Lower Leg Injury Resource Center
Ankle Fusion
Causes, Surgery, Recovery & Post-Surgery Mobility
Ankle fusion surgery, also called ankle arthrodesis, is when two or more ankle bones are permanently fused together. It’s usually done to treat ankle arthritis.
Ankle fusion surgery impacts ankle mobility and will probably limit activities like running and jumping. Walking after ankle fusion surgery becomes pain free, and most people eventually walk without a limp. Ankle fusion surgery is irreversible.
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WHAT IS ANKLE FUSION SURGERY?
Ankle fusion, or ankle arthrodesis, is a surgery that permanently fuses two or more ankle bones together so the joint can’t bend.
The two main ankle bones are called the tibia and talus, and over time the smooth surfaces of these bones and cartilage between them can wear away. This causes long-term pain and swelling.
During ankle fusion surgery, your surgeon will remove damaged joint surfaces and permanently join the bones using plates, screws and other hardware. The operation may include the fibula or other bones of the ankle as well.
Ankle fusion is used to treat long-term ankle pain and instability that’s usually caused by severe arthritis. It is generally performed only after other, non-surgical treatments have failed. The goal of ankle fusion surgery is to eliminate chronic pain and inflammation.
Ankle fusion used to be the gold standard procedure for ankle arthritis and has a good success rate [1]. There are options, however, including ankle joint replacement, as well as a number of non-surgical options that your doctor will recommend before suggesting any form of surgery.
Despite the success rates of ankle fusion surgery, it’s important to realize you’ll completely lose ankle mobility. If you get ankle fusion surgery, you’ll be able to return to many activities, but you probably won’t be able to run again.
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WHY WOULD I NEED ANKLE FUSION?
Most people who undergo ankle fusion surgery have severe, painful ankle arthritis that negatively impacts their daily lives.
Ankle arthritis is common and can be caused by previous injuries or chronic conditions like osteoarthritis or rheumatoid arthritis. Sometimes the ankle joint is simply well-used and worn out.
Ankle fusion may also be performed to help treat severe foot deformities like clubfoot, flatfoot or high-arches, all conditions that can destabilize and damage the ankle.
If you have ankle arthritis your doctor will probably suggest other treatments first because ankle fusion surgery is irreversible. Options include cortisone injections, shoe inserts, anti-inflammatory medicines, braces and canes, and physiotherapy.
If none of these alternatives to ankle fusion work, surgery may be your best option. Historically, ankle fusion was the most common and reliable type of ankle surgery but ankle replacement surgery, a procedure that replaces the ankle joint using a prosthetic, is increasingly popular and dependable.
Your doctor will discuss the options and help you decide which surgery is right for you. In general, ankle fusion puts more stress on nearby joints and can put them at higher risk of developing arthritis, while ankle replacement retains mobility and doesn’t impact nearby joints but has a time horizon of 10 to 15 years. Recent medical studies indicate that recommendations should be made on a case-by-case basis.
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WHAT HAPPENS DURING ANKLE FUSION?
Ankle fusion surgery is performed under spinal or general anesthetic. Your surgeon will make an incision and remove damaged cartilage to reveal healthy bone. They will position the bones anatomically and bind them using metal hardware. You shouldn’t be able to feel the hardware after surgery, and it generally won’t need to be removed. The operation usually takes two to three hours.
Ankle fusion may be carried out by open surgery, which requires a larger incision, or laparoscopic keyhole surgery, depending on factors like the extent of the arthritis, how damaged your joint is, and your surgeon’s preference.
When you wake following ankle fusion surgery, your leg will be elevated and in a brace or cast. You’ll probably spend at least a night in the hospital to make sure you’re comfortable and that your pain is under control.
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HOW LONG DOES ANKLE FUSION TAKE TO HEAL?
It can take up to six months to fully recover from ankle fusion surgery, but it’s a phased recovery that will include different levels of mobility.
For the first six to 12 weeks after ankle fusion surgery you won’t be able to put any weight on your foot or ankle at all. 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 put weight on the joint again. Physiotherapy can help to build ankle and foot strength during this phase of recovery.
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WALKING AFTER ANKLE FUSION SURGERY
It can take up to three months before you’ll start to walk again following ankle fusion surgery. This can be a frustrating and difficult time, especially if you’re used to an active lifestyle. Some people resign themselves to weeks of hobbling around on crutches, but there are alternatives to traditional crutches that can make getting around easier and possibly even accelerate the healing process.
