Page 21 - 2020 Summer CMTA Report

The Surgical Correction of the CMT Foot:

IS SURGERY RIGHT FOR YOU?

PART 3 OF 4:

THE ROLE OF JOINT FUSION

BY GLENN B. PFEFFER, MD There are 33 joints in the foot, brace, as discussed in the first two
and it is possible to fuse a few of parts of this series. If you take
surgical joint fusion, or them without any significant loss your clenched fist and put it into
arthrodesis, is a procedure of function. your pocket for several months,
that joins the bones of a The most common reason for your fingers probably won’t open
joint together. It is one of a fusion in a CMT patient, how- again. The soft tissues contract
A the oldest procedures in ever, is not arthritis but deformity and the joints become fixed. The
orthopedics and has been used for correction. When needed, it is an longer one waits, the more impos-
arthritis and deformity correction operation with superb results, but sible it becomes. Anyone whose Dr. Pfeffer is an ortho-
since the 19th century. severe deformity is a completely foot is not flat on the ground pedic foot and ankle
Today, the most common rea- preventable problem. If the muscle when walking needs to have a sur- surgeon and co-director
son for a fusion is joint arthritis, on one side of a joint is weak and gical correction before it becomes of the CMTA’s Center
which occurs when the cartilage the other is strong, as commonly fixed and a fusion is the only of Excellence at Cedars-
that covers the bones of a joint happens in CMT, the joint gradu- option. Big problems start small. Sinai Medical Center,
Los Angeles. He is also
becomes damaged by trauma, dis- ally becomes deformed and I recently operated on a 15- a member of the
ease or age. Age-related arthritis is eventually fixed. This does not year-old boy with CMT who, but CMTA’s Advisory
called osteoarthritis. Healthy carti- happen overnight and it is pre- for the surgery, would have needed Board.
lage is white and glistening and ventable if caught early enough. A a triple arthrodesis in a few years.
allows the bones of a joint to brace can help if the joints are still He and his family had been told
move smoothly. Arthritic cartilage flexible and can be held in the cor- for years that nothing could be
is greyish, thinned and pitted, and rect physiologic position by the done for him and that braces were
interferes with smooth joint brace. But all too often the foot his only option. Over time, his
motion. The joint becomes pro- deformity progresses despite the (continued on page 22)
gressively stiff, inflamed and
painful.
Surgical fusion of an arthritic
joint will take away the pain, but
it will also take away the motion.
It involves removing the compro-
mised cartilage and stabilizing the
remaining bones with metal
screws, plates or staples. The
surgery is done on an out-patient
basis, followed by six weeks in a
non-weight bearing cast on the
operative foot and another four
weeks in a walking cast. Remark-
ably, during this time the bones
grow together, fusing the joint. It
may sound horrible, but it is one
of the most common and best
pain-relieving surgical procedures
performed on the foot and ankle. Figure 1: A triple arthrodesis fuses three major joints in the hind foot.

SUMMER 2020 THE CMTA REPORT 21