Synostosis Resection and Arthrodesis in Hauts-de-Seine
Foot Surgery
What is synostosis resection and arthrodesis?
Dr Simon Tournemine in Hauts-de-Seine (92)
Synostoses and synchondroses are anatomical variations of the foot characterised by the persistence of bony bridges (synostosis) or cartilaginous bridges (synchondrosis) between adjacent bones.
During childhood, the foot is largely composed of cartilage, which progressively ossifies between 10 and 13 years of age. In some individuals, neighbouring bones fuse together during this process instead of forming a normal joint, creating an abnormal bridge that restricts movement.
Because this bridge joins two bones together, normal motion of the foot becomes limited, leading to pain, instability, reduced mobility and recurrent ankle sprains.
Although these coalitions may occur between any bones of the foot, talocalcaneal and calcaneonavicular coalitions account for approximately 90% of cases, while all other forms are considerably less common.
Synostosis Resection and Arthrodesis
Specialist in Foot Surgery in Hauts-de-Seine (92)
Several types of synostosis and synchondrosis exist, and the most appropriate treatment depends on the patient’s symptoms, anatomy and functional requirements. Management is therefore determined individually following discussion with your surgeon.
Two surgical options are available:
- Synostosis resection, during which the abnormal bony or cartilaginous bridge is removed.
- Arthrodesis, in which the painful, malformed joint is permanently fused.
Synostosis resection
A small incision is made directly over the coalition. The entire bony or cartilaginous bridge is excised, after which an interposition graft is placed between the bones to reduce the risk of recurrence.
The procedure takes approximately 30 minutes.
It is performed under either general anaesthesia or regional anaesthesia (where only the foot is anaesthetised). The choice of anaesthesia will be discussed during your consultation with the anaesthetist.
The operation is performed as day-case (outpatient) surgery, allowing you to return home on the same day.
Arthrodesis
A skin incision is made over the coalition. The abnormal bridge is removed before the affected bones are positioned in their optimal alignment and permanently fused using orthopaedic fixation devices, such as screws or staples.
The procedure lasts approximately 60 minutes.
It is performed under either general anaesthesia or regional anaesthesia (where only the foot is anaesthetised). The most appropriate anaesthetic technique will be determined with your anaesthetist before surgery.
This operation is also performed as day-case (outpatient) surgery, with discharge on the day of surgery.
Synostosis Resection and Arthrodesis in Rueil-Malmaison
Foot Surgery in Hauts-de-Seine
When should synostosis resection or arthrodesis be performed?
Many synostoses are discovered incidentally and cause no symptoms. In such cases, no treatment is required.
When symptoms develop, initial management consists of conservative treatment, including:
- custom orthotic insoles;
- activity modification;
- physiotherapy;
- anti-inflammatory medication.
If symptoms persist despite appropriate conservative treatment, surgery may be recommended.
Postoperative care and rehabilitation following synostosis resection and arthrodesis
Following synostosis resection
Pain management is closely monitored to maximise comfort and facilitate rehabilitation.
Anticoagulant treatment is prescribed for two weeks to reduce the risk of deep vein thrombosis.
Weight-bearing is not permitted for the first two weeks. During this period, the foot and ankle are protected in a removable walking boot.
Progressive weight-bearing begins after two weeks, with a return to normal footwear usually possible after four weeks.
Physiotherapy begins once immobilisation has been discontinued to restore muscle strength and foot mobility.
Return to work is generally possible after approximately two weeks, although sedentary occupations may resume sooner.
Driving is usually permitted after three weeks, while sporting activities can generally resume after approximately two months.
Following arthrodesis
Pain management is closely supervised following surgery.
Anticoagulant treatment is prescribed for six weeks to reduce the risk of deep vein thrombosis.
The foot and ankle remain immobilised for six weeks to allow bone fusion.
Walking is permitted only with two crutches and no weight-bearing during this period.
At six weeks, the cast is removed and progressive weight-bearing begins using a removable walking boot.
Driving generally becomes possible after approximately three months, while return to sporting activities is usually achieved after four months.
Physiotherapy starts after immobilisation has been discontinued to restore muscle strength and foot mobility.
Recovery times are average estimates and may vary according to individual healing.
Long-term clinical and radiographic follow-up is recommended to monitor healing and identify any potential complications.
Risks and complications of synostosis resection and arthrodesis
Every precaution is taken to maximise healing and minimise complications. Nevertheless, as with any surgical procedure, certain risks remain, although they are uncommon:
- deep vein thrombosis (DVT) and pulmonary embolism, with the risk reduced through anticoagulant treatment during the immobilisation period;
- worsening of pre-existing medical conditions, including heart disease or diabetes, which are monitored by the anaesthetic team;
- infection (risk below 1%). Should infection occur, further surgery to clean the operative site together with antibiotic treatment may be required;
- haematoma, which may occasionally require surgical evacuation;
- injury to small sensory nerve branches supplying the foot, potentially resulting in areas of reduced sensation;
- recurrence, representing the most frequent complication following synostosis resection (approximately 15-20% of cases), occasionally requiring further surgery;
- non-union following arthrodesis, which may require revision surgery to achieve successful bone fusion.
Complex Regional Pain Syndrome (CRPS) is a painful inflammatory condition that remains poorly understood. It is treated medically and may persist for several months, or occasionally several years, requiring specialised rehabilitation, additional investigations and, in some cases, dedicated pain management. Both its occurrence and long-term evolution remain unpredictable.
These represent the principal potential complications, although this list is not exhaustive. Rare and exceptional complications may also occur. Not every possible complication can be anticipated in advance. Your surgeon will discuss your individual case and answer any questions during your consultation.
Every precaution is taken to maximise healing and minimise complications. Nevertheless, as with any surgical procedure, certain risks remain, although they are uncommon:
- deep vein thrombosis (DVT) and pulmonary embolism, with the risk reduced through anticoagulant treatment during the immobilisation period;
- worsening of pre-existing medical conditions, including heart disease or diabetes, which are monitored by the anaesthetic team;
- infection (risk below 1%). Should infection occur, further surgery to clean the operative site together with antibiotic treatment may be required;
- haematoma, which may occasionally require surgical evacuation;
- injury to small sensory nerve branches supplying the foot, potentially resulting in areas of reduced sensation;
- recurrence, representing the most frequent complication following synostosis resection (approximately 15-20% of cases), occasionally requiring further surgery;
- non-union following arthrodesis, which may require revision surgery to achieve successful bone fusion.
Complex Regional Pain Syndrome (CRPS) is a painful inflammatory condition that remains poorly understood. It is treated medically and may persist for several months, or occasionally several years, requiring specialised rehabilitation, additional investigations and, in some cases, dedicated pain management. Both its occurrence and long-term evolution remain unpredictable.
These represent the principal potential complications, although this list is not exhaustive. Rare and exceptional complications may also occur. Not every possible complication can be anticipated in advance. Your surgeon will discuss your individual case and answer any questions during your consultation.
Results of synostosis resection and arthrodesis
Without treatment, the natural progression of symptomatic synostosis is characterised by worsening pain, increasing stiffness and progressive foot instability.
Surgical treatment provides good outcomes in the vast majority of patients, allowing a pain-free return to walking, everyday activities and sporting activities.
