Ankle Fusion Surgery

Ankle fusion surgery, also known as ankle arthrodesis, is carried out to relieve pain and maintain or improve function for patients with ankle arthritis. The procedure fuses together the three bones that make up the ankle joint. These are the tibia (the lower end of the shinbone), the fibula (the small bones of the lower leg) and the talus (the bone that fits into the socket formed by the tibia and fibula). The surfaces of the ankle joint are removed in order to promote fusion between the tibia and talus, which in turn allows the bones to grow together.

Ankle arthritis is degeneration of the cartilage that covers the ends of the bones that form the ankle joint. Articular cartilage lines the inside of the joint and is normally about a quarter of an inch thick. Arthritis can cause damage to the cartilage, and the pain can be quite severe. Ankle fusion surgery eliminates the joint motion and reduces pain coming from the arthritic or damaged joint.

Symptoms of Ankle Pain

Ankle pain is often caused through arthritis, although it can also be attributed to injury caused to the joint. It typically causes pain around the ankle joint and common symptoms include:

• Tenderness when you touch the joint or put weight on it
• Swelling around the joint
• Instability or a feeling the ankle may ‘give way’
• Increased pain or swilling after sleeping or sitting for long periods of time
• Joint stiffness
• Deformity of the joint

Ankle arthritis can sometimes lead to irritation of the nerves around the joint, causing tingling and numbness in the feet, although this is uncommon.

Diagnosis

Your doctor will take a detailed medical history and ask about any injuries or previous infections you have had. Try to provide as much information as you can, e.g. if a particular activity causes you more pain. Your doctor will carry out a physical examination which involves witnessing the way you walk, studying your rhythm, speed and length of your stride. This examination can usually determine whether you have arthritis, although it is likely that diagnostic tests will be requested to ascertain the full extent of the damage to your ankle.

An X-ray will determine whether there are any breakages to the joint, whereas an MRI will determine if there are possible injuries to the tendons, ligaments, muscles and cartilage in the ankle.

Treatment

Treatment of ankle arthritis should always begin with conservative methods (non-surgical) before considering surgery. One of the most important things that can ease ankle arthritis is by ensuring you wear comfortable shoes. Cushioned inserts can help alleviate symptoms, and the following are recommendations to consider:

• Rubber soles add more cushioning
• Wear shoes with good support, i.e. no slip-ons
• Shoes that are shaped like your foot
• Custom made orthotics produced through Gait Analysis

Other conservative treatments include the following:

Rest
The small ankle joint bears five times your body weight on each step, so weight reduction can help.

Exercise
Exercise helps to keep feet flexible, strong and pain free. Any exercise should not place excessive weight on the ankle joint, so non-weight bearing exercises such as swimming and cycling are ideal for protecting the ankle. 

Medication
Your doctor may recommend over the counter medications to help alleviate pain in the ankle. Aspirin and ibuprofen work well, although patients should use these carefully as they can result in side effects, particularly with long-term use.

If pain is more severe and over the counter medication is not working, you may be prescribed cortisone (steroid) injections to help manage it. Injections are particularly helpful during acute flare-ups of pain, although it is important to bear in mind that they can only be given 3-4 times a year.

Ankle Fusion Surgery

If conservative treatments are only providing temporary pain relief and is still affecting your day-to-day activities, your doctor will discuss surgical options with you. Ankle fusion surgery is the recommended treatment for patients with severe arthritis of the joint as it can be performed on patients of all ages. It is particularly preferred over ankle replacement surgery in more active patients as they may have a tendency to wear out the replacement joint. However, it is worth bearing in mind that patients who undergo fusion surgery will experience permanent stiffness in the joint and may not be able to perform certain activities such as running.

Surgery will first involve removing any remaining cartilage and creating a level bone surface on the top and bottom of the ankle joint. The bones are then aligned in the proper position for the fusion to be carried out. Metal implants, usually large screws, plates or wires are then used to hold the bones in place. The hardware is often permanent and will stay in place, even after the joint heals.

The procedure can be carried out in several different ways, depending on the extent of the arthritis and the amount of deformity of the joint. Some surgeons perform ankle arthroscopy to remove the cartilage, while others will make a larger incision to look directly at the joint.

Once the surgeon has completed the operation, the incision will be closed with either sutures or staples and the patient will be taken to the recovery room.

Post-Operative Recovery

You will be required to protect the area whilst the ends of the joints are growing together to form one solid piece. Immediately after surgery, you will need to keep the fused ankle elevated to minimise swelling. This will initially involve lying down or sitting in a reclined position. Pain medication will be provided for short-term relief.
Patients are often placed in splints or plastic boots to protect the ankle fusion. You will not be able to move it for a period of time and will need to keep all weight off the joint. This may involve using a walker, crutches or a wheelchair to initially get around.

Recovery from ankle fusion surgery usually takes up to 12 weeks, with 6-8 weeks for the tibia and talus to fuse sufficiently for patients to be able to put weight onto the leg. This can however take longer in some patients. It is important to ensure you have help with basic tasks and activities, particularly during the first two weeks post-surgery. Living accommodation may need to be appropriately adjusted; this may involve transferring the bed to ground level, adding a ramp to navigate stairs, and adapting shower facilities by adding railings or a chair.

You will be prescribed gentle exercises by a physiotherapist in order to keep the joint supple, and once sufficient time has passed, physical therapy will assist in making the ankle fusion sturdy enough for you to walk unaided with a gradual return to more physical activity.

Risks and Complications

In general, ankle fusion surgery is a relatively safe procedure, but all surgeries come with possible complications. A specific risk with ankle fusion is failure for the ankle bones to fuse together. Fusion is successful in more than 90% of cases, so the risk is relatively low. If however this does occur, a second operation to place bone graft in the ankle and place new hardware may be required. This condition is more common in smokers.

Other complications you could experience, although rare are:

• Infection
• Bleeding
• Blood clots
• Nerve damage
• Arthritis in nearby joint
• Painful scar tissue
• Loss of motion

Need Help?

Ankle fusion surgery is available at One Ashford Hospital in Kent and One Hatfield Hospital in Hertfordshire. 

You can use your private medical insurance or pay for your Ankle Fusion Surgery treatment. We offer competitive, fixed price packages. If you are using your health insurance, please contact your insurer first for approval and let them know you’d like to be treated at either the One Ashford Hospital or One Hatfield Hospital.

Why One Healthcare

• Modern purpose-built hospital opened in March 2016 (Ashford) December 2017 (Hatfield)
• Fast access to diagnostics including MRI, X-ray and Ultrasound
• 0% and low finance options**
• Private, spacious, en-suite rooms
• Specialist Physiotherapy and nursing teams
• Little or no waiting time
• ‘Ultra clean air’ theatres
• Freshly prepared food
• Calm, dignified experience

**Terms and conditions apply

Contact us and find out more

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If you are based in and around Hertfordshire and would like to visit the One Hatfield Hospital please click here.