Ankle Fusion: What’s Old Is New Again
By Michael O’Brien, M.D.
When severe ankle pain affects your ability to walk and prevents you from doing the activities you want to do, a surgical procedure called ankle fusion may return you to a more active lifestyle.
Before the advent of joint replacement, fusion was the primary surgical treatment for extremely painful ankles and other joints. For some patients, it is still the best option.
Goals of Ankle Fusion
Your orthopedic surgeon may suggest fusion when medications and other conservative treatments do not provide adequate relief. The goals of this surgery are to relieve pain, stabilize the joint, and restore function. Although joint fusion results in loss of mobility of the ankle, many patients have debilitating pain that has already caused some loss in their range of motion.
Candidates for ankle fusion surgery typically include people who have severe ankle misalignment, which is commonly caused by a fracture or osteoarthritis. The procedure also may benefit people who want to participate in high impact sports, such as skiing, and it may be a good option for young patients. When fusion is successfully performed, it should last a lifetime – which may not be the case with an artificial joint.
Inside the Ankle
Three bones make up the ankle joint -- the lower end of the tibia, or shinbone; the fibula, a small bone in the lower leg; and the talus, the bone that fits into the socket formed by the tibia and the fibula. Ligaments on both sides of the ankle help hold these bones in place, and numerous tendons that cross the ankle help the joint and the toes move. (Ligaments connect bone to bone, and tendons connect muscle to bone.)
A slick material called articular cartilage covers the ankle bones and allows them to move smoothly against one another. When the cartilage wears away, patients are left with a painful condition in which one bone rubs against another bone.
Open & Arthroscopic Surgery
The two basic procedures for fusing an ankle are traditional open surgery and the newer arthroscopic technique. The orthopedic surgeon will determine which procedure is most appropriate for you based on your medical history, current health, the condition of your ankle, and other factors.
The most common way to perform open surgery is to make an incision, open the joint, and clean away articular cartilage surfaces from the ankle, which will allow the tibia and the talus bones to fuse or grow together. The surgeon then inserts pins, rods or plates to immobilize the bones and prevent additional damage to the joint. In some cases, surgical pins are inserted inside the leg and ankle, and a metal rod and pins are placed on the outside. More commonly, only internal plates and screws are used.
During arthroscopic surgery, the orthopedic surgeon makes several small incisions and inserts an instrument called an arthroscope, which contains a tiny camera. With the arthroscope and other surgical instruments, the surgeon can visually monitor progress as he or she treats the joint. As with the open method, screws or pins are used to hold the bones together.
Recovery & Rehab
Following surgery, you can expect to wear a padded plaster cast, which will be removed in approximately two weeks and replaced with a short-leg cast. After eight to 12 weeks, the shorter cast will be replaced by an ankle brace.
You should avoid putting weight on the affected ankle during this time. As the ankle heals, you may work with a physical therapist to regain your ability to walk smoothly, without a limp. Once the bones have fused and completely healed, you may be fitted for a shoe insert to make walking easier, or you may simply wear flat shoes.
About the Author: Michael O’Brien, M.D., is a board certified orthopedic surgeon on the staff of Methodist Medical Center of Oak Ridge. He is in practice with Orthopaedic Surgeons of Oak Ridge. Dr. O’Brien earned his medical degree from St. Louis University of Medicine in St. Louis, Mo., and completed an orthopedic surgery residency at William Beaumont Hospital. He is a member of the American Academy of Orthopaedic Surgeons.
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