Hi,
Has anyone done a triple fusion before? Do you know whether there are
any side effect?. Do you know whether this will cause pain or damage,
due to deterioration of the body as it grows older.. over the age of
50? or anything you have to beware? Please respond so I can made a
wiser and thorough understanding than what the doctors says.

<anthony.mak@iname.com> wrote in message
news:1192708729.726082.267760@q5g2000prf.googlegro ups.com...
Several people have had it done and talked about in alt.support.arthritis
and my memory of them all is that it was an improvement in their way of
life.
Some of them had to wear a rounded shoe on the foot on the fuse side but
that seemed to be easy to adjust to. A person usually has a very painful
ankle to have this done but after the recovery,,,, no pain.
Harv

Thanks Harvey. It is good to hear that after the operation, there is
no pain.

Does anyone know if there is any problem caused by a triple fusion,
when people get to their 50s and beyond?

How long can one walk after an triple fusion operation? At the
moment,
due to inflammatory arthritis, my friend can only walk 20 mins
without
stop, and a bit more than 1 hours in total in a day. Would a triple
fusion,
allows, for example walking 2-3 hours shopping in a city street?
Walking
as much as a normal person?

For people who have done triple fusion, can you do jogging, badminton
or swimming?

<anthony.mak@iname.com> wrote in message
news:1192757771.594598.294950@e9g2000prf.googlegro ups.com...
after the operation. I am sure there is plenty of pain after the operation
but that is what the drugs are for. As always,,, something that has to be
gone through if you are going to improve the quality of your life.
Harv

<anthony.mak@iname.com> wrote in message
news:1192758510.557301.103640@k35g2000prh.googlegr oups.com...
going to have to get a grip on your age and your ability to do things.
I am sure that swimming would be just fine but the impact of jogging would
be a disaster to a newly fused ankle. Will this procedure make you like a
teenager again??? Hell no... Will it make you be able to stand or walk on
your feet for an extended period of time??? Maybe so and I would be happy
with that.
Harv

On Oct 19, 2:24 am, "Harvey R. Stone" <hrst...@swbell.net> wrote:
Thanks Harvey. It is good to hear there is no more pain after such
operation.

On Oct 20, 12:45 am, "Harvey R. Stone" <hrst...@swbell.net> wrote:
Sorry, just typing too rashly without wording my sentence correctly.
Anthony

On Oct 20, 12:52 am, "Harvey R. Stone" <hrst...@swbell.net> wrote:
Just trying to find out to what extend can one walk like a normal
person after
the operation, and what kind of sports is possible.
So that I can assure my girlfriend, that she will have a normal life,
if that is
in fact factual.
My wording one again must have sound like I am hoping I am hoping
something
unrealistic. But I can just trying to get all the facts for all the
positive and negative
changes that triple fusion operation can bring potentially.
I value the info you provided me for triple fusion. Thanks.
Anthony

you're not asking unreasonable questions, but the problem becomes one
of:

a) degree of damage already; done and having to correct for
b) actual 'fix' applied when they get in there and actually do the work
on it
c) any other medical conditions [like the existing r.a.,
that will influence her recovery, rehab, and overall general health

the procedure will give some relief and will give back some mobility and
possibly endurance - how much is going to be found out in rehab.

think of it this way - if the ankle is fused, and can no longer bend,
then you can't walk 'normally' - but you 'can' walk - and can
participate in normal activities -but each of us have different
capabilities afterwards - a classic YMMV outcome.

the alternative would be to continue to have capability diminish and
pain increase - so she [and you ] will be glad to have gone thru it, and
learn how to maneuver with whatever the outcome ends up being.

mind you, i can't have it done because i'm too brittle - but here is my
impression:

jogging - i wouldn't [jmo]
badminton - maybe
swimming - YES


anthony.mak@iname.com wrote:

On Oct 22, 5:12 am, "Paul T. Holland" <pholl...@bellatlantic.net>
wrote:
So, summarizing the opinions so far.

