Thread by @bambam1729

OK, so Tiger Woods had a subtalar fusion to his right foot today, to alleviate the pain from the arthritis that developed after his car crash in January 2021. What exactly is that, why did he have it done, and what can be expected from it? 1/n

First of all, the release specifically said it was a subtalar fusion. That is not an ankle fusion as I saw reported by Reuters. They are different surgeries. 2/n

What’s a fusion? A fusion is where you take two adjacent bones, that form a joint between them, and fuse them together to form one larger bone, and the joint goes away in the process. It is done to alleviate pain, usually, although it can be done for instability. 3/n

A subtalar fusion is a fusion of the talus and calcaneus bone in the hindfoot. The talus is the bone that articulates (=forms a joint) with the ankle bones, the tibia and fibula. The calcaneus is your heel bone, which lies under the talus. Thus, subtalar = below the talus. 4/n

When Tiger broke his talus my long Twitter thread said that it was his biggest long-term risk, developing arthritis around the talus. The reason is that the talus has a tenuous blood supply, and when you fracture it, you can disrupt the blood supply to the talus. 5/n

Without blood supply to any bone, the bone will die, a condition called avascular necrosis (AVN) (=osteonecrosis). This will then lead to arthritis 100% of the time. Where the arthritis is depends on the exact anatomy of the fracture. 6/n

So a subtalar fusion fuses the talus to the calcaneus, technically also called the talocalcaneal joint, but its usually called the subtalar joint. This will eliminate motion at the former joint, but also it will no longer be painful, almost uniformly. 7/n

The surgery is done by denuding the joint surfaces of their cartilage, roughening up the bone ends, adding bone graft, and then stabilizing the fusion, usually with screws, or sometimes a plate and screws. 8/n

With a subtalar joint fusion, Tiger will no longer have any motion @ that joint (after it heals), but in return he will have pain relief. It will limit his motion in his foot and ankle, but fortunately this is in right foot – in his left foot it would likely be career ending. 9/n

There are other, larger fusions that can be done around the talus – an ankle fusion, a triple arthrodesis (fusion) (fuses three joints around the talus), and a pantalar arthrodesis, which combines an ankle fusion with a triple arthrodesis, and severely limits motion. 10/n

Tiger will be in either a cast, a splint, or a boot for a period of time – its at the surgeon’s discretion. He will likely get around using a rolling stroller, in which you rest your knee on a padded surface, bend your knee, and that leg will roll along. 11/n

It usually takes 6 weeks to 3 months for the fusion to take effect, and Tiger will have limited weight-bearing during that time, which again will be at the surgeon’s discretion, and also depends on how the fusion is healing. 12/n

The status of the fusion will be determined by serial x-rays, or if needed, a CT scan – CT scans are better to visualize bones than MRIs, which are better at looking at soft tissues. 13/n

Can he play golf again? Yes, but that’s at least 6 months to a year in the future. His tournaments for 2023 are likely over, and I would not be surprised to not see him play again until Augusta 2024. 14/n

Can he play golf well again? Depends on your definition of well. He’ll never be the Tiger of 2000 or even 2015. The fact that this is his right foot/ankle is the saving grace, as you need motion in your left foot/ankle as you roll over it near impact. 15/end