Ankle Fusion

What is ankle fusion?

Ankle fusion is surgery that permanently joins the bones in one of your ankle joints together. It’s a type joint fusion (arthrodesis). Healthcare providers sometimes call it ankle arthrodesis.

Joints are any place in your body where two bones meet. Your ankle joint connects your foot to your lower leg. Specifically, it’s where your shin bone (tibia) and calf bone (fibula) meet your ankle bone (talus).

Surgeons most commonly use ankle fusion to treat severe ankle arthritis. If arthritis has worn away the cartilage that cushions and lubricates your ankle, the bones will rub against each other. Over time, this can damage your joint and become extremely painful. Your surgeon will fuse the bones in your ankle joint together to become one bone. This will reduce the extra friction inside your ankle and relieve the pain.

A healthcare provider will usually suggest ankle fusion after other, nonsurgical treatments haven’t worked for you. Fusion can relieve severe pain, stiffness and other symptoms that make it hard to move and use your ankle.

What happens before ankle fusion?

You’ll meet with your provider and surgeon before an ankle fusion. They’ll ask about the symptoms you’re experiencing and how much they affect your daily routine and quality of life. They’ll review which nonsurgical treatments you’ve tried and ask how well they’ve worked.

Be honest with your providers. It can be scary to consider surgery that permanently changes your ankle joint, but don’t shortchange your experiences. Tell your providers if ankle pain or other symptoms make day-to-day activities hard, or if it’s bad enough to make you avoid certain activities.

Before your surgery date, you’ll need:

• A physical exam to make sure you’re healthy enough for surgery.
• Blood tests.
• Imaging tests, including an X-ray. You might also need an MRI (magnetic resonance imaging) or CT scan (computed tomography scan).

Tell your provider and surgeon all the medications and over-the-counter (OTC) or herbal supplements you take. You may have to stop taking some medications or supplements before your surgery.

Your surgeon will tell you when you should fast the day before your surgery. Most people need to avoid eating and drinking for 12 hours before ankle fusion surgery.

What happens during ankle fusion?

The day of your surgery, you’ll receive anesthesia to numb your body and make sure you don’t feel any pain. An anesthesiologist will give you general anesthesia to put you to sleep and/or regional anesthesia to numb the area around your ankle.

During an ankle fusion, your surgeon will permanently join bones in your ankle together.

Most ankle fusions are open surgeries. That means your surgeon will make incisions (cuts) in your skin to operate on your ankle joint. If you have an open ankle fusion, your surgeon will:

1. Make incisions in the skin around your ankle joint.
2. Remove any damaged cartilage and bone.
3. Insert screws, plates or both into your ankle bones to join them together.
4. Secure the fasteners in place, then close the incisions.

Some people have ankle fusions done via an ankle arthroscopy. This is a minimally invasive technique. Your surgeon will make smaller incisions in your ankle than open surgery. Then, they’ll insert a special tool called an arthroscope into your ankle. The arthroscope includes a camera and a light that lets your surgeon see what’s going on inside your ankle.

The steps will be the same, it just depends on which surgery technique is right for you.

How long does ankle fusion take?

Ankle fusions usually take a few hours. How long your surgery takes will depend on how damaged your ankle joint is and which type of surgery you’re having.

What happens after ankle fusion?

Most ankle fusions are outpatient procedures, which means you can go home the same day. Your surgeon will put your ankle in a brace or boot to keep it supported and prevent you from putting weight on it.

You’ll probably have to use crutches, a walker or other assistive devices for a few weeks after your surgery.

What are the benefits of ankle fusion surgery?

The biggest benefit of ankle fusion is how much it can improve your quality of life. People who’ve had a fusion surgery usually experience a significant improvement in pain and other symptoms — in some cases, symptoms completely go away once they recover. It’s a safe, effective way to relieve symptoms that other treatments couldn’t manage.

Most people can return to all their routine physical activities, including exercise or playing sports.

What are the cons of ankle fusion?

Although it’s rare, nonunion is the most common complication after ankle fusion surgery. Nonunion happens when the bones in your ankle don’t fuse together like they should. You might need another surgery if your bones don’t fuse.

Like any surgery, ankle fusion has some risks, including:

• Infections.
• Bleeding.
• Pain.
• Reactions to anesthesia.

Having an ankle fusion permanently reduces the range of motion in your ankle (how far you can move it). Because the bones have been joined to become one, you won’t be able to move your ankle as much after surgery. You’ll still be able to move your heel from side to side, and the middle and front parts of your foot up and down. Even with the reduced range of motion in your fused ankle, the benefit outweighs the risk for most people who have severe ankle pain.

Having an ankle fusion can increase the risk you develop arthritis in other joints in your foot after surgery because the fusion can put more stress on these joints than before your surgery.

Some people need additional surgeries (revisions) in the future.

Talk to your surgeon about your risk of complications. They’ll help you understand any potential risks and decide if joint fusion is your best treatment option.

How long is recovery from ankle fusion?

It usually takes a few months to recover after an ankle fusion surgery.

As you heal, the bones that were fused will grow together and become one. This will make your ankle stronger, more stable and less painful. Everyone heals at their own natural pace, but it usually takes around 12 weeks (about three months) for bones to fuse.

Can you walk normally after ankle fusion?

It might take some time to adjust to your newly fused ankle, but you should be able to walk and move once you recover.

You might need physical therapy to help you regain strength as you heal. A physical therapist will help you start using your ankle safely. It usually takes a month or two before it’s safe to walk and put weight on your ankle after surgery.

Your surgeon will tell you what to expect and when it’s safe to resume physical activities.

When should I call my healthcare provider?

Call your surgeon or healthcare provider right away if you experience any of the following symptoms:

• Fever higher than 101 degrees Fahrenheit (39 degrees Celsius).
• Bleeding.
• Signs of infection at your surgery site, including leaking, swelling, discoloration, odor or a feeling of warmth.
• New or worsening pain.

Who is not a good candidate for ankle fusion?

Your healthcare provider usually won’t suggest ankle fusion until you’ve tried several other nonsurgical treatments.

It might not be safe for you to have ankle fusion surgery if you have:

• Severely damaged or weakened ankle bones.
• A health condition that causes poor blood circulation.
• Severe nerve damage in your legs or ankles.

A note from Cleveland Clinic

Living with constant pain in your ankle (especially for a long time) can wear you down and make you feel like every step is a marathon. Ankle fusion might be a good option if you’ve tried what feels like every other possible treatment and still have severe ankle pain that makes it hard to go through your daily routine. Talk to your healthcare provider and surgeon about the benefits, risks and any questions you have.

It might take some time to get used to the feeling of your newly fused joint, but ankle fusion can provide significant, potentially permanent relief.