As for walking, after a triple fusion, a person will be able to walk
much
more extensively and possible as much as a normal person.
(though the walking style may not be 100% as a normal person would
because the ankle is more rigid).

Swimming and cycling should be ok. And, perhaps some other non
ankle intensive sport. But for ankle intensive sport, better consult
with a doctor.

Ultimately, how much sports and how much stress one can put to
the ankle after the operation is depends on case by case on how
healthy was the ankle before the operation and other health factors.

Anthony

Does anyone know if triple fusion will have any side-effects when old
age?
I haven't heard much, but does this mean there is none?

[Note: Approximately five to 10 percent of ankles fail to fuse,]


not old age per se, rather time based wear and tear on the remaining
structure:

but "the surgery requires the removal of the joint cartilage, proper
positioning of the ankle and foot, and placement of screws, plates,
rods, or pins to hold the position while the bone knits together into a
solid painless structure, so:

Once fused, the ankle usually is painless or far improved from the
preoperative condition. In most patients, function is somewhat limited
by ankle fusion-especially going up and down slopes or stairs, walking
on uneven ground, and stooping to pick up objects. Over 10 to 20 years
after an ankle fusion, other joints of the same foot tend to wear out
and cause pain."

'nother note: if patient is a smoker - STOP - there is a much higher
failure rate for the fusion with smokers...

"Chronic smoking is a relative contraindication due to the associated
high incidence of nonunion"

you might want to look at:

http://www.emedicine.com/orthoped/topic354.htm

"Outcomes are typically good with high union rates of the subtalar and
CC joints. The TN joint has the highest incidence of nonunion; however,
this decreases with better understanding of the procedure and stable
fixation. Degenerative changes at the unfused distal and proximal joints
are still a long-term complication, but this is true with any fusion
procedure. A study examining 400 triple arthrodesis procedures found
less than perfect results in 24.5% of patients (Duncan 1978).

Up to 10 months are required for the patient to become pain free
(Gellman 1987). Return to high-impact activity is not a given.
Lower-impact activities like walking, cycling, and swimming should be
obtainable goals postoperatively."

anthony.mak@iname.com wrote:

increased stress [sports] will shorten the life span of the remaining
structure, see my next post

anthony.mak@iname.com wrote:

Wow, Paul. You know so much! If I may ask,are you a doctor?

On Oct 23, 4:57 am, "Paul T. Holland" <pholl...@bellatlantic.net>
wrote:
not
caused by the triple fusion, but just the natural wear-out of the
OTHER
parts of joint in the foot then. ?


foot joint structure? But from the above, it seems not entirely
impossible to do high impact sport? But I guess one should
take it as a grain of truth and be caution to whether or not
to do high impact sport, and this also depends on case by case and
need proper consulting with the arthrithis doctor and foot surgent?

All sources I found say triple fusion will definitely improve walking.
Is there any information or experience from other people out there,
that say whether after the operation (with recovery) the person can
walk as much/long as a normal person? e.g. assume a normal
person do 4 hrs of walking in total a day by going to shopping mall
....etc.

Thank you Paul & everyone on the internet!!

lol - no,no - just an old foggy who's been there i'm afraid

anthony.mak@iname.com wrote:
actually mixed message - in and of itself, old age doesn't have to mean
that we wear out - but, with less than good nutrition, and poor habits
in general, we do.

the leg structure [along with the spinal column] is subject an
incredible set of stressors just moving us around. if/when we neglect
general muscle tone and flexion/flexibility - the 'impact' stress in
magnified. and i'm also thinking 'weekend warrior' now -

since the hip/pelvis, knee, ankle, foot [sounds like the song!]
structure is a continuum, and for the female with the wider pelvic
girdle more so - it is normal for there to be wear and tear for those
that engage in 'impact' sports: running, jogging, etc, etc -

NOW: once the ankle is fused, that 'impact' is going to be transferred
from the 3 part section of the ankle, onto/though, the remaining
'normal' foot structure [and 'some] smaller amount back up to the knee
and hip]

so the wear and tear is going to be reflected in the remaining normal
structure and -simply put - wear 'em out earlier than normal - when i
gave the range a 10-20 years for this to happen, i should have said
that the older you are when you get fused [unless you are in picture
perfect shape], the lower the remaining years until you have issues with
the foot., so a 50 year old hits the wall faster than a 30 year old.

