Triple arthrodesis is a major foot operation to fuse three joints in the hindfoot — the subtalar, talonavicular, and calcaneocuboid joints. It provides powerful correction of foot deformity and is performed for severe hindfoot arthritis, deformity, or instability.
Incisions are made on the outer and sometimes inner side of the foot. The cartilage is removed from all three hindfoot joints. The bones are repositioned into optimal alignment and fixed with screws. Bone graft may be needed. The operation takes two to three hours.
Triple arthrodesis is recommended for severe hindfoot arthritis, rigid flatfoot or cavus foot deformity, posterior tibial tendon dysfunction (advanced stage), neuromuscular conditions causing foot deformity, and failed previous hindfoot surgery.
Orthotics, ankle-foot orthosis, footwear modification, and pain management. These may manage symptoms but cannot correct a fixed deformity.
Weight-bearing X-rays and CT scan. Smoking cessation is essential. Plan for prolonged non-weight-bearing.
Excellent pain relief and deformity correction. The foot is stable and plantigrade (flat on the ground). Most patients walk comfortably in supportive shoes.
Expected — this is the purpose of the surgery. The foot is less adaptable on uneven ground.
Foot swelling for many months.
Walking pattern changes, particularly on uneven terrain and stairs.
One or more joints may fail to fuse. Risk approximately 5-10%.
Increased stress on ankle and midfoot joints.
Multiple incisions increase risk.
Sural, superficial peroneal, or deep peroneal nerve.
The foot may heal in a suboptimal position.
General or spinal anaesthesia with nerve block.
Non-weight-bearing cast for eight to twelve weeks. Weight-bearing in a boot for a further four to six weeks. Physiotherapy. Full recovery nine to twelve months. Supportive footwear long-term.
Regular X-rays at six weeks, three months, and six months.
These three joints work together as a unit. Fusing all three provides the most reliable correction and stability. Fusing one in isolation may overload the others.
Most patients walk well on flat ground. Walking on uneven terrain, hills, and slopes requires more adaptation. Running is generally not recommended.