Ankle fusion surgery — ankle arthrodesis is the technical term for an ankle fusion — is an aggressive treatment for ankle pain that patients tend to opt for only after other treatment options prove unsuccessful.
Many candidates for ankle fusion surgery suffer from arthritis, which can be excruciating when it affects the ankle because that part of the body moves a great deal and has to bear a person’s weight.
Other candidates for ankle arthrodesis have sustained ankle injuries and as a result suffer chronic pain.
A Look Inside the Ankle Joint
Three bones converge to form the ankle joint: The tibia, the fibula and the talus. The tibia and fibula are leg bones, and the talus is the lower bone that is part of the foot and articulates with the other two. No muscles connect to the talus, so its position depends on the positions of the bones around it.
Inside the ankle joint, between the bones, is what’s called articular cartilage. This cartilage is often the source of ankle pain, whether through a lifetime of wear and tear, traumatic injury, or inflammation.
Ankle fusion surgery involves removing that articular cartilage and letting the bones in the ankle grow together.
Why Fuse the Ankle?
Ankle fusion eliminates some of the up-and-down motion that goes on inside of the joint and reduces the pain drastically — sometimes alleviating the pain entirely.
Many patients feel concerned at first that surgery will limit the motion in their ankle joints, but it is important to note that if ankle fusion is already on the table, the patient is already experiencing enough pain to limit his or her range of motion.
Before artificial joints, this was the only surgery available to alleviate ankle pain. Today, some patients opt instead for ankle replacement surgery, but ankle fusion is still the better option in many cases. This is something you would need to discuss with your doctor, but in general fused ankles tend to remain stable for the rest of your life. Ankle replacements might only be good for 10 to 20 years.
Two Options for Ankle Fusion
There are two ways surgeons can perform an ankle fusion: the open method and the arthroscopic method.
The open method involves making an incision that exposes the joint. Once the joint is opened, the surgeon takes a surgical saw to remove some of the surfaces of the three bones plus the articular cartilage. The surfaces are cut so they fit together cleanly, then screws are inserted to hold the bones together while the tissue heals.
The arthroscopic method is similar, but a smaller incision is made, and a tiny camera is inserted into the joint so the surgeon can see inside. Small tools are then inserted into the joint to prepare the surfaces, and screws are also used to hold the bones together while they heal.
Recovering from an Ankle Fusion
After surgery, expect to stay in the hospital for one or two days. Typically, the ankle operated on will be wrapped in a plaster case, and after about two weeks that cast will be replaced with a smaller one. Talk to your doctor about what specific dressings you can expect.
Expect not to be able to put weight on the ankle for 8–12 weeks. During that time, you will need to rely on mobility devices to get around. We have put together an extensive guide to recovering from foot and ankle surgery that covers everything you will need to know to prepare for this recovery period.
After about 12 weeks, your surgeon will take x-rays to determine whether your bones are fusing properly.
Common Concerns with Ankle Fusions
- Range of Motion in the Foot: Ankle fusion decreases the up-and-down motion for which your ankle is responsible, but other joints in the foot will continue to move normally. The way you walk will change, but with the right footwear most patients will not even limp.
- Active Lifestyles: A fused ankle is pretty strong, and patients who have recovered go on to continue working in physically demanding jobs, hike and ski. Talk to your surgeon about lifestyle concerns and what activities you hope to undertake after recovery. In general, running is not recommended.
- Removing Plates and Screws: Orthopedic hardware is generally not removed unless an infection develops or it causes some kind of irritation.
- Height: A fused ankle will be shorter, but only by a fraction of an inch. Patients typically do not notice the height difference. If you do feel the difference, you can use a heel lift.
- Complications in Other Joints: Because of the ankle joint’s newly limited mobility, the force from walking gets distributed a bit more across other joints in the foot and in the knee. There is potential, then, for arthritis to develop in other joints, particularly in the foot.
- Time Away from Work: Going by the standard 8–12 weeks in which a patient’s ankle cannot bear weight, you might only miss one or two weeks at a relatively sedentary office job, especially if much of your work can be done from home. For more physical jobs — for example construction workers, plumbers or firefighters — expect to take the full 3 months to regain the strength and mobility needed to return to work.