as to ability afterwards?

two edged:

those who are diligent and work their rehab [after the initial
non-weight bearing period - or it won't fuse right!!!] do better than
those who are tentative and slack off - but it is going to take months -
10 months isn't unreasonable to get to the new 'normal'

only then can a decision about impact sports be made with any reasonable
clarity.

having a goal is a good thing - but it is going to be a year away...and
it has to be built towards over the whole time.

each and every step magnifies the forces on the joint - taking a step is
one thing, increasing speed, length of stride, surface we are on, etc,

at minimum triples the forces - this amounts to many hundreds of foot
pounds (3 to 4 times body weight, up to 800+) [no pun intended] on the
legs and feet.

the triple fusion removes about 40% of the shock absorber the body came
with.

be looking for a good rehab specialist/sports medicine physiatrist. [not
usually paid for by insurance, unless you're a prof. athelete]

[aside: many women have shoes with higher heels - forget it after the
fusion - ankle won't bend that way anymore, and the arch of the foot
doesn't need the added stress]

hth

paul

the improvement is mostly from release of constant pain.

with the proviso that this could be as much as a year down the line -

and factoring in avoidance of ramps, inclines etc as much as possible

[One report showed a 13% decrease in dorsiflexion and a 16% decrease in
plantarflexion after fusion - so the remaining foot structure would get
strained negotiating inclined surfaces]

also, presuming that all three sections 'do' fuse - remember,
statistically the TN joint is more problematic than the ST and CC
joints

then yes, 4 hours spread out over time is reasonable and do-able.

also - be sure to look at the actual procedure being contemplated - one
bad outcome occurs from nerve damage due to the type of incision [the
lateral and medial incisions] some doctors use - familiarize yourself
and have a discussion before-

post-op, be aware of

"entrapments within surgical scar tissue which can take place in the
postoperative period; however, painful neuromas rarely occur. When they
do happen, standard conservative measures with appropriate medications,
injections, and physical therapy should be used. If these measures fail,
surgical neurolysis or proximal neurectomy with implantation into muscle
is performed."

anthony.mak@iname.com wrote:

Dear Paul,

I seems to see from what you wrote that inherently triple fusion does
not bring "side-effects" for people when they become old age
eventually.
But because the limit on the degree of freedoms on the joints, it
might(will?)
accelerate the natural wear-and-tear of the other joints in the foot.

Do you know if this acceleration is significant? Like double the
natural wear-and-tear, or 5% more and so on?

Anthony

anthony.mak@iname.com wrote:
the increased wear and tear 'is' a side effect of having the cartilage
of the three ankle joints removed and the bone fused.

this is a classic YMMV situation - no two outcomes will be the same, so
it can only be viewed by reviewing the conditions:

overall condition of the 'other' leg/foot structures at time of fusion,

state of overall health of patient,

any other contributing/ongoing disease processes like R.A.

degree of 'take' of the 3 fusion sites

VERY IMPORTANT: quality and length of post-op rehab

continuing level of activity that may affect the fused joint(s) after
full healing and rehab

some R.A.'s [small number] have had post-op avascular necrosis of some
of the bone ends - this appears to be from the auto-immune process, some
have had increased scarring of tendons/ligaments that required 'release'
surgery later.

several things are primary influences

any ongoing medical condition that affects soft tissue or bone - like
RA or other auto-immune processes. the degree of whatever condition will
likely accelerate any further breakdown

follow-up after healing for proper footwear - possibly even othotics or
special order/built shoes appropriate for activity level

age at time of fusion

degree of ongoing activity and what surfaces this is done on

bottom line is that since damage has already occurred for whatever
medical reason, 'and' this patient is very likely to want to, and will,
be active afterwards - yes, there probably will be some accelerated
breakdown of the rest of the structure.

how fast and to what degree would be pure blue sky guess.