Ankle Surgery Options

Ankle Fusion: Learn How Ankle Pain and Ankle Deformities May Lead to Ankle Fusion Surgery

When conservative methods of relieving pain or deformities in the ankle are unsuccessful, a surgical procedure called ankle fusion (arthrodesis) is sometimes considered.
The procedure dates back to the end of the 19th century. Multiple techniques are used, and the intended results are relief from pain and regained stability. This article discusses some of the medical conditions where ankle fusion may be considered.
In primary ankle fusion surgery, the ankle joint is removed, allowing the tibia (shinbone) to grow together, or fuse, with the talus bone (the first large bone of the foot). Pins, plates, screws or rods often are inserted through the bones to hold the bones together until they heal. More severe clinical indications may warrant fusing other joints, including the subtalar joint. Though the procedure results in the loss of some movement of the foot and ankle joints, it can be very effective in reducing pain, correcting deformities and stabilizing the joints.

Fusion is considered for people with persistent ankle joint pain and stiffness that is functionally disabling and is not alleviated by conservative, non-surgical means. These treatments include: anti-inflamatory medications, custom-made shoes and shoe inserts, ankle braces, physical therapy and coricosteroid injections. Some of the conditions that cause persistent pain and deformity in the ankle that can lead your physician to consider fusion include:

Avascular Necrosis

With avascular necrosis, the blood supply to the bones of the ankle joint loses circulation and the joint and bones begin to deteriorate. As a result, the bones of the foot and ankle can become soft and collapse, causing trauma or fracture. Avascular necrosis can occur as the result of accidents, dislocations, certain diseases, and as the side effect of powerful medications.

Charcot (or Charcot Foot)

This bone condition (pronounced “sharko”) is most often associated with diabetes and is one of the most serious foot problems. With Charcot, the nerve supply to the bones and joints is abnormal, and the patient’s ability to sense the position of the joints in the foot is seriously impaired or even lost. The muscles lose their ability to support the joint properly, and minor traumas such as sprains and stress fractures go undetected. Because there is a loss of feeling, Charcot patients often continue to walk on the damaged foot, which warps the shape of the foot as the bones disintegrate and fracture. Calluses and ulcers may form on the skin, and inside the joint, misaligned bones may grind against each other, causing fragments of bone and cartilage to fall into the joint. Amputation is a risk for some Charcot sufferers.

Additionally, patients experiencing ankle instability from trauma (injury), unsuccessful implant surgery or severe deformity may be considered for ankle fusion surgery.

Ankle fusion is considered to be quite durable, and when the joints are fused, most patients can walk without pain. However, the procedure stiffens the ankle and limits joint mobility. Some downward movement is still possible, but upward movement cannot take place. As a result, other joints of the foot are forced to move more than before, which can add stress to these joints.

Fusion has been used successfully to treat many conditions, but the procedure is clearly not for everyone. The recovery period is lengthy, and union (the degree of joint connection) can vary depending on the method of fusion, the surgeon’s skill and other factors. The procedure may minimize the option of joint replacement at a later date. If the fusion doesn’t heal properly, additional surgery may be needed. Only a foot and ankle surgeon can determine whether ankle fusion is suitable for a particular patient. Talk with your physician and discuss all options before undertaking fusion surgery.