Triple Arthrodesis Surgery Miami

Triple arthrodesis surgery is among the treatments we offer at Luxe Foot Surgery. It is a surgery with such a predictable level of success and with such positive results that it is often used as a definitive solution for many foot disorders, such as degenerative arthritis, advanced flat feet, apropulsive gait, degenerations that have resulted from poliomyelitis, and others that we will analyze later. The determining point for opting for triple arthrodesis surgery is that the pain has become intractable by non-surgical means.




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What is triple arthrodesis surgery?

Triple arthrodesis surgery, also known as TA, is a surgical procedure that involves fusing three joints in the hindfoot and midfoot: the subtalar joint (between the talus and calcaneus bones), the talonavicular joint, and the calcaneocuboid joint. This procedure is considered versatile as it can be used to treat a variety of foot disorders and is often used as a definitive treatment option. The goal of the surgery is to restore the patient’s ability to walk without pain and with propulsion.

While this type of joint fusion may result in a loss of mobility in the hindfoot, the benefits of the surgery often outweigh this disadvantage. However, it’s important to note that the surgeon must carefully evaluate each case, taking into account the patient’s activities, profession, expectations, and overall health, as well as the severity of the disorder being treated. If other, more conservative options are deemed more suitable, those may be pursued instead. Overall, the final decision on whether to proceed with triple arthrodesis surgery will be based on the surgeon’s judgement.

3d render of feet close-up with glowing bones Triple arthrodesis surgery Miami

What objectives are sought with a triple arthrodesis surgery

Triple arthrodesis surgery is a joint fusion procedure that is used to relieve intractable joint pain in the foot. This type of surgery is typically reserved for cases where other treatments, such as painkillers and splints, have been ineffective. The main objective of triple arthrodesis surgery is to alleviate pain caused by fractures that severely impair the joint, severe sprains, or advanced arthritis. 

It is important to note that the objectives of this surgery must be carefully evaluated on a case-by-case basis during pre-surgery research and that the results of the procedure should be closely monitored, particularly in the long term. Studies have already been conducted on the long-term results of triple arthrodesis surgery, with positive results, but more research is needed.

What foot disorders can be treated with triple arthrodesis surgery?

As we said above, triple arthrodesis surgery is considered a very versatile procedure with a high success rate. There are many foot disorders (or foot problems resulting from other diseases) that can be treated with triple arthrodesis surgery. In fact, this type of surgery is considered the first option in many of the following cases, since its results are often successful and definitive. The following numbered list also answers the frequently asked question of which patients need triple arthrodesis surgery:

  1. Degenerative or post-traumatic arthritis due to pain.
  2. End-stage flat foot deformities, resulting from loss of surrounding soft tissue structures or adaptive joint transformations, and pain.
  3. Pes cavus deformity as a consequence of surrounding joint adaptive transformations, and pain.
  4. Charcot arthropathy after coalescence with danger of ulcerations or apropulsive gaits.
  5. Tarsal coalitions due to pain or joint degeneration of the ankle/surrounding joints.
  6. Residual clubfoot deformity causing pain, degenerative joint disease, or apropulsive gait.
  7. Severe post-traumatic conditions, osteoarthritis (OA), neuromuscular disorders, extensive contractures, and prolonged dysfunction of the posterior tibial tendon.
  8. Certain neurological disorders that cause neuromuscular imbalances and a propulsive gait, such as: Charcot-Marie-Tooth, poliomyelitis, Friedreich’s Ataxia, spina bifida or cerebral palsy.
Woman suffering from leg foot ankle pain medical and health concept_Triple arthrodesis surgery - Luxe Foot Surgery Center

