An ankle fusion is a surgical procedure that is usually done when an ankle joint becomes worn out and painful, a condition called degenerative arthritis. Ankle fusion is sometimes called ankle arthrodesis.

Probably the most common cause of degenerative arthritis of the ankle is an ankle fracture. Many years after a serious fracture, the joint may wear out and become painful. Just as an out-of-balance piece of machinery wears out faster, a joint that is out of balance after it heals from a fracture can wear out faster than normal. This process may take many years. Other types of arthritis can lead to a painful ankle joint as well. For example, rheumatoid arthritis can destroy the ankle, leading to a painful joint.

Ankle Fusion Candidates

Candidates for ankle fusion surgery may include patients with severe ankle misalignment, osteoarthritis or other ankle conditions.

To relieve ankle pain when cartilage has been damaged or destroyed, the bones of the ankle can be fused.

Ankle Fusion Outcome & Benifits

An ankle fusion removes the surfaces of the ankle joint and allows the tibia to grow together, or fuse, with the talus. Before the development of artificial joints this was the primary operation available to treat an extremely painful joint. In some cases, fusion is still the best choice.

Ankle fusion is a good alternative for treating a worn out joint. This is especially true if the patient is young and very active. An ankle fusion, if successful, is not in danger of wearing out like an artificial ankle. A fusion keeps the ankle joint from moving during walking and other activities, therefore ankle fusion adds stress to adjacent joints.

Prepare for Ankle Fusion

The decision to proceed with surgery must be made jointly by you and your surgeon. You need to understand as much about the procedure as possible. If you have concerns or questions, you should talk to your surgeon.

Once you decide on surgery, you need to take several steps. Your surgeon may suggest a complete physical examination by your regular doctor. This exam helps ensure that you are in the best possible condition to undergo the operation.

On the day of your surgery, you will probably be admitted to the hospital early in the morning. You shouldn't eat or drink anything after midnight the night before. The amount of time patients spend in the hospital varies. You will need to stay until your medical condition has stabilized and you can safely use crutches or a walker.

Ankle Fusion Surgery Overview

Several different operations have been developed to perform an ankle fusion. The basic procedure in each operation remains the same, however. The most common way that an ankle fusion is done is by making an incision through the skin to open the joint. Once the joint is opened, the articular cartilage surfaces of the joint must be removed.

Once the articular cartilage is removed on both sides of the joint, the body will try to heal the two surfaces together just as if it were fractured or broken.

Once the cuts are made the bones must be held in place while they fuse. This can be done using large metal screws and metal plates if necessary. The screws are usually under the skin and are not removed unless they begin to rub and cause pain.

In some cases, especially if the fusion is being done because of an infection or a failed initial fusion, an apparatus called an 'external fixator' is used to hold the bones together while they heal. This apparatus has metal pins that are inserted through the skin and into the bone. The metal pins are connected to metal rods and bolts outside the skin that hold the bones in position while the ankle fuses. The fixator is removed after the bones have healed, usually in twelve to fifteen weeks.

Some surgeons have performed ankle fusions with the help of the arthroscope. The arthroscope is a miniature TV camera that is inserted into the ankle joint through a small incision. Using the arthroscope to watch, other instruments are inserted into the ankle joint to remove the cartilage surface. The cartilage surface is removed using a small rotary cutting tool. Once the surfaces are prepared, screws are placed through small incisions in the skin to hold the bones together as they heal, or fuse. This procedure is not significantly different from the open procedure except that the incisions are smaller.

Ankle Fusion Recovery

After surgery, your ankle will be wrapped in a padded plaster cast. This will be removed after two weeks and replaced with a short-leg cast. You will not be permitted to put weight down on your foot until it is certain the bones are fusing. This usually takes between eight and 12 weeks.

You should keep your leg elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting up.

Ankle Fusion After Care

An ankle brace will replace the cast after eight to 12 weeks. Your surgeon will take x-rays frequently to see if the bones are fusing together. You will probably need to use crutches for most of the time you wear the cast. As the fusion grows stronger, you will begin to put more weight on your foot when walking. You may need the help of a physical therapist to learn to walk smoothly and without a limp.

Once the fusion has completely healed, you will be fitted with several special shoe modifications to make walking easier. An insert in the shoe called a SACH foot is sometimes useful to help you walk more normally. This heel cushion compresses as you put your weight on the foot and allows the foot to roll more normally as you step. Another useful modification of the shoe is a rocker sole. Unlike a typical flat shoe sole, the rocker sole is rounded, allowing your foot to roll as you move through a step.

While you won't be able to run normally after an ankle fusion, a successful operation should result in a nearly natural walking gait.

Ankle Fusion Possible Risks

As with all major surgical procedures, complications can occur. This document doesn't provide a complete list of the possible complications, but it does highlight some of the most common problems.

The most common complications following ankle fusion are:

• anesthesia complications
• nerve or blood vessel injury
• infection
• nonunion of the bones
• malunion of the bones