Ankle fusion is a surgical procedure that permanently joins the bones of the ankle joint. It aims to alleviate chronic pain and provide stability for individuals with severe ankle conditions. The bones are encouraged to grow together into a single, solid unit. This intervention is considered when non-surgical treatments have not provided sufficient relief.
What is Ankle Fusion?
Ankle fusion eliminates motion in the tibiotalar joint, where the shin bone (tibia) meets the ankle bone (talus). During the procedure, damaged cartilage, the smooth tissue cushioning the joint surfaces, is removed. This prepares the bone ends for fusion, allowing them to grow together into one continuous bone.
This fusion stops bone-on-bone friction and provides a stable, pain-free ankle. While it eliminates movement at the ankle joint itself, other joints in the foot can often compensate to allow for a functional walking pattern.
Reasons for Ankle Fusion
Ankle fusion is recommended for individuals with severe ankle arthritis from various causes. These include osteoarthritis, a degenerative condition from wear and tear, and post-traumatic arthritis, often developing after an ankle injury or fracture. Rheumatoid arthritis, an autoimmune disease causing joint inflammation, can also severely damage the ankle.
This procedure is a last resort when conservative treatments fail to manage symptoms effectively. Non-surgical options, such as pain medications, physical therapy, bracing, activity modification, or steroid injections, are tried first. When these methods no longer provide adequate pain relief or maintain function, ankle fusion becomes a viable option. It may also be considered for severe ankle instability or when previous ankle surgeries have not yielded successful outcomes.
The Surgical Procedure
Ankle fusion surgery is performed under general or regional anesthesia. The surgeon makes an incision around the ankle to access the joint, though minimally invasive (arthroscopic) techniques using smaller incisions and a camera are also possible. Once exposed, damaged cartilage is removed from the ends of the tibia and talus bones.
The bone surfaces are then prepared to facilitate bone growth across the joint space. To hold the bones securely while they fuse, various types of hardware are used, such as screws, plates, or rods. In some cases, a bone graft, taken from the patient’s own body (like the pelvis or heel bone) or from a donor, may be used to promote healing and improve the fusion rate. The incisions are then closed with stitches or staples, and the ankle is immobilized.
Post-Operative Recovery
Immediately following ankle fusion surgery, the ankle is immobilized in a splint or cast, and elevation above heart level is important to minimize swelling and pain. Pain management is provided during this initial period. Patients are advised to remain non-weight-bearing for several weeks, ranging from 6 to 12 weeks, using crutches, walkers, or knee scooters.
After the initial non-weight-bearing phase, a walking boot or cast is used as weight-bearing is gradually introduced. Physical therapy begins a few weeks after surgery, sometimes as early as 10-14 days post-operation. Therapy focuses on exercises for other foot joints, maintaining strength in the leg, and adapting to the new gait pattern. While bone fusion can take about 12 weeks, a full recovery and return to daily activities may take 3 to 4 months, though individual healing rates vary.
Living with an Ankle Fusion
Living with an ankle fusion means adapting to a permanently stiff ankle joint with eliminated motion. Most individuals experience significant pain relief and improved stability. Daily activities like walking, climbing stairs, and driving are possible, though they may require some adjustments to gait and technique.
A long-term consideration after ankle fusion is increased stress on adjacent joints in the foot and leg. Because the fused ankle no longer moves, surrounding joints, particularly the subtalar and talonavicular joints, may experience increased biomechanical burden. This can lead to adjacent joint arthritis over time, though not all patients develop symptoms. Regular follow-up with a healthcare provider monitors these changes and addresses any new symptoms.