Outpatient Physical Therapy Following Triple Arthrodesis Surgery: A Case Report

N Bernardoni, BS, DPT Student University of New England

Background Patient History Interventions Outcomes

• Triple arthrodesis is the surgical fusion of the • 53-year-old male referred to physical therapy Soft tissue mobilization • Physical therapy sessions: 2 times per week for talonavicular, talocalcaneal, and by his surgeon following right triple arthrodesis Thermal modalities (hot and cold packs) 8 weeks calcaneocuboid joints of the foot. surgery 11 weeks prior Talocrural joint mobilizations • Employed as a supervisor at a naval shipyard • Work duties: prolonged walking and climbing Manual multiple flights of stairs posterior glide • Past medical history: osteoarthritis of left knee to promote and thumb and bliateral feet, 22-year history of dorsiflexion bilateral foot pain. http://www.gla.ac.uk/t4/~fbls/files/fab/tutorial/anatomy/jiet.html

• Joint surface preparation includes debridement, • Past surgical history: tendon augmentation and http://accessphysiotherapy.mhmedical.com removal of cartilage, burring of subchondral a bony procedure to correct for left hindfoot bone, and fish scaling of the joint surfaces. collapse ten years prior • Previous therapeutic interventions for right foot Manual anterior • The joints are then fused using screws. glide included cortisone injections, a foot orthotic, and use of a walking boot. to promote plantarflexion • patient was able to walk long distances (1000 feet), walk outdoors, and climb stairs with little difficulty.

http://www.ipcphysicaltherapy.com/AnkleImingement.aspx • Improvements in R ankle and R first toe ROM Active self joint mobilization resulted in increased dorsiflexion for the initial • Activity Restrictions: walking, standing for long contact phase of gait and increased periods of time, mowing his lawn, and climbing plantarflexion for toe-off. stairs • Increased ROM and decreased pain allowed

http://www.footeducation.com/triple-arthrodesis • Participation Restriction: fulfilling work duties è for an improved gait pattern leading to • No inversion or eversion motion, only decreased difficulty with walking long distance, plantarflexion and dorsiflexion. Examination walking outdoors, and climbing stairs. • Primary goals: abolish pain, correct underlying • Patient met all therapy goals deformities, and restore a stable platform for Stretches • Patient was please with the results of therapy ambulation. • Plantarflexion, dorsiflexion, toe flexion and • Indicated for severe arthritis, instability, and extension, and gastrocnemius/soleus Discussion deformity that cannot be controlled with Therapeutic Exercises nonsurgical approaches. • Recumbent bicycle, Total Gym® squats, As indicated by the patient’s improvements, the resisted dorsiflexion and plantarflexion, toe prescribed interventions appear to be a beneficial Purpose raises, and rocker board form of physical therapy management for patients Neuromuscular re-education following triple arthrodesis surgery. To provide an overview of triple arthrodesis • Anterior step over hurdle This case was a challenge due to the scarcity surgery and to report a case describing the • Step up/down step with right foot of literature about physical therapy management specific outpatient physical therapy management Home Exercise Program: stretches listed above, following triple arthrodesis. It would be useful to strategies used following surgery. resisted plantarflexion and dorsiflexion, toe raises, conduct clinical trials, in order to obtain more data * patient was able to walk long distances (1000 feet), walk outdoors, and climb stairs with moderate difficulty. and riding a recumbent bicycle on the effectiveness of various treatment methods.