Measurement of results of triple arthrodesis surgery by the AOFAS scale

An illuminating study published in 1999 in The Journal of Bone and Joint Surgery, entitled “Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients” (CL Saltzman et al.), conducted a sixty-seven-foot follow-up for an average time of between 25 and 44 years after triple arthrodesis surgery. The conclusion was that, after that time, 95% of the patients felt satisfied with the result of the surgery. This evidences an incredibly high effectiveness for triple arthrodesis surgery. Let us also examine another approach to results, based on the AOFAS scale. As we know, the AOFAS scale (acronym for the American Orthopedic Foot And Ankle Society) is a standardized instrument to measure the clinical status of the ankle and hindfoot, before and after treatments and surgeries, from 3 points of view: pain, functionality, and alignment. The AOFAS score ranges from 0 to 100: 40 points are assigned to pain, 50 to functionality, and 10 to alignment. Only fully healthy joints receive 100 points. Receiving a high score, for example, between 75, 80, and 90 points, is a great achievement for a operated joint. Objective information is of great importance for the measurement, but subjective information provided by the patient himself is also taken into account. Clinicians often evaluate the results of triple arthrodesis surgery using the AOFAS scale. This is the case of another study, published in 2007 and entitled «Long-term results after a triple arthrodesis of the hindfoot: function and satisfaction in 36 patients». This study was based on the AOFAS scale to measure the satisfaction of the patients in the research sample. The maximum possible score for a foot after triple arthrodesis surgery is 94, since loss of functionality or mobility is contemplated. The study cases obtained a classification between 69 and 94, the maximum, after verification of pain levels, dorsiflexion capacity, and plantarflexion measured with a goniometer and described as sagittal movement, as well as having the ability to walk more than 6 blocks (600 meters) without help, without limitation, and without pain.
Pain Neither Minimal or infrequent While walking on a slope At all times, except at break Continuous Severe 30 25 twenty 10 5 0 25 10 8 one *** *** 57.5% 23.0% 18.0% 2.5% *** ***
Daily activity Without limits With limitations With severe limitations 10 5 0 32 eleven one 72.5% 25.0% 2.5%
I wear shoes You can use all kinds of shoes You need to wear more comfortable shoes You can’t use them 10 5 0 27 17 *** 61.0% 39.0% ***
Hike More than 6 blocks Less than 6 blocks Home only Nothing twenty 10 5 0 35 7 2 *** 79.5% 16.0% 4.5% ***
Exercises Various sports Low competence recreation rehabilitation No exercise 10 5 0 12 32 2 27.5% 73.0% 2.5%
Worked There is improvement after surgery Works like before Changed job for a simpler one Can’t work twenty 10 5 0 39 4 one *** 88.5% 9.0% 2.5%
Diverse team of professional surgeon assistants and nurses performing invasive surgery on patient in the hospital Triple arthrodesis surgery Miami

Step-by-step view of triple arthrodesis surgery

Triple arthrodesis surgery is a procedure to fuse the joints in the foot, typically done to alleviate pain caused by severe fractures, sprains, or advanced arthritis. The surgical technique may vary slightly depending on the surgeon or clinic, but one common method is as follows:

  1. A lateral incision is made on the foot, extending from the base of the fourth metatarsal to the lower tip of the fibula.
  2. The articular cartilage is removed from the exposed facets of the talocalcaneal, talonavicular, and calcaneocuboid joints.
  3. The calcaneus, talus, navicular, and cuboid are positioned and fixed in their correct positions, often using screws, pins, or staples.
  4. The talocalcaneal joint is fixed first, followed by the talonavicular and calcaneocuboid joints.

Some surgeons may prefer to make a medial incision instead of a lateral one, but the choice is based on the surgeon’s preference. The advantages of a medial incision include avoiding lateral structures, reducing patient time in the operating room and reducing operating costs. However, the disadvantages of this type of incision are that a larger dissection is required, and this can damage the vasculature that supplies the body of the talus.

It’s important to note that there is ongoing debate among surgeons about the best approach to triple arthrodesis surgery, and more research is needed to determine the most effective technique.

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How much does triple arthrodesis surgery cost in Miami?

The price range for triple arthrodesis surgery in Miami is between $10,000 and $25,000 , with an average of $17,500. As is often the case, prices for treatments like these are often less expensive in Miami, and even around the world. The average cost of triple arthrodesis surgery throughout the US is $20,000, although there are places where prices go up to $32,000.

Techniques used to perform triple arthrodesis surgery

The medical literature includes various types of techniques to perform triple arthrodesis surgery. A classification point of view of the techniques is that which divides them into three types: simple triple arthrodesis surgery, modeling triple arthrodesis surgery, and panastalar triple arthrodesis surgery. Another criterion for classifying the techniques is carried out from the point of view of how the fixation of the joints to be fixed is approached. From this point of view, the techniques used to perform triple arthrodesis surgery are:

