Since I first talked about my tarsal coalition(s), I have been shocked at how many people have reached out about tarsal coalitions and subtalar fusions. People have DMd me, commented on blog and Instagram posts, emailed me, etc. Most of them ask about what to expect after subtalar fusion surgery. And when I shared that I was having my second one, arthritis patients started asking me, too.

There isn’t a lot of material out there from patients, so I totally understand!

To be 100% clear, I have had 2 subtalar fusion surgeries – 1 in each foot – and 5 foot surgeries overall. I have the genetic tarsal coalition condition as well as rheumatoid arthritis. I’ll explain what tarsal coalition is and what subtalar fusion is, so if you’re confused, don’t worry. But the focus of this post is what to expect after subtalar fusion surgery as someone with tarsal coalition and rheumatoid arthritis.

I am not a doctor. In this post, I cite my sources and share my personal experiences. 

Recovery from Subtalar Fusion Surgery: Basic Info

What is a tarsal coalition?

The American Academy of Orthopaedic Surgeons says, “A tarsal coalition is an abnormal connection of two or more bones in the foot” (x). The tarsals are seven bones that make up the hindfoot and midfoot, and one of these seven bones is the talus (x). 

While it’s hard to know the exact numbers – some people never have symptoms – it is estimated that 1% of people have a tarsal coalition (x). 50% of people with it have it in both feet (like me) and the other 50% only have it in 1 (x).

Tarsal coalition is a “genetically-determined” condition (x). Basically, this condition is caused by a gene mutation; the way I explain it is that my DNA thinks that there should be bone where there shouldn’t be. In my case, my grandmother has it and we think her mother had it, too. But it is caused by a gene mutation, and if that mutation was not passed down through your family, it could have occurred sporadically during your fetal development (x).

Living with Tarsal Coalition: My Experience with Symptoms, Surgery, and More

What is subtalar fusion?

Okay, this is going to be the kinda-gross part of the post. If thinking about bones and screws makes you squeamish, skip to the next one. (Actually, stop reading. This post will be a bad time for you.)

The subtalar joint is “where 2 foot bones called the talus and the calcaneus meet” (x). While we non-doctors might consider this the ankle, my surgeon is VERY adamant that the subtalar joint is part of the foot and not the ankle.

In subtalar fusion, your surgeon will “compress the bones together and attach them with plates, nails, screws, or other hardware” (x). How many and what type will depend what your fusion is needed for, the current state of your bones, and your surgeon. Sometimes it can be minimally invasive (x). 

More specifically, the surgeon will “realign [the] bones in the foot and ankle into the correct position, then secure them with screws, pins and plates” (x).

Johns Hopkins Medicine that the vast majority of people who need these fusions have osteoarthritis, rheumatoid arthritis, or arthritis due to previous joint injury (x). Please know that in no case will a reputable doctor suggest you go straight to surgery – if you have a doctor saying that, get another opinion. 

If you have a tarsal coalition and you’re nervous reading this, just know that it takes a lot to need a subtalar fusion. It’s just that, when it comes to tarsal coalitions, this is the only way to permanently deal with it, as the problem is in the gene (x). As I said, the DNA thinks that there should be bone where there shouldn’t be.

I’m not saying that once you have subtalar fusion surgery the tarsal coalition is cured, though. It’s still in your DNA, and you can still pass it on to any biological children.

Since we’ve already started talking about this, let’s look at my personal experience with tarsal coalition surgery.

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What is your experience with tarsal coalition surgery? 

I have had 5 tarsal coalition surgeries. On my left foot, I had coalition removal in 2004, an exploratory surgery in 2006, subtalar fusion surgery in 2009, and surgery to remove the fusion screws in 2009. In 2018, I had subtalar fusion surgery on my right foot. So if you’re wondering what to expect after subtalar fusion surgery, or what it’s like to have tarsal coalition surgery in general? I’m your girl.

That coalition removal in 2004 is the one that didn’t work. To be clear, it was a version of a tarsal coalition resection. That resection surgery is when “the tarsal coalition is removed from [the] foot and then replaced with muscle or tissue from another part of the body” (x). I never had muscle or tissue – synthetic or from another part of my body – placed there. My first surgeon just removed the bone, and then that bone grew back by 2008.

In the exploratory surgery, they put a camera in and tried to look around. I still had a lot of pain, and I/we don’t know whether or not that coalition was back yet by 2006. (My first surgeon lied to me about my body and my test results, so I can’t feel confident that one thing or another happened.)

