Ankle Fusion

Overview

What is an ankle fusion?

An ankle fusion (arthrodesis) surgery treats arthritis by joining your ankle bones using screws or plates to eliminate the painful arthritic joint. Your surgeon removes the cartilage at the ends of each ankle bone and positions them so they fuse together as they heal. The aching pain you feel from ankle arthritis should diminish, or possibly disappear. Such relief might allow you to return to the activities that are important to you with little or no pain. Be sure to try all nonsurgical options for ankle arthritis before you consider an ankle fusion.

What are the types of ankle arthritis?

There are different types of arthritis that can cause pain, swelling and inflammation in your ankles, including:

Before recommending surgery, your healthcare provider will treat your ankle arthritis with nonsurgical options, such as:

  • Activity modification to avoid activities (ex. prolonged standing and walking) that tend to increase the pain from ankle arthritis.
  • Medications like oral analgesics (NSAIDs) and topical pain medicines.
  • Supportive devices including braces, orthotics, shoe inserts, a cane or a walker.
  • Corticosteroids injections.
  • Physical therapy, exercise and occupational therapy.
  • Hot and cold packs.
  • Healthy eating.

Your healthcare provider might consider an ankle fusion if the nonsurgical options don’t help you enough. Let your provider know what does and doesn’t alleviate your pain.

What’s the difference between an ankle fusion and a total ankle replacement?

An ankle fusion stops your ankle joint from moving at all. It takes a stiff, painful ankle and converts it to an unbending, relatively painless ankle. A total ankle replacement (arthroplasty) is a surgical procedure where damaged parts of your ankle get replaced with plastic or metal prosthetics. They help your ankle joint retain some movement.

Procedure Details

What is an ankle fusion?

An ankle fusion (arthrodesis) surgery treats arthritis by joining your ankle bones using screws or plates to eliminate the painful arthritic joint. Your surgeon removes the cartilage at the ends of each ankle bone and positions them so they fuse together as they heal. The aching pain you feel from ankle arthritis should diminish, or possibly disappear. Such relief might allow you to return to the activities that are important to you with little or no pain. Be sure to try all nonsurgical options for ankle arthritis before you consider an ankle fusion.

What are the types of ankle arthritis?

There are different types of arthritis that can cause pain, swelling and inflammation in your ankles, including:

Before recommending surgery, your healthcare provider will treat your ankle arthritis with nonsurgical options, such as:

  • Activity modification to avoid activities (ex. prolonged standing and walking) that tend to increase the pain from ankle arthritis.
  • Medications like oral analgesics (NSAIDs) and topical pain medicines.
  • Supportive devices including braces, orthotics, shoe inserts, a cane or a walker.
  • Corticosteroids injections.
  • Physical therapy, exercise and occupational therapy.
  • Hot and cold packs.
  • Healthy eating.

Your healthcare provider might consider an ankle fusion if the nonsurgical options don’t help you enough. Let your provider know what does and doesn’t alleviate your pain.

What’s the difference between an ankle fusion and a total ankle replacement?

An ankle fusion stops your ankle joint from moving at all. It takes a stiff, painful ankle and converts it to an unbending, relatively painless ankle. A total ankle replacement (arthroplasty) is a surgical procedure where damaged parts of your ankle get replaced with plastic or metal prosthetics. They help your ankle joint retain some movement.

Risks / Benefits

What are the advantages of an ankle fusion?

An ankle fusion can reduce or eliminate arthritis pain in your ankle. The relief might let you return to activities you’ve been unable to do because of the pain.

What are the risks or possible complications of an ankle fusion?

Nonunion is the biggest risk of an ankle fusion. That’s where your ankle bones fail to fuse. This happens in about 10% of cases. An ankle fusion can also increase the rate of arthritis in your foot and nearby joints as these joints in your foot will now take on more stress.

Not everyone with ankle arthritis can have an ankle fusion. There’s a lot to consider. For example, your orthopaedic surgeon might not recommend the procedure after the imaging tests if you have other issues, including:

  • Not enough bone.
  • Poor quality of bone.
  • Bad nerve function.
  • Severe deformity of your leg.
  • Conditions that increase the risk of general anesthesia.

Some complications are possible no matter what type of surgery you’re having. They include:

  • Problems with anesthesia.
  • Blood clots.
  • Bleeding.
  • Infection.
  • Damage to nerves.
  • Damage to blood vessels.

Recovery and Outlook

What are the ankle fusion outcomes?

About 90% of ankle fusion procedures result in successfully fused bones. The remaining 10% fail to meld together. Speak with your healthcare provider about your concerns and see if they have an opinion regarding the likelihood of success.