  • Natural bone graft: Bone tissue is placed to join the joints. Bone tissue from another part of the patient’s body may be used (autograft), or bone donors or bone banks may be used (allograft). Surgeons usually prefer autograft, since in this case the forming cells are native. The difficulty of autograft lies in the low availability of bone, while the allograft has high availability, but involves risks such as immune problems, demineralization, tissue death, loss of properties due to freezing, etc.
  • Artificial bone graft: In these cases, the wide variety of synthetic bones available on the market in commercial presentation are used. They usually have only osteoconductive matrix function, but some manufacturers have recently begun to make synthetic bone with osteoinductive properties.
  • Bone graft using metal fixators: In these cases, metal implants (nails, screws, staples, wires, etc.) are used to place them in the bones and keep them fixed and united in a position that favors bone growth and fusion of the bone.  A combination of metal fixators with natural or synthetic bone grafts may also be used.
Foot splint for treatment Triple arthrodesis surgery Miami

How long does it take for the bones to fuse after triple arthrodesis surgery?

This question includes another very frequent one: How long do you have to wait to notice results after triple arthrodesis surgery? A study carried out in 2003 directly with 40 patients who had undergone triple arthrodesis surgery, concluded that there is an optimal time for immobilization and rehabilitation after the operation. The optimal immobilization time is 12 weeks , neither more nor less.

In less than 12 weeks, the efficacy of bone healing is quite debatable, so the surgery would not have met its goal of fusing the joints. 12 weeks or 3 months is correct in the vast majority of cases, although after this time it will be the doctor who will determine if the bones have really healed and the joints have fused correctly.

It is important to clarify that it is not advisable to maintain immobilization of the foot beyond 12 weeks, not even in cases in which it is necessary to extend the rest. Maintaining immobilization of the foot beyond 12 weeks (which is almost always done to achieve consolidation of a joint that has been slow to fuse), can imply circulatory disorders, joint disorders, and even osteoporosis.

Male doctor bandaging foot of female patient_Haglund’s deformity surgery - Luxe Foot Surgery Center

Mediate and immediate risks of triple arthrodesis surgery

Virtually all surgical procedures have some degree of risk, and triple arthrodesis surgery is no less. In this case, some risks are better known by all and even discussed by specialists, and other risks are less known or are still in the process of investigation, so they require more studies that either demonstrate the risk or ultimately help. to dismiss the arguments against this type of surgery.

Let’s first look at the immediate risks of triple arthrodesis surgery, and then the immediate risks. Some of the points also indicate solutions or palliatives for these risks. Keep in mind that the vast majority of studies on this subject are regional, carried out by hospitals, universities and research centers using local samples and of a limited number, so these results should not be extrapolated or applied mechanically.

a) Immediate risks of triple arthrodesis surgery

Some patients, in an immediate period after surgery, present cutaneous slough and necrosis of the pedal muscle due to excessive traction during the surgical act. This is due to inadequate dissection. As a solution in these cases, daily cures can be performed, and after 4 weeks a free skin graft can be performed. Some patients also immediately developed a localized infection in the talocalcaneal and talocalcaneal pegs. In these cases, the pins were extracted, without this procedure affecting the correction achieved with triple arthrodesis surgery.

b) Mediate risks of triple arthrodesis surgery

One of the most observed and discussed risks of triple arthrodesis surgery is the suspicion that the loss of mobility of the hindfoot, and the consequent plantigrade foot, in the long term can generate chronic pain. However, in the short term this has not been proven. On the other hand, the most frequent and proven complication of long-term triple arthrodesis is pseudarthrosis, which varies between 0% and 40% of cases according to different studies.

Some patients, long-term after surgery, present with a nonunion specifically in the talonavicular joint. Some of them remain asymptomatic, experiencing no changes or pain despite the pseudarthrosis, while others do feel pain, or even significant disability. In these cases, a new operation can be carried out when the necessary number of months has passed. Early weight bearing, insufficient bone apposition, and insufficient internal fixation are factors that may have contributed to the development of the nonunion.

On the other hand, some patients have reflex sympathetic dystrophy, which can cause foot pain for up to 8 months after surgery. Normally this is solved with medical-kinesic treatment. Some patients experience residual flat feet as a consequence of undercorrection. Some degenerative changes in the ankle and midfoot have also been reported in more than 50% of cases.

Elderly woman lies on bed with pills Triple arthrodesis surgery Miami

How the patient can prepare for triple arthrodesis surgery

To prepare for triple arthrodesis surgery, the patient should take the following steps:

  1. Consult with their surgeon: Before the surgery, the patient will have a consultation with their surgeon to discuss the details of the surgery, including the risks and benefits, and to answer any questions the patient may have.

