Ankle Fusion: Surgery, Recovery, Mobility Options, and FAQ
Ankle fusion is when two or more bones of your ankle are fused together permanently. This type of surgery is usually carried out to repair a worn-out ankle joint.
If you’re considering ankle fusion this article explains the procedure in more detail, including the reasons why surgery might be needed, recovery time, and success rates. It also addresses some of the most frequently asked questions about ankle fusion.
Ankle fusion, also known as ankle arthrodesis, is a type of surgery where two or more bones are permanently fused together at the ankle joint so that it can’t bend. The two main bones of the ankle joint are called the tibia and talus, and over time the smooth cartilage on the surface of these bones can wear away, which causes pain and swelling. During ankle fusion, the surgeon will remove these damaged joint surfaces and join the bones together using screws. They may include the fibula or other bones of the ankle too.
Ankle fusion is used to treat long term ankle pain and instability, usually caused by severe arthritis, and is generally carried out after other, non-surgical treatments have failed to improve symptoms. The aim is to eliminate the chronic pain and inflammation in your ankle.
Ankle fusion is considered the gold standard procedure for ankle arthritis and has a good success rate[i]. However, it’s important to know that you will lose the motion in your ankle and while you’ll still be able to return to most of your pre-operative activities, you probably won’t be able to run again.
Most people who undergo ankle fusion surgery do so because they have arthritis in their ankle that has been causing long-term pain and is affecting their daily life.
Ankle arthritis is pretty common and can be caused by both a previous injury that has damaged the joint or a chronic condition like osteoarthritis or rheumatoid arthritis. Sometimes it’s simply because the joint has worn out.
Ankle fusion may also be carried out to treat a severe foot deformity, like club foot, high-arched or flat foot which has damaged the ankle joint or made it unstable.
If you have arthritis in your ankle your doctor will probably suggest that you try other treatments first, as the surgery is irreversible. They include cortisone injections, shoe inserts, anti-inflammatory medicines, using a brace or cane, and physiotherapy.
If none of these work for you, then surgery may be your best option. Ankle fusion is the most common type of operation but ankle replacement is becoming more popular. This is when the damaged bits of your ankle joint are removed and replaced with a new prosthetic joint.
Your doctor will discuss the options and help you decide which surgery is right for you. Ankle fusion is usually recommended for younger, more active people because it tends to last longer and is less restrictive. However, ankle replacement can provide more mobility and protect the other joints around your ankle from becoming arthritic.
Before your procedure, remember to tell your doctor about any medication that you’re taking, even over the counter ones. You may be advised to stop taking drugs that make it harder for your blood to clot (like aspirin or Warfarin).
If you can, try to stop smoking because this can increase the risk of complications and slow down the healing process. When you get home from hospital you won’t be able to put any weight on your ankle for a while so you may need to make some preparations in advance.
Ankle fusion is performed under spinal or general anaesthetic. Your surgeon will make an incision and remove the damaged cartilage to reveal healthy bone underneath. They will then position the bones correctly and compress them together using metal hardware. You shouldn’t be able to feel these screws and they don’t need to be removed unless they’re causing problems. The operation usually takes two to three hours.
Ankle fusion may be carried out by open surgery – where a larger incision is made – or keyhole surgery, depending on factors like the extent of the arthritis, how damaged your joint is, and your surgeon’s preference. They will discuss the options with you.
When you wake up, your leg will be elevated, in a brace or cast. Tell your doctor or nurse if you’re in any pain so that they can manage this. You’ll need to spend at least one night in hospital after your surgery to make sure that you’re comfortable and that your pain is under control.
When doctors are ready to discharge you, you’ll be sent home to recover. You’ll need to return to the hospital a couple of weeks after the surgery to have your stitches removed and your cast changed.
In order to heal properly, you won’t be able to put any weight on your ankle for 6-12 weeks after ankle fusion surgery. During this time, you’ll need to use traditional crutches, a knee scooter, or a hands-free crutch to get around.
