Closure / Post-Operative Care

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Closure A final check is performed using fluoroscopy The longitudinal incision of the extensor retinaculum is closed by continuous absorbable 0 suture The skin is closed with interrupted non-absorbable 3-0 sutures A drain is not used routinely A thick compressive dressing is applied and the foot placed in a reusable prefab splint The tourniquet is deflated   Post-Operative Care On the second post-operative day, the compressive dressings and prefabricated splint are replaced by a removable cast. This allows the use of an inflatable footpump in case of substantial post-operative swelling. After subsidence of the swelling (mostly between day 6 and 14 days postop), a below-knee walking cast is applied and left in place until the eighth post-operative week Removal of the stitches should not be done before the 14th post-operative day Once the walking cast is applied, weight-bearing is allowed as tolerated; usually full weight-bearing is achieved after 10 to 14 days post-operatively At eight weeks, the cast is removed and standard radiographs are taken. If bony fusion is considered not to be sufficient, a removable walking cast is applied for another 4 to 6 weeks. If the fusion is considered to be sufficient, the patient is allowed free ambulation on custom shoes. Low molecular heparin or oral anticoagulants should be given, as long as the walking cast is in place or free full weight bearing is not granted

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