How do I take care of myself after an ankle fusion surgery?

You might need to have someone on hand to help you out during the first two weeks following the ankle fusion. It’s important to get a lot of rest with your foot elevated.

It might be necessary to make some changes at your home before surgery. Install ramps if there are stairs, put your bed at ground level, put railings near your toilet and bathtub and get a shower chair.

What’s the recovery time for ankle fusion surgery?

It will be about six to 12 weeks before you can put weight on your ankle. When you’re allowed to walk you’ll have to wear a boot or cast that protects your ankle.

Will I have to limit my activity?

You won’t be able to do your normal activities while you recover. Don’t put any weight on your healing foot until your surgeon says that it is OK to do so. Be sure to check with your surgeon before resuming activities.

Once your bones successfully fuse and heal, you should be able to return to many activities, including:

  • Walking.
  • Hiking.
  • Cycling.

But keep in mind that you will no longer be able to run or jump on a fused ankle.

How long does the pain last after an ankle fusion?

You’ll have the most pain during the first two weeks following surgery.

When can I go back to work/school?

Talk to your healthcare provider about how soon you can go back to work or school. You might still be using crutches or a wheelchair when you return.

How long after an ankle fusion can I drive?

Discuss the timeline with your healthcare provider. You might have to wait longer than someone else, depending on how well you’re healing.

When to Call the Doctor

When should I see my healthcare provider?

You’ll see your healthcare provider again about 10 to 14 days after your surgery to get your stitches or staples removed. At that time more X-rays may be ordered.

See your healthcare provider if you think you have an infection. Signs include:

  • Warmth around the incisions.
  • Redness around the incisions.
  • Slow healing.
  • Oozing pus from the incisions.

When should I go to the emergency department?

In non-urgent situations, it's usually best to contact your surgeon for advice. You may need to go to the emergency department if you develop an acute problem such as:

  • Excessive pain that is not controlled by elevation and pain medication.
  • The onset of shortness of breath or chest pain.
  • A high fever.
  • A sudden loss of sensation in the foot.

Frequently Asked Questions

Will I be able to move the area at all?

After the procedure you will be able to move your heel from side to side. The ankle joint won’t be able to move, but you will still have some up and down motion of the foot because the joints in front of the ankle joint will still be mobile.

Will I limp after an ankle fusion?

Whether or not you limp on your fused ankle often depends on your shoes. With appropriate shoe wear many patients will not have a noticeable limp. Talk to your healthcare providers about the best footwear options for after you’ve recovered.

How much does ankle fusion cost?

It’s impossible to guess how much your ankle fusion will cost because prices depend on several unpredictable factors, including:

  • The amount your insurance covers.
  • Your location.
  • How many X-rays your healthcare providers take.
  • Your orthopaedic surgeon’s fees.

Is ankle fusion covered by insurance?

An ankle fusion is covered by most insurance plans, but you might want to check with your insurance provider prior to surgery.

A note from Cleveland Clinic

An ankle fusion — a surgery that fuses your ankle bones — reduces or eliminates arthritis pain in your ankle. Choosing to go through surgery is never an easy decision. There are pros and cons to this procedure. You might worry if an ankle fusion is the best solution for your pain. Without the surgery, you might be in pain for the rest of your life. With the surgery you might get to return to activities you love: pain-free hiking with your family, skiing with your friends, taking long walks with your dog. Keeping the outcomes in mind might help you make this decision. Your healthcare providers will help you every step of the way.

Last reviewed by a Cleveland Clinic medical professional on 10/12/2021.

References

  • Abidi NA, Gruen GS, Conti SF. Ankle Arthrodesis: Indications and Techniques. (https://pubmed.ncbi.nlm.nih.gov/10874227/) Journal of the AAOS. 2000; 8(3):200-209. Accessed 10/15/2021.
  • American Orthopaedic Foot & Ankle Society. What is Ankle Arthrodesis? (https://www.footcaremd.org/conditions-treatments/ankle/ankle-arthrodesis) Accessed 10/15/2021.
  • Gaedke IE, Wiebking U, O’Louglin PF, et. al. Clinical and Radiological Mid-to-Long-term Outcomes Following Ankle Fusion. (https://iv.iiarjournals.org/content/32/6/1463) In Vivo. 2018;32(6):1473-1471. Accessed 10/15/2021.
  • Wang C, Xu C, Li M, et.al. Arthroscopic ankle fusion only has a limited advantage over the open operation if osseouos operation type is the same: a retrospective comparative study. (https://josr-online.biomedcentral.com/articles/10.1186/s13018-020-01599-5) Journal of Orthopaedic Surgery and Research. 2020;15:80. Accessed 10/15/2021.

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