I am new to this forum. 56 year old male and had RA for 16 years. Was under control in the early days, however last five years has got steadily worse. I take Biologics MTX and steroids when needed.
I had an MRI on my feet a couple of weeks ago with a follow up last week. My hind foot and ankles are a mess, with no cartilage and bone on bone. The consultant is suggesting I have a triple fusion on both feet, followed by ankle replacement. Just wondered if anyone has had a fusion and what the be if it’s were.
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property2
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I have a problem with my right foot and my orthopaedic consultant has recommended ankle fusion in due course. However he gave me a steroid injection (under ultrasound) which has given me considerable relief for the time being. Have you tried that?
Yes, gave some relief, however looking at the scans would only be a temporary solution as the damage is severe. My mobility is hugely reduced and at 56 that’s not great!
Yes but my consultant told me that ankle surgery is fairly drastic and to postpone it for as long as possible if steroid injections do give relief. He advised that ankle surgery can change one's walking gait, which itself can set up more problems with knees and hips.
I had a fusion of talo-calcaneum joint having been reduced to not being able to walk more than a few steps about eight years ago - it has been a marvellous success. The orthopaedic surgeon said he would see me in a few years to do the same for my ankles, but that hasn't been necessary yet.
As I only had one done, I was able to use a knee scooter to get around for the twelve weeks off weight bearing (6 complete, 6 partial) and got many envious looks from children as I whizzed along!
If it's severely affecting your activities - go for it!
Thank you so much for your reply. I think I will go for it as not sure I have much other choice. They will do one at a time, and revisit the ankles at a later date.
I just wanted to say welcome to the forum. I have a telephone appointment with my GP next week due to right foot pain which is beginning to hamper my mobility. I was doing reasonably ok recently too.
Hi Mmrr,I was just about to put up a question about foot pain when I came across your comment! My foot is extremely painful at the moment and I was wondering what you thought of compression socks/ whether you have tried them? I tried to get one on to my foot, but it was just too painful to pull it over the swelling. Just wondering if it might do more harm than good to try to persevere? I would welcome any insights or previous experiences.
My RD began with a swollen painful red lump on the top of my right foot approaching 5 years ago, it disappeared within a few weeks, but not before the other symptoms of RD developed.It has niggled on and off, but nothing major until very recently.
The swelling, quite boggy and generalised foot pain is limiting at times and my foot feels as if it is 'clawing' up, but it is not red or particularly hot (although my feet are hot, have been for many years).
I rang the rheumatology helpline and got a ringback last week (a week later) when I was on holiday....unfortunately it went straight to answerphone and I missed the call. I was advised to contact my GP, hence the call next week.
I couldn't wear compression socks as I have hot feet anyway, and don't think I could get them on and off.
Hi, Your story sounds very similar to mine, although I am still waiting for scans. My RA has been well controlled but my feet are unbearable at the minute too. ( on them all day to because of my job!)
I was offered steroid injection but they decided against it until I have had ultra sound scans. I know it won’t be good news, my ankles were bad years ago ( xrays showed damage then).
Sorry I can’t offer advice, I hope all well for you.
Sorry to hear you are having ankle problems. I had the triple fusion (ankle & hindfoot) 3 years ago. It had needed doing for a number of years but I kept avoiding it. The first surgeon i was sent to was very negative, and only talked about all the things that could go wrong. Unfortunately the level of deformity meant i kept having repeated stress fractures in my ankle. Between 2009 and 2018 i had 7, and spent these years in and out of plaster casts for weeks at a time. This wasn’t ideal either! I had steroid injections, and whilst they can be very helpful, they can only do so much. Eventually, i saw another foot surgeon who was lovely. He explained it would be difficult, but that if left the deformity would continue to worsen leading to the breakdown of skin, bone protrusion and possible ulceration and continued fractures. It felt like there was no choice. The ankle was too damaged to consider a replacement, and I was told ankle replacements are still very hit and miss although I think there are some site members who have had this done successfully.
I had the op done October 2018. Thankfully it all went to plan. Obviously, it’s painful afterwards, but compared to other ops, I didn’t find the pain too bad. The hardest part (and one of the things that had put me off for years), was the non-weight bearing. I’m 52 and have had severe ra for 38 years so all joints are very damaged. I was expected to be completely non weight bearing in a plaster for 8 weeks, then partial weight bearing (still in plaster) for another 4 weeks. Finally, i was in a walking boot for a further 6 weeks. It’s a long recovery as they have to wait for the bones to start to fuse properly. You’re expected to use crutches and hop. There was no way I could do this. I started off with a tripod wheeled walker with a seat and had to sit on it and wheel myself around backwards with the other foot. I then found something called a Modelito Home Mobility Aid which I rented. Not perfect, but it certainly helped. Some people use knee scooters, but i have knee replacements and limited bend, and there’s no way I could’ve used one. I won’t lie, this period was very, very difficult simply because it was so awkward. It wasn’t due to pain.