In January 2009, I had the subtalar fusion surgery on my left foot. In addition to the tarsal coalition, there was major cartilage damage, scar tissue, and arthritis. So while my surgeon did the fusion, he also removed the scar tissue, fixed the cartilage, and added a synthetic bone graft. 

I had a lot of pain from the screw and bolt from that surgery, so once the fusion was complete – it took 3 months to grow the bone to complete the fusion – I had them taken out. It then took another 3 or so months to grow back the bone in the space that the screw and bolt left. 

In March 2018, I had basically that same surgery done on my right foot as had been done on the left in January 2009: subtalar fusion for tarsal coalition, plus scar tissue removal, cartilage repair, synthetic bone graft, etc. This is the surgery we are going to talk about the most, as it is the more recent fusion, and my rheumatoid arthritis is a lot more advanced now than it was in 2009.  

On My March 26 2018 Ankle Surgery

Subtalar Fusion Surgery Recovery: My 2018 Surgery

The first month after surgery was difficult in terms of pain and fatigue … and my other illnesses. Due to having surgery – especially one that was so invasive – I had an RA flare and a POTS flare. 

That being said, here is what happened in the first month after surgery in both 2009 and 2018. 

I was hospitalized for the first couple of days for pain control and because, in both cases, I had a nerve block. Basically, it’s a way for you to not feel from a particular spot in your body on down. In both surgeries, the nerve block went in my knee, so for 12 hours I couldn’t feel my foot. If you have the option, get a nerve block. My god it was a good decision. Seriously, as someone who had a pain medication fail in 2009 and then felt the screws, bone graft, etc. without pain medication in my system after the nerve block ran out, you want it. 

Once I was discharged from the hospital, I was on bedrest for 2ish weeks. If you’ve ever had any surgery, you know that you need to keep the operated part of the body elevated. This keeps the inflammation down, which also helps with the pain. 

When you wake up from surgery, your foot will be in a splint, which isn’t as restrictive as a cast. That accommodates inflammation. It’s very bulky, so I suggest you stock up on athletic shorts and sweatpants with extremely wide legs! You can’t take the splint off. To be completely clear, you will be non-weight bearing for at least 2 months. Weight bearing can disrupt the fusion process, so it’s super important to stay off of.

Once I hit 2+ weeks, I had a post-op appointment where they took off the splint, took x-rays, discussed the fusion and healing process, and got a cast. 

Something you should know is that, when you get x-rays, you have to put pressure on the foot in order for them to see the progress of the fusion. No one told me that ahead of my 2009 post-op x-ray! I know I just said weight bearing can disrupt the fusion, but the x-ray is the only time the doctor will ask you to put weight on it. And yes, it hurts. But it’s only as long as they need to get the right x-ray. 

Once my splint came off and I was cleared to be off bed rest, I spent a few more weeks not wanting to do things other than lie down with my foot elevated. That required taking baby aspirin. As long as I was mostly non-mobile, I took baby aspirin to reduce the chance of blood clotting. 

Blood thinners – including medications like over-the-counter aspirin – “are usually prescribed for two or five weeks after knee or hip surgery, respectively, to reduce the risk of blood clots in the legs or lungs” (x).

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I felt like I made a lot of progress in my recovery from one day post-op to one month post-op, and the next couple of months the progress felt really slow. Looking back 3 months post-op, I could see the progress, but it was really slow. 

My fatigue was super intense for a solid 6+ months. That’s how long it took for my fusion to set (compared to 3 in 2009), which is why the fatigue was so intense. I was not only healing from intensive surgery, but I was also growing new bone. 

I was in a traditional fiberglass cast for 2+ months. This time, it was actually removable, so I could put on jeans that weren’t baggy and just roll the leg up to the knee to put my cast on. Plus – and this is the real reason it was removable – I could work on flexing the foot up and down. 

Towards the 3-month mark, I started physical therapy. At this point, the therapy was basic flexing and the therapist manually worked on the muscles that hadn’t been used much. Basically, the goal was to encourage healing and get me ready to put weight on it.  The foot and ankle weren’t the only parts of the body that hadn’t been used; the calf and knee hadn’t been used much, either. 

The Emotional Side to My Tarsal Coalition Surgery Recovery

At 3 months, I went into a walking cast. Physical therapy started being more intensive at 3 times a week and me doing more exercises at home. 

