight and see if anything swells. I know that doesn't sound very scientific, but it's the best way to go.

Now if healing seems delayed or if swelling persists for 4-6 months, your doctor might choose to order a CT scan to see how well the fusions sites are fusing.

But remember, every doctor is going to be a bit different in your return to activities. Just go slow and use moderation. Was there any talk of a removable walking cast with the PA?

Jeff

Thank you so much for your quick reply, Dr. Jeff.

Yes, I have a cam boot.

I think I just didn't have confidence in what the PA had to say. You are right - I will just go slow and let my foot tell me what it can handle. There is probably not much I can do to hurt it at this point without knowing it.

You are absolutely terrific. Thank you again. I will keep in touch.

Magpie

I agree. There seems to be a loss in the translation if it's not coming from the surgeon.

Jeff