Ankle Fusion (arthrodesis) FAQ’s

What is arthritis?

Arthritis is a term that refers to inflammation of the joints. There are many types of arthritis, but the most common ones are osteoarthritis and rheumatoid arthritis.

  1. Osteoarthritis (OA): This is the most prevalent form of arthritis and occurs when the protective cartilage that cushions the ends of bones wears down over time. It commonly affects joints in the hands, knees, hips, and spine, leading to pain, stiffness, and reduced joint flexibility.
  2. Rheumatoid Arthritis (RA): RA is an autoimmune disease where the immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. This can lead to inflammation, joint damage, and pain. RA often affects multiple joints and can also have systemic effects on other organs.

Arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life. Treatment options vary depending on the type of arthritis and may include medication, physical therapy, lifestyle changes, or in some cases, surgery.

It’s essential for individuals experiencing joint symptoms to consult with a healthcare professional for an accurate diagnosis and appropriate management plan.

 

What is ankle arthritis?

Ankle arthritis involves inflammation and deterioration of the ankle joint cartilage. Ankle arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life.

What causes ankle arthritis? How do you get arthritis in your ankle?

In vast majority of patients (60-80%) ankle arthritis occurs secondary to injury. This can be a fracture of the ankle or an impact injury without fracture. The initial insult to ankle cartilage results in a slow deterioration of the joint. Over time this progressively results in worsening progressive arthritis. To a lesser extent, ankle arthritis can also be due to a patient’s natural history, infection, gout, or underlying medical conditions such as rheumatoid arthritis / hemophilia.

In many of these cases, an initial fracture/impaction injury results in uneven force dissipation across the ankle joint. This causes the ankle to be overloaded in certain area. After years of walking on this unevenly distributed joint, the cartilage starts to wear thin, and inflammation ensures. 

What is an ankle fusion (arthrodesis procedure)? What is ankle arthrodesis? What is the definition of ankle arthrodesis?

An ankle fusion procedure, also known as ankle arthrodesis, is a surgical intervention aimed at stabilizing and immobilizing the ankle joint. This is typically done to alleviate pain and address severe arthritis, deformities, or instability within the ankle.

Is an ankle fusion the same as an ankle arthrodesis?

Yes. These are different names for the same procedure. 

How is an ankle fusion done? How does ankle fusion work?

In order to do an ankle fusion, we first make the decision to do it using a traditional open incision, or arthroscopically (though a camera). This depends mainly on how severe the arthritis is. In either case, we expose the joint and removed any residual cartilage. Bony ends of the talus and tibia are exposed. All debris is removed. We then Make perforations that facilitate healing. We then oppose the bony ends of the talus and tibia in a functional position. We use screws or plates to compress and hold this bony apposition. The incisions are closed.

After the procedure the ankle is casted, and you are kept non-weight bearing for a minimum of 6 weeks. After that point, we start the rehab process. 

What are the indications for ankle fusion (arthrodesis)?

Ankle arthrodesis, or ankle fusion, is typically considered when conservative treatments have failed, and the patient experiences persistent pain, instability, or deformity in the ankle joint. Common indications for ankle arthrodesis include:

  1. Severe Osteoarthritis: When conservative measures such as medications, physical therapy, and joint injections are no longer effective in managing pain and functional limitations caused by advanced osteoarthritis.
  2. Rheumatoid Arthritis: In cases of rheumatoid arthritis where the immune system attacks the synovium, leading to joint inflammation, pain, and deformity.
  3. Post-Traumatic Arthritis: Following a severe ankle injury, such as fractures or dislocations, that results in long-term joint damage and arthritis.
  4. Failed Ankle Joint Replacement: In situations where a previous ankle joint replacement has not been successful, ankle fusion may be considered as a salvage procedure.
  5. Ankle Instability: For cases of chronic ankle instability, where the ligaments supporting the joint are significantly damaged, and conservative measures are inadequate.
  6. Deformities: Ankle fusion may be recommended for individuals with deformities affecting the ankle joint, such as severe misalignment or joint malformation.

The decision to undergo ankle arthrodesis is based on a thorough evaluation by an orthopedic surgeon, considering the individual’s specific condition, symptoms, and the likelihood of success with the procedure. It’s important for patients to discuss their symptoms and treatment options with their healthcare provider to determine the most appropriate course of action.

 

What are the complications associated with ankle fusion (arthrodesis)?

