Ankle Fusion

What is ankle fusion?

Ankle fusion is a type of surgery to fuse the bones of your ankle into one piece. It’s also known as ankle arthrodesis. The surgery is done to treat arthritis in the ankle.

The ankle joint is also called the tibiotalar joint. It’s where the shinbone (tibia) rests on top of a bone of the foot called the talus. The ankle also includes the subtalar joint. This is where two foot bones called the talus and the calcaneus meet.

Arthritis can affect these two joints in the foot. Over time, the smooth cartilage on the surface of the bones wears away. This results in pain, inflammation, and swelling in your joint.

Ankle fusion is a surgery to fuse two or more bones in the ankle. This helps stop the pain and swelling. Your surgeon will make an incision in your ankle to work on the joint. He or she will then compress the bones together and attach them with screws and other hardware. Your doctor may also use a bone graft to help the bones heal together.

In some cases, an ankle fusion can be done with minimally invasive surgery. This uses a smaller incision and a tiny camera to help do the surgery.

Why might I need ankle fusion?

You may need an ankle fusion if you have severe arthritis in your ankle. It can cause symptoms such as severe pain, inflammation, and stiffness. These can lead to difficulty walking. The three types of ankle arthritis are:

• Osteoarthritis, caused by wear and tear over time
• Rheumatoid arthritis, caused by an immune disease that affects the joints
• Arthritis due to previous injury of your joint

If you have mild or moderate arthritis, your doctor will likely advise other treatments first. These may include pain medications and corticosteroid injections. You may be given special shoes or shoe inserts. Or your doctor may advise physical therapy. If you still have severe symptoms that interfere with your daily activities, your doctor may advise an ankle fusion surgery. Talk with your doctor about your options.

What are the risks of ankle fusion?

Every surgery has risks. The risks of ankle fusion include:

• Infection
• Damage to nearby nerves
• Bleeding
• Blood clot
• The bones not joining together properly
• Misalignment of the bones
• New arthritis in nearby joints (very common)

A normal side effect from ankle fusion is a reduced range of motion in the joint. This isn’t a major problem for most people.

Your risk of complications may vary according to your age and your general health. For example, if you are a smoker or if you have low bone density, you may have a higher risk of certain complications. People with poorly controlled diabetes may also have a higher risk of problems. Talk with your doctor to learn which risks apply most to you.

How do I prepare for ankle fusion?

Talk with your doctor how to prepare for your surgery. Tell your doctor about all the medications you take. This includes over-the-counter medications such as aspirin. You may need to stop taking some medications ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your doctor if you need help to stop smoking.

Before your surgery, you may need imaging tests. These may include ultrasound, x-rays, or magnetic resonance imaging (MRI).

Do not eat or drink after midnight the night before your surgery. Tell your doctor about any recent changes in your health, such as a fever.

You may need to plan some changes at home to help you recover. This is because you won’t be able to walk on your foot normally for a while. Plan to have someone drive you home from the hospital.

What happens during ankle fusion?

Your doctor can help explain the details of your particular surgery. An orthopedic surgeon and a team of specialized nurses will perform your ankle fusion. The whole operation may take a few hours. In general, you can expect the following:

• You may have spinal anesthesia. This is so you won’t feel anything from your waist down. You’ll also likely be given sedation to relax you. Or you may be given general anesthesia. This will prevent pain and make you sleep through the surgery.
• A health care provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.
• The surgeon will make an incision through the skin and muscle of your ankle, and likely another one on your foot. If you have minimally invasive surgery, the surgeon will make a smaller incision. He or she will then use a tiny camera with a light to help do the surgery.
• Your surgeon will remove any remaining cartilage from the affected joint. He or she will connect the bones together in the proper position.
• Your surgeon will make any other repairs that are needed.
• The team will close the layers of skin and muscle around your ankle and foot with sutures.

What happens after an ankle fusion?

Talk to your doctor about what you can expect after your surgery. When you wake up, your leg will likely be elevated and in a brace to keep it from moving. You can resume a normal diet as soon as you are able. You may need follow-up x-rays to see how your surgery went. You will likely need to stay a few days at the hospital.

You may have a lot of pain right after your surgery. Pain medications will help to relieve your pain. The pain should begin to go away in the next few days. It may be helpful to rest and elevate your leg as much as possible right after your surgery.

After your surgery, you will likely need to wear a splint for a couple of weeks. You might also need to use crutches for several weeks. Your doctor will give you instructions about how you can move your foot as you recover. You won’t be able to put your full weight on it for a few months.

You won’t be able to see your incision. But let your doctor know right away if pain at the incision site gets worse, or if you have a fever.

Make sure to keep all your follow-up appointments. This is so your doctor can keep track of your progress. You may have your splint replaced with a cast a couple of weeks after your surgery. This cast may come off about 12 weeks after your surgery. You might need physical therapy for a few months. This is to help you keep your strength and range of motion in the ankle. It may be several months before you can return to all your normal activities.

Make sure to follow all your doctor’s instructions about medications, wound care, and exercises. This will help make sure the surgery works well for you.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• The risks and benefits of the test or procedure
• When and where you are to have the test or procedure and who will do it
• When and how will you get the results
• How much will you have to pay for the test or procedure