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Ankle Fusion

Ankle fusion is arguably the most definitive way to treat ankle arthritis. It is a very good operation that has withstood the test of time. Surgeons have been performing ankle fusions with good results for decades. The operation is indicated for end-stage ankle arthritis that has failed other conservative treatment modalities such as activity modification, anti-inflammatories, and bracing. The operation involves removing what remains of the damaged articular cartilage and then allowing the the tibia and talus bones to fuse together thereby eliminating the ankle joint. The surgery generally involves using internal hardware such as an intramedullary rod, a metal plate, or screws to accomplish a successful fusion. The operation is generally reliable in relieving pain but also sacrifices ankle motion. It may be that the decrease in motion at the ankle joint is compensated for by motion in other joints of the foot. Many patients find it to be a very successful operation in relieving their pain and don't miss the motion as much as they thought they would. Sometimes the ankle arthritis was so severe prior to surgery, that the patient already has very little motion at the ankle joint. When the ankle successfully fuses it provides a very strong and stable platform for walking and may last longer than an ankle replacement. In fact, often times ankle replacements eventually are taken out and the ankle joint is then fused. Ankle fusion surgery is a very good choice for patients with lifestyles that may not allow them to take care of an ankle replacement. Patients with ankle joint infections, patients with severe deformities, or patients who are too overweight for an ankle replacement may also be good candidates for an ankle fusion.

Preoperative Evaluation

During your preoperative evaluation we will review your history and possibly any prior radiographs, MRIs, and CT scans. Even if you have existing radiographs, your visit will likely include new standing radiographs of your foot and ankle. We will answer any questions that you have regarding the ankle fusion surgery and we will be happy to discuss any other alternatives of treatment including nonsurgical options. There are multiple methods I use for performing an ankle fusion and I would be happy to discuss which way I think would be best for you depending on your personal circumstances. 

The Surgical Procedure 

Ankle replacement is performed in an operative suite with an anesthesiology team and an orthopaedic surgery team. Anesthesia is determined on a case by case basis but most patients prefer to have a nerve block placed in the leg. The nerve block is left in place for up to three days for postoperative pain control. The surgical procedure usually takes about 2 hours. Sometimes additional procedures are performed simultaneously with ankle fusion such as removing previously placed hardware, fusing the subtalar joint, or balancing the foot. After surgery, you will go to the recovery room for about an hour. Depending upon your age, medical conditions, how far you've traveled, and other factors, you may stay in the hospital overnight. This is determined on a case by case basis. 

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After Surgery


You will receive nursing care on the floor from the highly skilled nurses. An orthopaedic associate will see you each day. A physical therapist may also come to assist you in safely walking with crutches or a walker without putting weight on your fused ankle. Much of the time immediately after surgery is spent resting and elevating your leg to decrease swelling. We generally recommend you keep your leg elevated as much as possible during the first week. You will be discharged from the hospital immediately after surgery or on post-op day 1 with a prescription for pain medicine to help control your pain as the nerve block begins to wear off.

Your ankle is usually immobilized for 12 weeks in a cast to promote bone healing. You will not be able to put weight on your ankle during the first six weeks and will need to use crutches, a walker, or a rolling knee walker to mobilize. You will be discharged home in a splint and then we will see you in office at 1 week to check your incision and place a cast.  At three-weeks, sutures are usually removed and a new non-weight bearing cast is placed. Typically, at six to eight weeks following surgery, the cast is changed to a walking cast. You will be seen again at twelve weeks after surgery and transitioned into a post-operative walking boot. Typically, patients wear the boot for about 4-6 weeks as they gradually transition back into a regular shoe. Typically, office visits are 1 week, 3 weeks, 6 weeks, 12 weeks, 6 months and one year. Some patients may be seen on a yearly basis to ensure adequate observation.

© 2015 Jesse F. Doty, MD - Reviewed: October, 2015

Dr. Doty is a foot and ankle fellowship-trained orthopaedic surgeon with an interest in providing musculoskeletal care to the lower extremity. Subspecialty training equips him to confidently address some of the most complicated deformities of the foot and ankle. He is well-versed in internal fixation as well as external fixation in treating chronic hindfoot and forefoot deformities.