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Ankle Fusion

What is ankle fusion?

Ankle fusion is a type of surgery to fuse the bones of your ankle into 1 piece. It’s also called ankle arthrodesis. The surgery is often done to treat arthritis in the ankle.

The ankle joint is also called the tibiotalar joint. It’s where the shinbone (tibia) rests on top of a bone of the foot called the talus.

Arthritis occurs when the smooth cartilage on the surface of the bones wears away. This causes pain, inflammation, and swelling in your joint.

Ankle fusion helps stop the pain and swelling. Your surgeon will make an incision in your ankle to work on the joint. They'll remove any remaining cartilage and then compress the bones together. They'll attach them with plates, nails, screws, or other hardware. Your surgeon may also use a bone graft to help the bones heal together.

In some cases, an ankle fusion can be done with minimally invasive surgery. This uses a smaller incision and a tiny camera to help do the surgery.

Why might I need ankle fusion?

You may need an ankle fusion if you have severe arthritis in your ankle. It can cause symptoms such as severe pain, inflammation, and stiffness. These can make it hard to walk. The 2 main types of ankle arthritis are:

  • Osteoarthritis, caused by wear and tear over time

  • Rheumatoid arthritis, caused by an autoimmune disease that affects the joints

  • Arthritis from a prior injury of your joint

If you have mild or moderate arthritis, your healthcare provider will likely advise other treatments first. These may include pain medicines and corticosteroid injections. You may be given special shoes, braces, or shoe inserts. Or your provider may advise physical therapy. If you still have severe symptoms that prevent you from doing your daily activities, your provider may advise an ankle fusion surgery. Talk with your provider about your choices.

What are the risks of ankle fusion?

Every surgery has risks. The risks of ankle fusion are:

  • Infection

  • Damage to nearby nerves

  • Bleeding

  • Blood clot

  • The bones not joining together the right way

  • Misalignment of the bones

  • New arthritis in nearby joints (very common)

A normal side effect from ankle fusion is a reduced range of motion in the joint. This isn’t a big problem for most people.

Your risk of complications may vary based on your age and your general health. For example, if you're a smoker or have low bone density, you may have a higher risk of certain complications. People with poorly controlled diabetes may also have a higher risk of problems. Talk with your provider to learn which risks apply most to you.

How do I get ready for ankle fusion?

Talk with your healthcare provider about how to prepare for your surgery. Tell them about all the medicines you take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your provider if you need help to stop smoking.

Before your surgery, you may need imaging tests, such as:

  • CT scan

  • Ultrasound

  • X-rays

  • MRI

Follow any directions you're given for not eating or drinking before surgery. Tell your provider about any recent changes in your health, such as a fever.

You may need to plan some changes at home to help you heal. This is because you won’t be able to walk on your foot normally for a while. Plan to have someone drive you home from the hospital.

What happens during ankle fusion?

An orthopedic surgeon will do your ankle fusion, and they can help explain the details of your surgery. The surgeon will be aided by a team of specialized healthcare providers. The whole procedure may take a few hours. In general, you can expect the following:

  • You may have spinal anesthesia. This is so you won’t feel anything from your waist down. You’ll also likely be given sedation to relax you. Or you may be given general anesthesia. This will prevent pain and make you sleep through the surgery.

  • A healthcare provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.

  • The surgeon will make a cut (incision) through the skin and muscle of your ankle, and likely another one on your foot. If you have minimally invasive surgery, the surgeon will make smaller incisions. They will then use a tiny camera with a light to help do the surgery.

  • Your surgeon will remove any remaining cartilage from the affected joint. They will connect the bones together in the proper position using hardware as needed.

  • Your surgeon will make any other repairs that are needed.

  • The surgeon will close the layers of skin and muscle around your ankle and foot with stitches or staples.

What happens after ankle fusion?

Talk to your surgeon about what you can expect after your surgery. When you wake up, your leg will likely be raised up and in a splint. This is to keep it from moving. You can go back to a normal diet as soon as you are able. You may need follow-up X-rays to see how your surgery went. You may need to stay a few days at the hospital.

You may have a lot of pain right after your surgery. Pain medicines may help to ease your pain. The pain should start to go away in a few days. It may be helpful to rest and elevate your leg as much as possible right after your surgery.

After your surgery, you'll likely need to wear a splint for a few weeks. You might also need to use crutches for a few weeks. Your healthcare provider will give you instructions about how you can move your foot as you get better. You won’t be able to put your full weight on it for a few months.

You won’t be able to see your incision at first. But let your provider know right away if pain at the incision site gets worse. Also tell them if you have a fever or chills.

Keep all your follow-up visits. This is so your provider can keep track of your progress. You may have your splint replaced with a cast or boot a couple of weeks after your surgery. This cast may come off a few weeks after your surgery. You might need physical therapy for a few months. This is to help you keep your strength in the ankle and leg. It may be a few months before you can return to all your normal activities.

Follow all your surgeon's instructions about medicines, wound care, and exercises. This will help make sure the surgery works well for you.

Next steps

Before you agree to the test or the procedure, make sure you know:

  • The name of the test or procedure

  • The reason you are having the test or procedure

  • What results to expect and what they mean

  • The risks and benefits of the test or procedure

  • What the possible side effects or complications are

  • When and where you are to have the test or procedure

  • Who will do the test or procedure and what that person’s qualifications are

  • What would happen if you did not have the test or procedure

  • Any alternative tests or procedures to think about

  • When and how you will get the results

  • Who to call after the test or procedure if you have questions or problems

  • How much you will have to pay for the test or procedure

Medical Reviewers:

  • Raymond Turley Jr PA-C
  • Stacey Wojcik MBA BSN RN
  • Thomas N Joseph MD
    •