Abstract
Surgery to the midfoot (usually fusion) may be performed for trauma, arthritis, deformity or combinations.
There are reports of good results, meaning primary fusion rates of 90+percent, 12 % serious complication rates and need for hardware removal 1n 25% of cases from specialist centres (Nemec et al AOFAS 2010). But even these good results mean 10% of patients needing lengthy revision surgery, and a third needing some additional intervention.
Surgery to the midfoot, like all surgery has both consequences (which everyone experiences) and complications (which some peolple get).
The consequences of midfoot surgery are time in hospital, long periods in cast (often non-weight bearing) and long rehabilitation periods leading to a “second best” result where pain is relieved, but mechanics and full function are not restored, and longterm stiffness and swelling are comon. Usually the patient still needs to restrict activities and wear orthotics or adaptive footwear.
The commonest complication is probably a failure to inform patients of the consequences of surgery – inevitably leading to disappointment with result and outcome.
Common complications include:
Wound, nerve and vascular problems.
Delayed union, malunion and non-union.
General complications such as DVT and embolism.
All these complications are more common in patients who smoke, are diabetic or have a BMI over 30.
By showing examples of problems seen in the last 15 years of tertiary referral (and the authors own cases), a system to minimise complications, and to address them when they occur, will be presented, based on:
Good preparation and timely accurate information
Planning surgery (approach, execution and post operative management)
Rehailitation and after surgery care.
These can usually only be brought together by a surgeon performing this surgery on a regular basis, and with the support of an equally experienced multi-disciplinary team.