  2. Complete pre-surgical tests: The patient will be required to complete pre-surgical tests such as blood work and imaging tests to ensure that they are healthy enough for the surgery.

  3. Stop smoking and limit alcohol consumption: Smoking and alcohol consumption can increase the risk of complications during and after surgery. Therefore, it’s recommended that the patient stops smoking and limits alcohol consumption before the surgery.

  4. Arrange for transportation and post-surgery care: The patient should arrange for transportation to and from the hospital and for post-surgery care. The patient will need help with daily activities during the recovery period.

  5. Follow a healthy diet and exercise regularly: Eating a balanced diet and getting regular exercise can improve the patient’s overall health and help them recover more quickly after the surgery.

  6. Discuss with their surgeon any medications they’re taking: Before the surgery, it’s important to discuss with the surgeon any medications the patient is taking, including over-the-counter medications, vitamins and supplements, to determine which should be discontinued before the surgery.

  7. Prepare the home environment: To ensure a smooth and successful recovery, it is important to prepare the home environment for the patient’s needs. If the patient’s bedroom or bathroom is located on a different floor from where they will be resting, it is recommended to make adjustments before the surgery such as lowering the bed or raising the resting area to avoid the need for climbing stairs. This should be maintained for at least the first 6 weeks of recovery.

  8. Follow any pre-surgery instructions: The patient should follow any additional pre-surgery instructions provided by the surgeon or the hospital to ensure a smooth and successful surgery.

  9. Prepare for time off work: Patients can expect to need at least 12 weeks, or roughly 3-4 months, to fully recover from the surgery. This means that if the patient is employed, they will need to take that amount of time off work for medical reasons.

Tips for recovery after triple arthrodesis surgery

After triple arthrodesis surgery, it is important for the patient to follow a strict recovery plan to ensure optimal results. Here are some tips for recovery:

  1. Follow the immobilization protocol: During the postoperative recovery, the patient will need to keep their ankle and foot immobilized in a short leg cast. For the first six weeks, it will be strictly prohibited to put weight on the foot. After this time, weight bearing can be carried out, but always using a short leg cast to walk for another four to six weeks.

  2. Follow the rehabilitation plan: In total, about 12 weeks (3 months) of rehabilitation are required. The patient must comply with the rehabilitation plan as recommended by the doctor in order to achieve a true recovery.

  3. Listen to your surgeon: Throughout the recovery process, it is important to listen to your surgeon’s instructions and recommendations, as they will be able to guide you through the process and help you achieve the best possible outcome.

  4. Be patient: Recovery from triple arthrodesis surgery can take several months, so it’s important to be patient and stay focused on the end goal.

  5. Physical therapy: Physical therapy is an important part of the recovery process after triple arthrodesis surgery. The physical therapist will work with the patient to improve range of motion, strength, and mobility in the foot and ankle.

  6. Medications: The patient may be prescribed pain medication to manage pain and discomfort during the recovery period. It’s important to take the medication as directed and to let the surgeon know if there are any side effects or problems.

  7. Keep the wound clean: The patient will need to keep the surgical wound clean and dry to prevent infection. They should follow the surgeon’s instructions for wound care and let the surgeon know if there are any signs of infection such as redness, swelling, or discharge.

  8. Monitor for complications: It’s important for the patient to monitor for any complications such as swelling, numbness, or tingling in the foot. If any of these symptoms occur, the patient should contact the surgeon immediately.

  9. Follow up with your surgeon: The patient should follow up with the surgeon regularly to ensure that the recovery is progressing as expected. The surgeon will evaluate the patient’s progress, adjust the treatment plan if necessary, and provide guidance for continuing care.


Frequently Asked Questions

Triple arthrodesis surgery is a complex and sometimes controversial procedure that can raise many questions for patients and even for researchers and specialists. In this section, we will address some of the most frequently asked questions from the public and patients, to provide more clarity on this topic.

We have already talked about this throughout the article, so let’s deal with the topic here point by point and succinctly. This will help to clarify and systematize the advice that the patient must follow to the letter during the 12 weeks or three months that the rehabilitation lasts, because otherwise there is a risk that the triple arthrodesis surgery will not be successful. These tips are generic, not casuistic. It is best to consult with the doctor who performed the triple arthrodesis surgery, what are the things you can and cannot do after the operation.

