Welcome to this edition of The First Aid Show. Now, this edition we are carrying on from a previous video we did on the Ankle Arthroscopy and this is the Ankle Subtalar Fusion. Now, something that I have had to have done, I had to have it on both feet, so I think I can quite happily say that it is something I experienced quite well. They will not do both the ankles at one time. So, you have to have them one at a time because it would just be impossible to walk around. Now, what the subtalar joint is, is the joint between your heel bone and your ankle. And in my case, it was after a car accident and the actual joint over the last 30 years had got really, really bad. You might think you do not actually have a joint there, but you do. And it causes. The operation will stop inward movement of your foot. So, I can still bend my ankle, I can still move my ankle around, but what I cannot do is twist it from side to side.

Now the operation itself, the doctors would tell you all about it, but we wanted to really to show what it is like from the patient's point of view. Now, full anaesthetic, so you are called in early in the morning, have a full anaesthetic. When you come around, they would inject in painkillers and also, they inject in an agent which numbs the ankle. Now, in most cases, this works fine, for me, it did not actually work, which is a little bit unfortunate. But what they then did is gave more painkillers and that to actually try and take some of the pain away. Now, when you come around, you will be in a half cast of plaster, so it is a cast underneath and around the sides, and then it is bandaged in place. Now that will stay on typically for about two weeks. The reason they do not put a full cast on at the start is that if they put a full cast then the swelling, it could cause other problems.

Now the other thing, you can see the swelling quite well in your toes and it was quite a lot of pressure. Personally, I had a lot of pain with mine. But I have spoken to a lot of people who have had this done, and a lot would say that apart from that, they just get minor discomfort. Now, I am not quite sure why I was getting pain and they were not, but a lot of people do not have pain. After the two-week mark, you go in and they cut away the plaster and then they put on the full cast. And that will stay on for about four weeks, so you are sort of six weeks total in plaster. With mine, I was in for seven weeks, but it depends on the recovery of the ankle. What they then do is remove that plaster cast. They will use an electric circular saw. It sounds worse than it is, but it literally just cuts away the cast. It does not matter if it touches the skin, because the way it is working, it works on an oscillating basis, so it will not actually hurt your skin. So, they cut that away. Once they have done that, they will typically then take an x-ray. That is really the interesting part.

You see, the x-ray, you can actually see where they have joined it together. So, in my operation, and some of these operations do vary, is effectively they drilled a hole, right through the heel bone, into the ankle, and then they have put a large bolt in there. It is screwed in tight, so it is pretty solid. Other doctors sometimes use two bolts. It depends on the actual surgeon that you are working with, but in both my cases, they have used the single bolt going through. So, when you see that on the x-ray, it is quite interesting. And then they will put you into, at that point, into an Aircast boot. And what that is, is a boot you can remove. At that point, you then are allowed to weight bear again, subject to your doctors, but if you had just one foot done, then you are walking on the other foot. You will start to put more and more weight on it. You will start to get better. And typically, the Aircast boot stays on for around about four weeks. All this time you are on crutches. And then after that event, you are then going to take it off. For me, when I had the first one done, obviously my problem was that I was walking on a foot that was bad, but it does tend to reduce your mobility quite a lot.

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