Triple Arthrodesis: Advanced Surgery for Severe PTTD

When PTTD progresses to the point where joints have developed severe arthritis and conservative treatments no longer provide relief, triple arthrodesis becomes the definitive surgical option. This major procedure fuses three key joints in the foot to eliminate pain and restore stability.

What Is Triple Arthrodesis?

Triple arthrodesis is a surgical procedure that permanently fuses three joints in the back of the foot:

  • Talocalcaneal joint (ankle bone and heel bone)
  • Calcaneocuboid joint (heel bone and cuboid)
  • Talonavicular joint (ankle bone and navicular)

By eliminating motion in these joints, the procedure removes the source of pain caused by arthritis and joint degeneration while maintaining the foot’s overall structure.

This surgery is typically considered when:

  • PTTD has progressed to advanced stages with significant joint damage
  • Severe flatfoot deformity has developed
  • Arthritis has developed in the subtalar and midfoot joints
  • Less invasive surgeries are unlikely to provide relief
  • Pain significantly limits daily activities

Triple arthrodesis is generally considered a last-resort option after other treatments have been exhausted.

The Surgical Procedure

During triple arthrodesis:

  1. The surgeon makes incisions along the outside and inside of the foot
  2. Damaged cartilage is removed from all three joints
  3. The bones are positioned to restore proper alignment
  4. Hardware (screws, plates, or pins) is placed to hold bones in position
  5. Bone graft may be used to promote fusion

The procedure takes 3-4 hours and requires general anesthesia. Hospital stay is typically 1-3 nights.

Recovery Timeline

Recovery from triple arthrodesis is extensive but predictable:

Weeks 1-6: Non-weight-bearing in a cast. Use of crutches or walker required.

Weeks 6-10: Transition to a removable boot. Gradual weight-bearing begins.

Weeks 10-14: Physical therapy intensifies. Weight-bearing increases.

Months 4-6: Most patients return to supportive shoes. Low-impact activities resume.

Months 6-12: Continued strengthening. X-rays confirm bone fusion.

Year 1+: Full recovery expected. Hardware may be removed if causing discomfort.

Long-Term Outcomes

Triple arthrodesis has excellent outcomes for pain relief:

  • Pain relief: 90-95% of patients report significant pain reduction
  • Function: Most return to daily activities with improved mobility
  • Fusion rate: Approximately 85-95% of fusions heal successfully

The fused joints lose their motion, but the surrounding joints compensate well, allowing for relatively normal foot function.

Important Considerations

Before undergoing triple arthrodesis:

  • This is irreversible—fused joints will never move again
  • Recovery requires significant patience and commitment
  • Plan for 3-6 months of limited activity
  • Consider getting a second or third opinion
  • Choose a surgeon experienced in this specific procedure

While triple arthrodesis is major surgery, it offers reliable pain relief and functional improvement for those suffering from advanced PTTD with arthritis.