Excision of tarsal coalition

Summary

This operation is performed for symptoms caused by a tarsal coalition, an abnormal failure of separation of 2 bones in the foot.  The coalition can cause a painful, stiff foot and can be a cause of a stiff flat foot in adolescents.

Factors to Consider

Symptoms from a tarsal coalition normally occur in young adults.  The coalition can occur between any of the bones but usually involves the bones around the heel.  This may cause difficulty walking on uneven surfaces or pain on walking long distances.

It is likely that you have already tried non-surgical treatments for your foot such as pain killers, shoe modification, physiotherapy and orthotics.  If these measures have not improved your symptoms then the next logical step is to consider surgery.

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation is usually performed through a short incision in your foot.  The coalition is identified and removed using a saw and chisels.  The gap following removal is then filled with bone wax and or soft tissue in the operative field to prevent the coalition from recurring.  

The operation takes about 45 minutes.

Anaesthetic

The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The main risk for this operation is recurrence of the coalition or failure to resolve all your symptoms.  The foot has become stiff over time and so it is difficult to fully resolve all that stiffness.  

The risk of infection is small and is thought to be about 1%.  Most infections will settle simply with antibiotics.  Damage to nerves and blood vessels around the foot can occur but this is rare.  

Surgery to the foot may increase the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Dressings

Depending on the site of the coalition you may wake up with your foot in a plaster.  This is kept on for the first 2 weeks to allow the wounds to heal.  You will not be allowed to weight bear during the first 2 weeks.  The surgeon will give you instructions as to when you can start weight bearing.

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients but normally takes about 4-6 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 6 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable.  Your symptoms should be approximately 80% better by 3 months with the majority fully recovered by 6 months.  It can, however, take up to a year for some patients to fully improve.