Traditional Crutches
Traditional underarm crutches are the most common mobility device for people recovering from ankle fusion surgery. Traditional crutches are relatively cheap and lightweight, but can also be frustrating. They require the full attention of your hands and arms, which makes simple activities like cooking breakfast or taking out the trash exhausting or impossible. What’s more, many people find that traditional crutches hurt their hands, forearms and wrists.
Knee Scooters or Knee Walkers
Knee scooters, also called knee walkers, can be helpful during recovery. They look like a child’s scooter but are carefully engineered to protect your injured leg while you move around on wheels with a padded platform and a handlebar.
Knee scooters can be used in a variety of circumstances and are a great alternative to crutches, but they have obvious limitations. They can’t be used on uneven ground or stairs and are bulky, which makes them challenging to transport. Knee scooters also require use of your hands, which makes it impossible to carry anything while using them.
iWALK Hands-Free Crutch
The iWALK hands-free crutch is a medically-approved, award-wining mobility device that solves the shortcomings of traditional crutches and knee scooters.
The iWALK is a lightweight device that can be used by the majority of people with lower leg injuries. It functions like a prosthetic leg and enables people recovering from foot, ankle and lower leg injuries to walk freely and unaided. This restores freedom and mobility, which has physical and psychological benefits during recovery. Recent clinical research showed that 86 percent of non-weight bearing patients preferred the hands-free crutch over other mobility devices. Moreover, cutting edge medical studies show the iWALK boosts blood-flow, reduces muscle atrophy and may accelerate healing.
Most people learn to use the iWALK quickly and, with practice, can put it on and remove it in seconds. Using the hands-free crutch, you’ll be able to continue living your life while you recover. You can go to work, walk the dog, look after your kids and even go to the gym.
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ANKLE FUSION FAQs
How painful is ankle fusion/ankle arthrodesis surgery?
You may experience some pain and discomfort following ankle fusion surgery but your medical team will manage it by prescribing prescription or over-the-counter pain killers. Long-term, the surgery should eliminate the ankle pain that prompted you to get the surgery.
Is ankle fusion/ankle arthrodesis surgery my only option?
Ankle fusion surgery is usually only recommended after other, non-surgical treatments have failed to alleviate long-term pain. Non-surgical options include shoe inserts, cortisone injections, using a brace or cane, physiotherapy and anti-inflammatory medicines.
Surgical options include ankle fusion and ankle replacement. Ankle fusion is more common, but ankle replacement is gaining popularity thanks to medical advances. Both surgeries have upsides and downsides, and your doctor will discuss which option is best for you.
Will I limp after ankle fusion/ankle arthrodesis?
Most people don’t limp after ankle fusion surgery. A 2004 medical study found 94 percent of patients didn’t limp at all or had only a slight limp following surgery. However, it can affect how you walk, and specially-designed shoes or inserts may be prescribed.
How long does it take to recover from an ankle fusion/ankle arthrodesis surgery?
You’ll be off your feet completely for six to 12 weeks following ankle fusion surgery. It can take up to six months to fully recover, and you may have swelling for up to a year.
What does ankle fusion/ankle arthrodesis mean for my future?
Ankle fusion has a high success rate and almost always eliminates the pain and swelling associated with arthritis. Ankle fusion surgery should last a lifetime.
However, ankle fusion surgery can place increased stress on the surrounding joints in your foot, and that may cause arthritis in those joints. Eliminating this side-effect is one of the reasons ankle replacement surgery is becoming more popular.
It’s important to accept that after surgery you’ll won’t have motion in your ankle. 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 [2] found that 83 percent of patients were either very satisfied or satisfied with their ankle fusion when they returned for a long-term follow up appointment.
The information above is intended for informational purposes only and is not intended to prevent, treat, or diagnose any illness or disease. We aim to provide the highest quality information, so if you have any questions on the information above, we welcome your feedback!
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RESOURCES
- Gowda, B. N., & Kumar, J. M. (2012). Outcome of ankle arthrodesis in posttraumatic arthritis. Indian journal of orthopaedics, 46(3), 317–320. https://doi.org/10.4103/0019-5413.96392
- Faux JR, Smith RW. Ankle arthrodesis: Long-term functional and clinical performance. Presented at the American Orthopaedic Foot and Ankle Society 20th Annual Summer Meeting. July 29-31, 2004. Seattle.
- Sinclair V., O’Leary E., Pentlow A., Hepple S., Harries B., and Winson I. The long-term outcomes of arthroscopic ankle arthrodesis and the prevalence of adjacent degenerative joint disease. Orthopaedic Proceedings 2016 98-B:SUPP_19, 19-19 https://online.boneandjoint.org.uk/doi/abs/10.1302/1358-992X.98BSUPP_19.BOFAS2016-019
