Immobilization After Subtalar Arthrodesis and Calcaneus Hardware Removal

Rationale for Functional Support vs. Rigid Immobilization

Functional support for 4-6 weeks is preferred over rigid immobilization for lower extremity injuries, as it allows controlled loading of damaged tissues while providing protection, according to the British Journal of Sports Medicine 1, 2
A minimum of 4 weeks in a lower leg cast results in less optimal outcomes compared with functional support and exercise strategies (22 RCTs, n=2304), as reported by the British Journal of Sports Medicine 3
Functional treatment with ankle braces shows greater effects compared with other types of functional support (level 2 evidence), as stated by the British Journal of Sports Medicine 2

Functional support allows for earlier return to work (RR 5.75, 95% CI 1.01 to 32.71), better patient satisfaction (RR 4.25, 95% CI 1.12 to 16.09), earlier return to sports activities (RR 1.86, 95% CI 1.22 to 2.86), and fewer days until return to work (MD 8.23 days, 95% CI 6.31 to 10.16), according to the British Journal of Sports Medicine 4
Removable rigid dressings have been shown to reduce acute hospital length of stay (15.9 days vs. 8.7 days, p < .001), accelerate limb volume reduction rates, and lead to earlier and more frequent use of prosthesis, as reported by PM&R (The Journal of Injury Function & Rehabilitation) 5

A short period (<10 days) of immobilization with a plaster cast or rigid support can be of added value in decreasing pain and edema immediately post-operatively, according to the British Journal of Sports Medicine 3
Patients treated with functional support have significantly fewer complications such as skin irritations (RR 0.11, 95% CI 0.01 to 0.86) compared to rigid immobilization, as stated by the British Journal of Sports Medicine 4

Consider short-term (<10 days) rigid immobilization immediately post-operatively to control pain and initial swelling, as recommended by the British Journal of Sports Medicine 3
Transition to a removable functional brace for 4-6 weeks, as suggested by the British Journal of Sports Medicine 1, 2
Begin appropriate exercise therapy as early as possible to improve outcomes, according to the British Journal of Sports Medicine 2

Prolonged immobilization (>4 weeks) in a rigid cast can lead to ankle stiffness and impaired mobility, delayed return to work and activities, and muscle atrophy and deconditioning, as reported by the British Journal of Sports Medicine 3, 4, 2
Failure to initiate early exercise therapy may result in poorer functional outcomes, according to the British Journal of Sports Medicine 2