Ankle Fusion

An ankle fusion procedure consists of combining together the foot bone (the talus) with the leg bones (the tibia and the fibula). It is performed as a last resort procedure, the goal of which is to produce a functional, pain-free lower extremity. This surgery is recommended when all conservative therapy has been performed without obtaining satisfactory functional outcome and relieving of signs and symptoms, most notably pain. 

The Treatment Journey

Upon the initial visit, a detailed health history will be collected, along with a thorough physical exam assessing the extent of the problem. Next, X-ray imaging and sometimes advanced imaging, including CT scans, may be performed to assess the integrity of the ankle joint. Determination of the extent of the problem relies heavily on the inability to use the extremity in a pain-free manner to perform the activities of daily living. Review of prior conservative therapy and other conservative treatment measures will be discussed prior to the recommendation/ determination of an ankle fusion procedure appropriateness. 

Prior to surgery, it is important to have medical conditions reviewed by primary care physicians and any additional specialists as appropriate. The process of obtaining clearance for surgery may require additional testing, including lab work, X-rays, and cardiac examinations. It is required that patients quit smoking 8 weeks prior to surgery in order to allow for optimal healing. 

An ankle fusion procedure is performed using an anterior or lateral incision in order to get access to the joint. Alternatively the procedure can be performed arthroscopically. It requires adequate preparation of the joint, confirming appropriate alignment/positioning, and application of structurally sound hardware in order to maintain the corrected position. 

During the initial 4 days after surgery, a patient is expected to have pain and swelling, which is within the normal healing course. A short-term combination of pain medication will be prescribed in order to make the patient comfortable during the healing. Following the procedure, a specialized splint will be applied, and the patient will be provided crutches or a wheelchair in order to not put weight on the operative site. 

Physical therapy is an essential component of a successful ankle fusion surgery. As the ankle joint will be permanently locked in position, it is essential for peripheral joints and surrounding muscles to get acclimated to the changes and allow for the best functional outcome with as minimal pain as an end result. Following completion of the healing and full course of physical therapy, it is expected that patients will be able to perform their activities of daily living pain-free. It is worth noting that surrounding joints will compensate for the motion that was previously performed by the ankle joint. As well, there may be some difficulty experienced by patients to fit into tapered pants due to the decrease in foot motion. 

Ankle Fusion Techniques

Arthroscopic ankle fusions are performed using an optic camera and shaving instruments in order to prepare the joint with small incisions. Following this, percutaneous screws are applied to hold the correction and for the joint to fuse in optimal alignment. Traditional ankle fusions consist of an anterior or lateral incision. With these incision techniques, direct access to the joint is attained, followed by a subsequent takedown of the joint. This would then be followed by positioning the foot and ankle into optimal alignment and then applying hardware to maintain the position. For patients who may have open wounds or cannot tolerate internal fixation, an option would be to apply external fixation in a compressive manner at the level of the ankle joint to allow the patient to heal. 

At a certain point in the healing process, the patient will be asked to start walking in the external fixator frame in order to further stimulate bone healing/fusion. For patients with limb length discrepancy, multiplanar deformity, or excess bone loss, it may be helpful to apply a bone graft to help elevate the limb, fill in any voids present, and fill in any defects, respectively. The bone graft is sometimes autogenous, meaning it comes from the patient’s own body, such as their heel bone, leg bone or hip bone (iliac crest). In other instances, a cadaveric bone graft is used in order to limit any donor site complications to the patient. 

Risks and Complications

Like all foot and ankle surgery, ankle fusion comes with the risk of pain, swelling, infection, need for further surgery, the bones not fusing together, or the bones taking longer to fuse together, and issues with the implanted hardware. The risks of complications for ankle surgeries are generally low. However, sometimes they can occur, and you can rest assured that your surgeon, and the Modern Orthopaedic team will be by your side in every step of the healing journey until the finish line is reached. 

It is important to recognize specific signs and symptoms such as fever, chills, shortness of breath, chest pain, or calf pain when they present. It is important to call your provider immediately or present to the nearest emergency department if you experience these signs or symptoms. Additionally, worsening pain, swelling, redness, warmth, and white or yellow drainage following the initial few days of surgery may warrant urgent medical attention as well.

Cost and Insurance Considerations

The costs associated with an ankle fusion procedure depends on your specific insurance plan, your associated copays, deductibles and out of pocket maximums for the year. An in-depth discussion will be performed with you and a member of the Modern Orthopaedics billing department about the specific fees associated with all planned procedures to prevent any surprise bills. Elective ankle fusion surgery is covered by insurance when it is performed on a patient who has pain and deformity warranting the surgical correction.

Alternative Treatments

Physical therapy, Steroid injections, PRP injections, collagen, glucosamine chondroitin, and turmeric supplementation can help. Some alternative surgeries to ankle fusions include ankle arthroscopy, ankle arthrodiastasis, and ankle replacement surgery. 

Contact Us

For ankle fusion treatment in NJ, call us at Modern Orthopaedics of New Jersey!

Frequently Asked Questions

Can you walk normally after ankle fusion?

It is expected that a patient will return to regular, pain-free walking after completing the healing course and full gait training with physical therapy.

How long does it take to recover from an ankle fusion?

Full recovery and full gait training from ankle fusion takes about 4 months on average. 

How serious is ankle fusion surgery?

Ankle fusion surgery is one of the more involved surgeries of the lower extremities. Elective in nature, it is important to have the patient’s health and nutrition optimized and maintained prior to the surgery and throughout the course of healing to ensure the best possible outcome. 

What are the cons of ankle fusion?

The limitation of the surgery is the time it takes to recover from it and the slight decrease in motion of the foot and ankle. However, over time, a substantial amount of compensation by surrounding foot bones will be experienced, making limitations less noticeable. 

What is an arthrodesis procedure?

Arthrodesis is the medical word for fusion or, in other words, the act of bringing two bones together. 

Is arthrodesis a major surgery?

Yes, ankle fusions fall under the classification of a type of arthrodesis.

What is an example of arthrodesis?

Examples of arthrodesis procedures are ankle, subtalar, talonavicular, calcaneocuboid, 1st tarsometatarsal, 1st metatarsophalangeal, and digital, to name some of the common joint fusions of the lower extremity. 

What is the purpose of arthrodesis?

The purpose of arthrodesis procedures is generally the same as that of an ankle fusion. To alleviate pain and symptoms to the specific joint(s), allowing for a good functional outcome with good functionality of extremity once full healing and rehabilitation is completed.