  • During the first 6 weeks (half the rehabilitation time) you must rest completely. The person cannot attend work or do housework.
  • During the first six weeks you cannot put weight on your foot, nor can you place the weight of the body on the operated foot.
  • You should not go up or down stairs, so you have to put the resting place, the sleeping bed and an alternative bathroom in the same place.
  • During the second six weeks (the other half of the rehabilitation time) rest does not have to be absolute, but the type of special footwear supplied by the surgeon must be strictly used.
  • In this second half of the rehabilitation, certain moderate weight can be placed on the foot, but always using the special footwear supplied by the surgeon.
  • During this second half of the rehabilitation (and actually until the doctor indicates), the patient must continue without doing sports or activities of intense physical effort.
  • It is highly recommended that at this stage the patient receive physiotherapy. It has been shown that patients who receive physiotherapy recover better (not faster but with better quality in terms of achieving all the objectives of the operation).

This response must be divided into 2 or 3 stages, depending on the patient. Total rehabilitation time is usually 12 weeks or 3 months. Rehabilitation can be extended to 4 months, but it would already be without immobilization of the foot, without absolute rest and with physiotherapy.

  • First six weeks: During the first 6 weeks, it is strictly forbidden to place any type of weight on the foot,  it is even forbidden to put the weight of the body on the operated joint.
  • Second six weeks: During the second half of the recovery, that is, during the six weeks that constitute the second half of the total rehabilitation time of 12 weeks, the patient can place weight on the foot at will, with caution, but always using special footwear which is supplied by the clinic.
  • Extra time: The vast majority of patients have recovered after 12 weeks. The extra rehabilitation time is only for a few cases of patients. It may be around 1 more month, and during this time the patient will be able to place weight on the foot to the extent determined by the surgeon or physiotherapist, either in daily life or in physiotherapy.

It is not absolutely essential in triple arthrodesis surgery to place devices to fix the bones. As discussed above, in the operation the calcaneus, talus, navicular, and cuboid bones are manually corrected toward their correct position. And after this, very often surgeons choose, for greater security, to fix said bones in that new position by means of screws, nails or staples.

In this way it is much safer for the foot to remain in its natural alignment and what is called “pseudoarthrosis” is avoided, which is nothing more than a false fusing of the bones. Later, when fusing has actually been achieved (which is more like fusion in the case of triple arthrodesis surgery), the surgeon will remove the fixators if they have been placed.

However, it must be reiterated that nails, screws, staples, or other types of metallic implants are not always used. In the absence of the use of metal fixators, in some cases bone grafting is used (using bones from other parts of the patient’s own body is almost always preferred, but bones from donors or from a bone bank can also be used). In other cases, synthetic bones (made based on granules and hydroxyapatite or tricalcium phosphate) are also used, which emulate natural bones very well.

Triple arthrodesis surgery is performed with the patient under anesthesia, and this ensures that the procedure itself does not hurt at all. After the surgery, when the effects of the anesthesia wear off, the patient may feel some postoperative pain. Any surgical operation implies a certain degree of invasion into the body, however little it may be. The specific degree of pain will depend on the pain threshold of each patient. But there are patients who consider that it is not a surgery with painful effects. In any case, the surgeon will prescribe analgesics that eliminate any trace of pain, and if the patient fully complies with postoperative rest, the pain will be minimal or none.

We already saw towards the beginning of this article that one of the main reasons for triple arthrodesis surgery is to treat and alleviate pain that is considered intractable by non-surgical means (that is: therapies, physiotherapy, anatomical support devices, analgesics, etc. ) Taking into account the considerable degree of pain that the patient experienced before surgery, it is rare that a patient who felt such pain does not feel less pain after having the operation.

Surgery may not completely relieve pain in a percentage of cases, but it will not make it worse in the vast majority of patients either. Even in cases in which patients feel that the surgery hurts a little when the anesthesia wears off, or that rehabilitation is uncomfortable, the vast majority of them answer yes to the famous question of whether they would undergo surgery again if necessary, since it is worth an uncomfortable period to alleviate great pain.

10 Group of surgeons performing operation in operation room Triple arthrodesis surgery Luxe Foot Surgery Center

Triple arthrodesis surgery and double arthrodesis surgery are the same surgery. It is actually a confusion of terms. It so happens that, among surgeons in Europe, this procedure is known as double arthrodesis surgery , because they consider the calcaneocuboid and talonavicular joints to be a single joint (following the concepts of the 18th century French surgeon François Chopart).

