An ankle fusion is a surgical procedure that is usually done when an ankle joint becomes worn out and painful, a condition called degenerative arthritis. Ankle fusion is sometimes called ankle arthrodesis.
A joint that is out of balance after it heals from a fracture can wear out faster than normal even though it may take many years. When the joint wears out it becomes painful. Arthisis can also lead to a painful ankle joint as well. For example, rheumatoid arthritis can destroy the ankle, leading to a painful joint.
How does the ankle joint work?
The ankle joint is made up of three bones: the lower end of the tibia (shinbone), the fibula (the small bone of the lower leg), and the talus (the bone that fits into the socket formed by the tibia and fibula). The talus sits on top of the calcaneus (the heelbone).
The talus moves mainly in one direction. It works like a hinge to allow your foot to move up and down. Ligaments on both sides of the ankle joint help hold the bones together. Many tendons cross the ankle to move the ankle and the toes.
The large Achilles tendon at the back of the ankle is the most powerful tendon in the foot. It connects the calf muscles to the heel bone and gives the foot the power for walking, running, and jumping.
Inside the joint, the bones are covered with a slick material called articular cartilage. Articular cartilage is the material that allows the bones to move smoothly against one another in the joints of the body. It is the shock absorbers for the ankle.
Why is an ankle fusion procedure performed?
Ankle fusions are typically performed when all conservative options have been attempted. An ankle fusion actually removes the surfaces of the ankle joint and allows the tibia to grow together, or fuse, with the talus. Pain relief comes when a worn-out joint is fused. An ankle fusion should last the patient a lifetime.
Some of the conditions that produce unremitting pain and deformity in the ankle joint are:
- Post-traumatic arthritis
- Rheumatoid arthritis
- Failed ankle implant
- Congenital ankle deformities
- Neuromuscular disorders (i.e. post-polio syndrome, paraplegia, etc.)
- Lateral ankle instability (after failure of operative and non-operative treatment)
- Avascular Necrosis (secondary to trauma or metabolic disease states)
- Charcot Neuropathy
Techniques for ankle fusion
Over the years many ankle joint fusion techniques have been devised but today there are three different techniques that your surgeon may use. They are open technique (use of one or two incisions on the outside and the front of your ankle) with screw fixation, open technique with external fixator fixation and arthroscopic ankle arthrodesis. Most surgeons use all three of these techniques, with the open technique with screw fixation the most commonly used. The technique used is surgeon’s preference for your clinical findings, but all have equal fusion rates. Sometimes your doctor may need the use of bone graft, typically taken from your hip area (iliac crest), if you have defects in you ankle from previous trauma or surgery to help support the arthrodesis site.
Recovery Time from Ankle Fusions
Time off work depends on the type of ones work as well as the procedures performed. Usually a patient can return to work in 2 to 4 weeks if they are able to work while seated. If your job requires standing and walking, return to work may take several weeks when one is able to bear weight. Complete recovery may take six months to a full year.