Once your cast has been removed, you’ll probably wear a protective boot for a few weeks while you slowly start to bear weight again. Physiotherapy can help to build up the strength in your ankle. It can take up to six months to fully recover from ankle fusion surgery.
It can take up to three months before you’re walking again after surgery. This can be a frustrating and difficult time, especially if you’re used to being active. Most people resign themselves to weeks of hobbling around on crutches. Fortunately, there are now some alternatives which can make the process a lot easier for you. Here are the main options:
Traditional underarm crutches are the most commonly used mobility device. They are relatively cheap and lightweight, making it easier to transport them around. However, as anyone who has used them can testify to, they’re frustrating. Not only do you lose the use of your arms and hands as well as your leg, you’ll be exhausted after only a short journey. Plus many people find them painful too. All in all, they can make the whole process pretty unbearable.
If you want to be able to travel any distance without feeling like you’ve run a marathon, or you’d like to make yourself a cup of coffee and actually enjoy it during your recovery period, you may want to consider other options.
Knee scooters, or knee walkers as they’re also known, can be a useful and fun way to get around while you recover. They look a bit like a child’s trike but are carefully engineered to protect your injured leg while you scoot around from point A to point B.
Knee scooters can be used indoors and outdoors and are a great alternative to crutches. However, they can’t be used on uneven ground or stairs and are quite bulky, which makes it difficult to transport them. You also need to use your hands to ‘drive’ them which means that you can’t really carry things around.
The newest kid on the block is a hands-free crutch called the iWALK2.0, a medically-approved, award-wining device which is gaining popularity. This lightweight device can be used by the majority of people with lower leg injuries and functions like a prosthetic leg, enabling you to walk around freely and unaided. This gives you your mobility – and freedom – back during your recovery period which has both physical and psychological benefits. Recent clinical research showed that 86% of non-weight bearing patients preferred the hands-free crutch over other mobility devices.
Most people get used to the device very quickly and, with some practice, can take it on and off in seconds. Using the hands-free crutch, you’ll be able to continue to live your life while you recover – going to work, walking the dog, looking after the kids, even going to the gym.
Here are the most frequently asked questions about ankle fusion:
You may experience some pain and discomfort after surgery but this should be managed by your medical team. When you’re discharged from hospital you’ll be given a prescription for painkillers to take home with you so that you can keep any pain under control.
Long term, the surgery should eliminate the pain you’ve been experiencing in your ankle.
Surgery is usually only considered after other, non-surgical treatments have been tried first. These include shoe inserts, cortisone injections, using a brace or cane, physiotherapy and anti-inflammatory medicines.
After this, the two surgical options are ankle fusion and ankle replacement. Ankle fusion is more common but ankle replacement is gaining popularity thanks to medical advances. Both surgeries have pros and cons – your doctor will discuss which is best for you.
Most people don’t limp after ankle fusion. A 2004 medical study[i] found that 94% of patients had no limp or a slight limp following surgery. However, it can affect how you walk and you may be advised to wear special shoes or inserts.
After surgery, you’ll be off your feet for 6-12 weeks. Once your cast is removed you’ll be able to start bearing weight on your leg again, slowly building up to walking normally. It can take up to six months to fully recover and you may have swelling for up to a year afterwards.
Ankle fusion has a high success rate at eliminating the pain and swelling associated with arthritis, which can have a huge impact on your quality of life. It should last a lifetime.
Ankle fusion surgery can place increased stress on the surrounding joints in your foot, which may cause you to develop arthritis elsewhere in the long term. This is one of the reasons why ankle replacement surgery is becoming more popular, as the risk is reduced.
It’s important to accept that after surgery you’ll won’t have motion in your ankle (you’ll still have it in your foot). You probably won’t be able to run but you should still be able to go about your day to day activities and participate in many sports, like walking, hiking, cycling and golf. A study published in 2018[ii] found that 83% of patients were either very satisfied or satisfied with their ankle fusion at long-term follow up.
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