While ankle arthrodesis (ankle fusion) is generally a successful procedure with good outcomes, as with any surgery, there are potential complications. Some of the possible complications associated with ankle arthrodesis include:

  1. Non-union: In some cases, the bones may not fuse properly, leading to a non-union. This may require additional surgical intervention.
  2. Mal-union: The bones may fuse in an undesirable position, causing malalignment. This can affect the function of the ankle joint and may require corrective surgery.
  3. Infection: As with any surgical procedure, there is a risk of infection. This risk is minimized through sterile surgical techniques and postoperative care.
  4. Delayed Wound Healing: The incision site may take longer to heal than expected, especially in individuals with compromised healing abilities.
  5. Nerve or Blood Vessel Injury: There is a slight risk of damage to nearby nerves or blood vessels during surgery, which can lead to numbness, tingling, or circulation problems.
  6. Hardware Issues: If screws, plates, or rods are used to stabilize the joint, they may cause irritation or require removal if they cause discomfort.
  7. Joint Stiffness: Ankle fusion eliminates joint motion, which can lead to stiffness. This may impact the way a person walks and may increase stress on adjacent joints.
  8. Pain Persistence: While ankle fusion aims to alleviate pain, some individuals may experience persistent pain, either due to incomplete relief or complications.

It’s important for patients to discuss potential risks and complications with their orthopedic surgeon before deciding to undergo ankle arthrodesis. The decision to proceed with surgery should be based on a thorough understanding of the potential benefits and risks in the context of the individual’s specific condition.

What is recovery like after an ankle fusion (arthrodesis)?

Once the surgery is complete, you are placed into a cast. The cast is required for minimum of 6 weeks. We will remove the sutures 2-3 weeks post op. You will have to remain non-weight bearing for minimum of 6 weeks. Once the cast is removed, we can start weight bearing and rehab. Often, we will transition you to a rigid removable boot, to start weight bearing. This will be weaned as you progress in physical therapy. 

It will likely take 3 months before you feel that you can walk on the ankle comfortably. You may have a slight limp during this period. The fusion will continue to heal and remodel for over a year. Swelling will be present for at least 6 months. In some cases, swelling is present for over 18 month. It goes away eventually as you rehab. 

How long are you non weight bearing after ankle fusion?

Typically, 6-8 weeks.

How long does it take to walk after ankle fusion?

Most patients start walking in a pneumatic boot approximately 6 weeks post op. 

Will I limp after ankle fusion?

Your gait after an ankle fusion will be different compared to pre op, or someone without arthritis. However, it is important to keep in mind, that most patient who undergo ankle fusions have severe ankle arthritis. They have stiffness in the ankle, and tend to walk with an alter gait / limp pre op. The goal of surgery is to try and eliminate this limp, however some patients may have a residual limp post op. 

How long does pain last after ankle fusion?

The pain of surgery is worst in the first few days. After this pain slowly improves. Most patients have little pain by 6 weeks. Swelling is typically the biggest hurdle and may exacerbate pain as you increase your activity. However, this settles over several months. 

How limited is ankle movement after a ankle arthrodesis?

When we fuse the ankle joint, you lose all motion at that joint. However, you are still able to flex and extend your foot through the midfoot joint. You lose approximately 50-60% of the flexion/extension motion through the ankle/midfoot. Most patients will notice stiffness in the foot / ankle after the procedure. There will be adaptations in your gait and day to day activities, as you rehab. 

How long does an ankle arthrodesis take to heal?How long does an ankle arthrodesis take to heal?

The incision is well closed around 2-3 weeks post op. The bones are typically united 6-8 weeks post op. However, the bones will continue to remodel / heal for over a year. Patient factors can affect this healing time. Delays in healing time are seen in patients that have diabetes, smoke, are non-compliant with post op orders, have peripheral vascular disease, etc. 

Does arthrodesis of ankle include tenolysis? Is tenolysis of ankle included with ankle arthrodesis?

Often when we perform an ankle arthrodesis, we will mobilize tendons as a part of our approach. This allows us to safely move them out of the surgical field, so that they are at less risk of damage. In doing so, we also have a chance to remove adhesions within the tendon sheath, which is common in arthritis. 

What is arthroscopic ankle arthrodesis?

The main procedure is the same. However, in some cases, we can use a minimally invasive technique to minimize the risk associated with surgery. There we make small incisions and use cameras to perform our work inside the joint. The cartilage and joint preparation can be done this way. The remainder of the procedure is the same. Ask one of our experts if you are a candidate for this procedure. 

A triple arthrodesis involves fusion of which joints?

This is a commonly asked question. This is not typically done for ankle arthritis, as the joint involved in a triple arthrodesis do not involve the ankle. These are the sub-talar, talonavicular, and calcaneocuboid joints. Most commonly we perform this for arthritis secondary to foot deformity. 

Is ankle fusion a disability?

Ankle fusion is a surgical procedure aimed at treated patients with ankle pathology. Typically, patients have disability pre-op due to pain/stiffness/instability/ and deformity. However, the goal is to eliminate this disability post operatively. 

Is ankle fusion a major surgery?