I’m very happy to say, despite everything and my apparent high risk of non-union of the fused bones, it went really well and healed better than the surgeon expected. It’s much straighter now, and i can actually wear a pair of boots once more!! The reduction in pain is amazing. It feels much more stable and no longer gives way. Also, as yet, no more fractures.
So, despite my various reservations, it has worked well for me and I’m very grateful. My mobility is limited anyway, but the ankle made it so much worse. I never knew when i stood up if i would be able to stand on it properly. Also, apart from being painful and inconvenient, i never knew when it would fracture. I could literally stand up from sitting and i would get the fracture pain and that was it - it had happened again as it was being constantly stressed. My advice would be, if the pain and limitations are too much - and i think you will know when that’s the case for you, then it could be a good idea. Make sure you like and have faith in the surgeon. Also, get clear in advance what his non weight bearing, partial weight bearing etc schedule is so that you are prepared. Most importantly, make sure you’ve found a safe and manageable way that you can non-weight bear beforehand.
Obviously, it does feel different after. The ankle will not move up and down, or side to side. The only movement will be in the front part of your foot. It does alter your gait slightly, and i found my balance was a bit different. If you sleep on your back, your foot will always point directly upwards (I found that a bit weird to get used to), and it can be awkward getting shoes/boots/socks on and off over it at times. Walking up and down slopes takes a bit of adjusting to balance wise, as do stairs and steps. These things really aren’t massive problems though, it can just seem a bit weird a first but you soon adapt. You may not even notice or experience these things. Frankly, it’s not been too bad to get used to, compared to the massive decrease in pain.
The one thing i was confused about in your post was your comment about the surgeon saying you could have a fusion and then a possible replacement in the future. Apologies if I’ve misunderstood that. I was told it’s basically a choice of either/or and once you’ve had a triple ankle fusion you cannot have a replacement ankle done afterwards as obviously, the joint will be fused. I would clarify what was meant by that.
I do hope this helps. I’ve tried to think of everything i experienced, and also things it would have been useful for me to know, to try and give you a rough idea what to expect. Obviously, this is only my personal experience. If you do want to ask any other questions though, please feel free.
Many thanks for your very detailed reply very helpful. The surgeon has suggested a triple fusion to the hind foot followed by ankle replacement at a later date?
We also talked about amputation, however I have ruled that out as seems to drastic at this stage. My biggest concern is that both feet need doing, so I will need to go through the process twice.
You are very welcome. I'm pleased it may have been helpful for you. Apologies for the length, but it was one of the ops I've felt most apprehensive about, and couldn't quite manage to find put the kinds of things i wanted to know!
I see they have mentioned the 'A' word to you. One of the reasons I didn't warm to the first surgeon I saw was that he kept talking about amputation as though it would somehow be inevitable! I started to wonder if he perhaps liked collecting feet!!😉I didn't mention that in my earlier reply in case it hadn't been discussed with you. Could have been a bit of a shock!! The second surgeon did mention it, but only as a very last resort, and also pointed out that if I left it as it was, amputation would be even more likely in time..I suppose that's what I meant by no longer having a choice! I completely agree though, that at your stage, amputation is far too drastic an option, and I would try and put it out of your mind.
It is a worry that you will have to go through it twice, whichever op (fusion or replacement), you have. I can't think of anything to say to make that aspect better! It will be an unpleasant period, for hopefully a long-term gain. It's very hard when you are at the beginning of it, and facing both. I've been in that position with hips and knees.
I would definitely try and clarify what was meant by a replacement after a fusion. Perhaps there is a way it can be done? The only thing is, then that would be at least 4 operations if it's both ankles, and big ops too. There is a lot of debate over which is best - fusion or replacement? It hadto be a fusion for me, so I'm a bit grateful I didn't have to make that big decision. Obviously there's pro's and cons for each, but one of the things that did appeal to me about the fusion was that if it did work, that would hopefully be the end of it - no worries about having to have a replacement re-done. Everyone has their own ideas though about which things are important to them.
Anyway, as I said before, if you do want to discuss anything about it, please feel free as I know what a tricky decision it can be.
Hello property2, yes I have had a triple hind foot fusion on my right foot and am waiting for the left foot to be done. I would highly recommend it, my surgeon told me it would not help my mobility but would help with the pain, and that is true. The right ankle is still uncomfortable but that is to be expected as I have RA, OA and Fibromyalgia.Do hope that helps and you get some relief.
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