What is ankle fusion surgery?
Ankle fusion surgery is where the bones that make up the ankle joint are joined as one so it ceases to be a joint but becomes one unit. Ankle fusion is also known as ankle arthrodesis.
Brief anatomy about the ankle joint
The ankle joint is made up of the lower end of the shin bone (tibia), the lower end of the fibula (thin long bone in the leg), and the talus which is a bone found in the foot.
Fusion is achieved by the removal of the layer of cartilage found at the end of the shin bone (tibia) and where it glides onto the talus in order to expose the raw bone. With the bone-to-bone contact created, it heals to form a single unit.
Who needs ankle arthrodesis?
- Ankle joint arthritis.
The ankle joint, like any other is also prone to arthritis. Any individual who is not a candidate for ankle joint replacement and has failed to get relief from conservative means can have arthrodesis done.
Pros and Cons of ankle fusion
| PROS | CONS |
| You will be pain-free | your walking style may change |
| you can carry out activities of daily living without pain | you will lose motion at the ankle joint |
| You have a stable ankle joint again | complications associated with surgery. These include infection, implant failure, excessive bleeding, nerve injury |
Do you need to see a paediatric orthopaedic surgeon?
Different types of ankle fusion surgery
The type of surgery can broadly be divided into two types of surgery.
- Open surgery
This involves the use of fairly large skin incisions in order to access the ankle joint. The kinds of implants that can be employed include; plates and screws, external fixators, intramedullary nails e.t.c
- Arthroscopic surgery
In this case, a small camera is used to visualize inside the joint. All the work is done using very small incisions.
Contraindications to ankle fusion
In which cases shouldn’t you get ankle fusion surgery? These include;
- Active or latent infection in the joint. Infection may hamper bone healing therefore infection must first be treated before fusion is done.
- Smokers. Smoking does interfere with bone healing, a process that is essential to arthrodesis therefore chances of the surgery failing are high if an individual smokes.
- Very active persons who want continued ankle flexibility. Due to the loss of motion at the ankle joint which follows ankle fusion surgery, very active people would do better with alternatives like ankle replacement surgery.
Recovery following ankle fusion
Recovery varies from person to person but on average, the range is from 6 weeks to 16 weeks. The end goal is to have the bones united at the site of the ankle arthrodesis. Immediately following surgery, you will wear a cast and have your leg elevated on a pillow to ease the swelling.
Walking after ankle fusion
You will be allowed to move around with the aid of crutches but will not be allowed to bear weight on the foot until your surgeon gives the go-ahead.
With the recent innovations in foot and ankle surgery and the right footwear, a limp is unlikely to occur following ankle fusion surgery.
Footwear (shoes) and ankle fusion
You have a normal life following ankle fusion except for the fact that you will lose plantarflexion (downward movement) and dorsiflexion(upward movement) of the ankle joint. Loss of these movements may lead to the expenditure of extra energy during walking.
Reseacrch shows that rocker bottom shoes are a suitable footwear for patients who have undergone ankle arthrodesis
You are allowed to wear all kinds of shoes following ankle fusion as long as your primary surgeon clears you. Some shoes however have been shown to make walking much easier following ankle arthrodesis.
- Rocker bottom shoes.
These shoes are slightly curved at the sole so that they ease rocking back and forth. They are commonly prescribed for patients following ankle arthrodesis. They are effective because they interrupt the need for plantarflexion by just “rolling over.”
2. Runner shoes have also been said to provide great comfort for patients following ankle fusion.
High heels may be extremely uncomfortable due to the restricted motion in the ankle joint but sandals, flat pump sandals can all be worn.
Pain following ankle fusion
Many patients report minimal pain to no pain following ankle fusion when compared to the pain status pre-operation. Studies also state an improvement in the pain scores for patients with ankle arthrodesis.
In conclusion, ankle fusion surgery helps people with debilitating pain from ankle joint arthritis get back to a more functional state. You may lose some motion in your ankle joint but will be able to walk around with little to no pain. However, it is worth discussing the pros and cons with your surgeon before you make the definitive choice.
