When can a patient start bearing weight after left calcaneal hardware removal, subtalar arthrodesis, and tarsal tunnel release?

Weight Bearing After Calcaneal Hardware Removal, Subtalar Arthrodesis, and Tarsal Tunnel Release

Direct Recommendation

Begin protected weight bearing at 6 weeks postoperatively in a walking boot, transitioning to full weight bearing by 8-12 weeks based on radiographic evidence of fusion consolidation. 1

Weight Bearing Protocol

Initial Non-Weight Bearing Phase (0-6 Weeks)

• Maintain strict non-weight bearing for the first 6 weeks to allow initial healing of the subtalar arthrodesis, which is the most critical component of your procedure requiring bony union 1, 2
• The subtalar fusion site requires adequate time for early consolidation before mechanical loading 3
• During this period, elevate the foot when possible to minimize swelling 4
• Apply cryotherapy during the first postoperative week to reduce pain and inflammation 4

Transition to Protected Weight Bearing (6-8 Weeks)

• At 6 weeks, initiate protected weight bearing in a walking boot that limits excessive motion at the fusion site 1
• The walking boot should provide rigid support to protect the arthrodesis while allowing functional recovery 4
• Begin with partial weight bearing (20 kg or as tolerated) and gradually increase over 2-4 weeks 2, 3

Progression to Full Weight Bearing (8-12 Weeks)

• Advance to full weight bearing between 8-12 weeks based on radiographic confirmation of bony union at the subtalar joint 5, 1
• This timeline aligns with the traditional AO guidelines for calcaneal procedures, though individual surgeon practices vary significantly 5
• Once adequate fusion is demonstrated radiographically, transition out of the boot into supportive footwear 4

Critical Considerations Specific to Your Combined Procedure

Hardware Removal Component

• The calcaneal hardware removal site heals relatively quickly and is not the limiting factor for weight bearing progression 5
• Hardware removal alone would typically allow earlier weight bearing, but the subtalar arthrodesis dictates the timeline 1

Subtalar Arthrodesis as the Rate-Limiting Factor

• The subtalar fusion is the primary determinant of your weight bearing protocol 1, 3
• Premature weight bearing risks nonunion, which occurred in 6.7% of cases in one series and required revision surgery 3
• All patients in a pediatric subtalar arthrodesis series achieved successful union when weight bearing was delayed until 6 weeks 1

Tarsal Tunnel Release Considerations

• The tarsal tunnel release does not significantly alter the weight bearing timeline 2
• However, if extensive correction was performed during the arthrodesis, prophylactic tarsal tunnel release may have been performed to prevent nerve compression 2
• Monitor for any neurologic symptoms during the rehabilitation phase 3

Evidence Quality and Clinical Reality

Guideline Adherence

• Only 33% of Dutch foot and ankle surgeons strictly adhere to AO guidelines for calcaneal procedures 5
• 96% of surgeons interpret protocols flexibly based on individual patient factors, particularly patient compliance and symptom reports 5
• 87% of surgeons report no relationship between early weight bearing and complications, but this applies primarily to fracture fixation, not arthrodesis 5

Key Distinction

• The evidence showing safety of early weight bearing applies to calcaneal fracture fixation with external fixators (mean 11.6 days to full weight bearing) 6, which is fundamentally different from arthrodesis requiring bony union 1
• Do not extrapolate early weight bearing data from fracture fixation to fusion procedures 6, 1

Common Pitfalls to Avoid

• Allowing early unprotected weight bearing before 6 weeks risks nonunion of the subtalar arthrodesis, the most serious complication requiring revision surgery 1, 3
• Removing the protective boot before 8 weeks without radiographic confirmation of fusion can compromise surgical outcomes 4, 1
• Failing to use supportive footwear with stiff soles after boot discontinuation may cause excessive stress at the fusion site 4

Monitoring Requirements

• Obtain radiographs at 6 weeks before initiating weight bearing to assess early fusion 1, 3
• Repeat imaging at 8-12 weeks to confirm adequate consolidation before full weight bearing 5, 1
• Assess for pain, swelling, or warmth that would indicate premature loading 7
• Monitor for tarsal tunnel symptoms including numbness, tingling, or burning in the plantar foot 2, 3