ANKLE ARTHRODESIS

The goal of ankle arthrodesis (also known as ankle fusion) is to relieve pain and maintain or improve function for patients with ankle arthritis.  Ankle arthritis is degeneration of the cartilage that covers the ends of the bones that form the ankle joint. These bones are the tibia, the fibula, and the talus. Pain typically is made worse with movement of the arthritic ankle. In ankle arthrodesis the ankle bones are fused into one bone. This eliminates the joint motion and reduces pain coming from the arthritic joint. 

SURGERY
Ankle arthrodesis may be performed through an incision on the outside of the ankle or the front of the ankle.

Sometimes a bone graft may be used to aid in fusion. This graft may be taken from the pelvis, heel bone, or just below the knee. After the joint has been accessed, tools are used to scrape away remaining cartilage and the joint surface is prepared for fusion. 

Screws or screws and plates may be used to hold the ankle in the correct position. If a patient is having their subtalar joint fused at the same time, a nail or rod may be used to hold the joints in position. Hardware may be placed through the incision used to access the ankle joint and/or through small poke holes. In rare cases, pins and bars outside the skin are used to hold the ankle in position.
X-rays are used during surgery to check the alignment of the joint and the placement of hardware. The choice of approach and hardware depends on a patient's specific anatomy and condition, and the surgeon's preference.

Incisions are closed with sutures or staples. Patients are often placed in splints or plastic boots to protect the ankle fusion.

COMPLICATIONS
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

A specific risk associated with ankle arthrodesis is nonunion, or failure of the ankle bones to fuse together. The ankle bones successfully fuse in more than 90% of operations, so the risk is relatively low. If nonunion does occur, a second operation to place bone graft in the ankle and place new hardware may be needed.

Loss of motion in the ankle after a fusion causes the other joints in the foot to bear more stress than they did prior to the surgery. This can lead to an increased rate of arthritis in those other joints. This typically takes several years to develop and may or may not be symptomatic.

FREQUENTLY ASKED QUESTIONS
  • Will I lose all motion in my foot?

    The ankle joint is responsible for the majority of up-and-down motion. Ankle fusion decreases this movement, but the movement of the subtalar joint and the other joints of the foot remains. This allows the heel to move from side to side and the middle of the foot to move up and down. A fused ankle typically does not result in a fully rigid foot. Ankle arthrodesis does change how a person walks, however, with proper shoes most patients do not limp.

  • Are there activities I should avoid with an ankle arthrodesis?

    Once the ankle has fused, it is quite durable. Many patients work physically demanding jobs, walk long distances, hike, cycle, and ski on fused ankles. The fused ankle will never function exactly like a normal ankle, however. Patients are encouraged to discuss specific hopes for return to activity with their foot and ankle orthopaedic surgeon. Running and similar activities are not recommended.

  • Do I need to have the plates or screws removed?

    No. Occasionally the plates and screws may be removed if they are close to the skin and cause irritation. They may also need to be removed if an infection develops. Otherwise hardware is not typically removed. There is usually not enough hardware in place to set off metal detectors.

BACK TO FOOT AND ANKLE TREATMENTS PAGE
Information provided by American Orthopedic Foot and Ankle Society (AOFAS) via FootCareMD.com