Under my surgeon’s care, I started trying partial weight-bearing for 1 hour a day and slowly increased it until I was fully weight-bearing. Aka, I would walk in my walking cast while also using crutches. 

By the 4-month mark, I was completely weight-bearing. Once we confirmed that the fusion was finished at 6 months, I got the okay to be out of the walking cast for 1 hour a day and to slowly increase that time. 

Over November 2018 – 8 months after surgery – I went to Delaware for Thanksgiving and for the first time didn’t bring or use my walking cast, crutches, or cane. I still needed a lot of help, and I couldn’t comfortably stand for more than a few minutes at a time, but that was the first big thing I did without them. It was so nerve wracking! 

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I’m not going to lie: this is a heavy-on-the-pain surgery. But it is absolutely worth it. To spend 6 months to a year with more frequent (and sometimes more intense) pain, in order to have reduced pain afterwards? So worth it. 

Today I am 30 years old. To spend 1 year out of 30 on this surgery ? To spend 1 year out of 70? (Or however many years I live.) So unbelievably worth it. 

Tarsal Coalition Surgery Recovery: Final Thoughts

What was your total tarsal coalition surgery recovery time? 

The 2009 surgery was probably 9 months total. I had surgery in January 2009, and I was super recovered and could even wear sandals by May. However, no matter what shoe I was wearing, the hardware in my foot caused major pain, so the screw and nut were removed in June. By the time I went to college in August, I was basically recovered, and that improved to fully recovered by the end of September.

When it comes to the 2018 version – same surgery, but more advanced rheumatoid arthritis – I would say 10 months was the point when I was as recovered as I was going to get. It’s a little wobbly because my surgeon discharged me in January 2019, but I’ve really never been able to wear non-sneakers without a problem. So from surgery date to being as fully recovered as possible, maybe 11 months. (The Fiasco slowed some progress, for sure.)

As a note, I have been able to comfortably tolerate keeping my screws this time around. They bothered me a lot when I started walking without a cast, but I don’t even notice them now. My surgeon told me ahead of time that this might be the case, as it’s a different hardware strategy from 2009. OH, and by the way, that x-ray up there is mine. That’s my foot and those are my screws!

Describing Pain Levels to a Doctor

Did rheumatoid arthritis affect the tarsal coalition surgery? 

It absolutely affected my recovery time. All of my doctors agreed: the reason it took so much longer to recover in 2018 than it did in 2009 was that my rheumatoid arthritis was a lot more advanced in 2018 than in 2009. 

In autoimmune arthritis, the immune system attacks the lining of the joints, among other areas (x). In subtalar fusion, it takes months for the bones to fuse, thereby eliminating the space between the bones (x). Specifically, “Although partial weightbearing often is allowed within a few weeks after surgery, full weightbearing in shoes usually takes at least 8-12 weeks” (x). The specific timing will depend on when x-rays show that the fusion has reached the point when your surgeon feels comfortable with you doing activities (x). This will depend on each person. 

In 2009, my fusion finished in 3 months, aka 12 weeks. In 2018, it took 6 months. In 2009, I was partial weight-bearing at the 3-month mark and was fully weight-bearing by month 4. In 2018, while I was partially weight-bearing at 3 months, as I mentioned, it wasn’t until month 8 that I was fully weight-bearing without a walking cast all the time. 

I wasn’t diagnosed with rheumatoid arthritis when I had my 2009 subtalar fusion surgery, but I had it. My surgeon agreed that the RA affected my healing, but if you want more proof than “Kate’s surgeon told her this,” here it is: the Hospital for Special Surgery says, “the quality of their bones, and deformities of the joint [in RA patients] may contribute to poor outcome” (x). All things considered, I’ve had a really positive outcome from my fusions. It just hasn’t been easy or quick.

But my rheumatoid arthritis was also affected by having surgery for the tarsal coalition!

Subtalar fusion surgery is a surgery that’s really good for rheumatoid arthritis. I mean, my left foot – the foot that my 2009 surgery was in – is easily my best joint. It only bothers me a couple times a year! In comparison to all day, every day, that’s a big improvement.

The fusion means that instead of 2+ smaller joints around my tarsals I have 1 piece of bone. I quite literally have fewer joints in my feet now than I did in 2008, and rheumatoid arthritis means joint pain. It’s hard to have pain in a joint when that joint doesn’t exist any more! 

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What other questions do you have about subtalar fusion surgery for tarsal coalition?

Like this post? Check out: 

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