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Ankle Fusions

Ankle fusion has long been an acceptable form of treatment for painful ankle arthritis. 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 procedure involves removing what remaining damaged articular cartilage and then allowing the tibia and talus bones to fuse together, thereby eliminating the painful arthritic ankle joint. Internal hardware such as an intramedullary rod, a metal plate, or screws are often used to accomplish a successful fusion. The operation is reliable in relieving pain but will sacrifice any remaining ankle motion. The decrease in motion at the ankle joint is partly compensated for by other joints of the foot. Most patients find an ankle fusion to be highly satisfactory in relieving their pain and do not miss the motion. In fact, in many cases ankle arthritis is so severe prior to surgery, that the patient already has little to no motion.  An ankle fusion also provides a stable platform for balance and walking and may actually improve gait.  Ankle fusion surgery may be the best choice for patients with medical comorbidities or lifestyle factors that do not allow them to have an ankle replacement. Patients who are significantly obese, neuropathic, or have severe malalignment may be better candidates for an ankle fusion rather than an ankle replacement. 

Preoperative Evaluation

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 ankle fusion surgery and we will be happy to discuss any other alternatives of treatment including nonsurgical options. There are multiple procedure alternatives that can be used for performing an ankle fusion, and we can discuss which way would likely be best tailored for you depending on your personal circumstances.
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45 year-old with severely crushed ankle bone and heel bone undergoing a salvage fusion to avoid amputation

The Surgical Procedure

Ankle fusion is performed in an operative suite with an anesthesia team and an orthopaedic surgery team. Sometimes additional procedures are performed simultaneously with an ankle fusion, such as removing previously placed hardware, or balancing the foot. Most patients go home 'outpatient' the day of surgery, but depending medical conditions and how far you've traveled, you may prefer to stay in the hospital overnight.

’28-year-old attempting to walk for five years with a malunited traumatic injury, which was corrected using a gradual correction small wire external fixator’

What to expect after your surgery

You will receive nursing care on the PACU from our highly skilled nurses. If you spend the night in the hospital, a physical therapist may also come by to assist you in safely walking with crutches or a walker without putting weight on your operative leg. Much of the time immediately after surgery is spent at home resting and elevating the ankle to decrease swelling. We generally recommend to keep your leg elevated as much as possible during the first couple weeks. 

You will not be able to put weight on your ankle during the first 6 weeks and will need to use crutches, a walker, or a rolling knee scooter to mobilize. You will be discharged home in a splint and then we will see you in office to check your incision and may place a cast. Typically, at 6 weeks following surgery, you can start putting weight on the ankle.  Patients wear a boot for about 6 weeks once they start walking. They gradually transition back into a regular shoe around 3 months after surgery.