On the other hand, Anglo-Saxon surgeons are the ones who call the procedure that we have analyzed here triple arthrodesis surgery , because they consider that each of the joints involved, although from the functional point of view they work as a whole, from the anatomical point of view they are three isolated joints.

Despite what we have just said (which is the most general criterion), there are specialists who consider and support that triple arthrodesis surgery and double arthrodesis surgery are two different procedures.

Immediately after surgery, the patient will be placed in a low cast, which will immobilize the foot and ankle and prevent them from wearing any type of footwear. This should last about a month and a half, that is, six weeks. Following this time interval, the patient will likely be required to wear a special type of shoe supplied by the surgeon, possibly for an additional six weeks, or for as long as the surgeon directs.

Regarding the use of shoes and other types of footwear once the patient is discharged after 3 or 4 months, this will depend on the case. The prospects are mainly good. As we saw in the AOFAS scoring scale table cited above, up to 61% of patients who have undergone triple arthrodesis surgery manage to wear shoes of all types after the operation.

Only 39% of the cases stated that they needed to wear more comfortable shoes after the operation, which does not necessarily show that they worsened with the surgery. So that no patient (and in this the exceptions are very few) declares not being able to wear shoes at all after surgery.

The best thing, perhaps not to speed up, but at least to avoid delaying recovery, is to fully comply with the rest times indicated by the doctor, not put weight on your foot until possible, and use the special footwear that the doctor provides . In principle, it will have to rest for about three months in total. But it is better that it is the doctor who dictates what time it should be.

A study that we already mentioned above, carried out in 2003 with 40 patients who had received triple arthrodesis surgery, concluded that patients recover optimally in a time of no more and no less than 12 weeks (approximately the 3 months that we already mentioned). Less time than that does not guarantee a correct fusion of the joints. The cited study showed that, of the patients who had a rehabilitation of less than 12 weeks, none obtained good results, but only fair to poor results.

Something that can improve the quality of recovery (although not speed it up) is receiving rehabilitation treatment and physiotherapy. Patients who receive rehabilitation during recovery do not recover sooner, but they do recover better. As is known, physiotherapy is considered an ideal complement to practically all orthopedic surgical procedures, since it promotes the restoration of muscular and joint functions, and stimulates a good circulatory and emotional state of the patients.

As we have reiterated throughout the article, in a certain percentage of cases, after triple arthrodesis surgery, arthritic sequelae can be generated. Pseudarthrosis can also be generated, which, despite its name, is not an arthritic-type disorder but a false fusion of the bones. In a percentage of cases of pseudarthrosis, the disorder may be completely asymptomatic, while in another percentage there may be pain and affect the normal functioning of the foot.

If the question is whether the patient can play sports shortly after triple arthrodesis surgery, the answer is that he absolutely cannot play sports until later. During the first 6 week interval after surgery, the patient will not even be able to put weight on the foot. And then, for a second six-week interval, you will be able to place weight on the foot only when wearing the special type of shoes your surgeon will provide you.

The total time in which the patient must maintain this care will depend on his own condition, his state of health, his postoperative evolution, and ultimately will depend on the surgeon’s criteria. In this type of operations there are no absolute times. The best thing is that the surgeon is the one who indicates when the person can do sports.

The answer is yes. Insurance usually covers triple arthrodesis surgery. Doubts regarding insurance arise from the fact that it does not usually cover cosmetic surgeries, or at least does not cover them in full. But in the case of triple arthrodesis surgery, it is a procedure that is entirely aimed at resolving a physical condition of the foot that generates severe pain and greatly hinders the person’s normal life.

  1. Saltzman CL, Fehrle MJ, Cooper RR, Spencer EC, Ponseti IV. “Triple arthrodesis: twenty-five and forty-four-year average follow-up of the same patients.” J Bone Joint Surg Am. 1999 Oct;81(10):1391-402. [PubMed]
  2. Phisitkul P, Haugsdal J, Vaseenon T, Pizzimenti MA. “Vascular disruption of the talus: comparison of two approaches for triple arthrodesis.” Foot Ankle Int. 2013 Apr;34(4):568-74. [PubMed]
  3. Schramm CA, Hein SC, Cooper PS. Triple arthrodesis. AORN J. 1996 Jul;64(1):31-52; quiz 54-61. [PubMed]
  4. Horstmann HM, Hosalkar H, Keenan MA. Orthopaedic issues in the musculoskeletal care of adults with cerebral palsy. Dev Med Child Neurol. 2009 Oct;51 Suppl 4:99-105. [PubMed]

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