Ankle fusion is considered and intermediate risk surgery. It is more involved than bunion surgery, but less major than replacement surgeries. 

Can you run after ankle fusion?

Some patients are able to get back to running after an ankle fusion. However, the neighboring foot joints are at higher risk of deterioration after an ankle fusion. They seem much more force with impact activity. As a result, some patients may no tolerate running after an ankle fusion. 

Can ankle fusion be reversed?

No. However, in some rare instances, we can take down an ankle fusion and do a ankle replacement. 

Can you have an ankle replacement after a fusion?

Yes. In some rare instances, we can take down an ankle fusion and do a ankle replacement. Talk to one of our experts if you think you are a candidate for this procedure. 

Can you have ankle fusion after ankle replacement?

Yes. This is done often done when an ankle replacement wears down beyond revision replacement. 

Can I drive after ankle fusion? How long after ankle fusion can I drive?

Yes. Once you have recovered and rehabbed enough to safely operate the pedal, you can drive. Typically, this is 6-8 weeks after surgery. However, you should always confirm with your doctor prior to taking this risk.

Can I walk normally after ankle fusion?

In order to eliminate ankle pain, we need to unite the bones that make your ankle joint. Patient will typically notice stark improvement of pain, at the cost of flexibility. The ankle is stiff after. This means that you can typically walk, without pain. However, your gait may be slightly different. Some patients have a limp in the post operative period, but this resolves with time. 

Can you wear heels after ankle fusion?

 Typically, no.

Can you wear normal shoes after ankle fusion?

Yes

Do you have to wear special shoes after ankle fusion?

Typically, no. However, you may benefit from custom shoes if you have an underlying foot deformity. 

How long do ankle fusions last?

In most cases, an ankle fusion lasts the remainder of your life. However, many patients have other foot issues, which may require surgery later in life. 

How long does an ankle fusion operation take?

Approximately 2-4h. 

How much does an ankle fusion cost?

Most of the cost related to ankle fusion is covered by your insurance. Your out-of-pocket cost depends on your individual insurance plan. Speak to a member of our billing team to figure out details related to anticipated out-of-pocket expenses. 

Is ankle replacement better than ankle fusion? Which surgery is better for ankle arthritis?

 

This is a difficult and complex question. For many decades, there have been similar outcomes in terms of post operative pain, function, and satisfaction when comparing ankle replacement to ankle fusion. Both offer similar pain relief and function. However, ankle replacements preserve motion. Additional, ankle replacements are high risk surgeries. There is higher risk of complications such as infection, fracture, nerve / vessel injury, and requirement for further surgery in the future. 

 

Historically, ankle fusions were the surgery of choice for vast majority of patients. However, as ankle replacement implants evolve, there is a paradigm shift. We are starting to see better outcomes for replacement patients compared to fusion. Patients are happier, more functional, and have more motion. There is also a lesser risk of neighboring joint degeneration because ankle motion is preserved. This means that there is a lesser risk of the rest of the foot deteriorating because of a fused ankle. Have a look at the below study which demonstrates this. 

 

https://pubmed.ncbi.nlm.nih.gov/36375147/

Can an ankle fusion cause peroneal nerve damage?

Yes, however this is a very rare complication. 

Can an ankle fusion result in plantar fasciitis?

Some patients can experience plantar fasciitis in the post operative period. This is usually in patients with an element of plantar fasciitis prior to surgery. It tends to be exacerbated by casts and pneumatic boots. 

Can I dance after ankle fusion?

Yes. 

Can I go upstairs after ankle fusion?

Yes

Can I hike with ankle fusion?

Yes

Can I work construction after an ankle fusion?

Typically, yes. There may be other foot conditions that limit your ability to perform hard manual labor after this type of surgery. But in isolation, after rehab, you should be able to return to construction. 

Can they do ankle fusion on both feet? Can I get bilateral ankle fusions at the same time?

This is not recommended. We will usually recommend that you have one side at a time. This will allow you to rehab using the un-operative leg. You cannot put weight on the operative side; thus, you need a leg to stand on. Otherwise, you will have very limited mobility for a few months. Furthermore, bilateral surgery increases the risk of blood clots, falls, secondary trauma, etc. 

Can you ice skate after recovering from an ankle fusion?

Yes. Although, many people have problems getting into skates. We recommend back or front-loading ice skates (similar to ski boots) for skating. 

Can you squat after an ankle fusion?

Yes.

Can you ride a bike after ankle fusion?

Yes

Do they scrap out arthritis in ankle fusion?

Yes. We removed residual cartilage, cartilage flaps, hard subchondral bone, and loose debris. 

Do you need physical therapy after ankle fusion?

Vast majority of the time, yes. 

Do bone stimulators work for ankle fusions?

There is a theoretical advantage to using a bone stimulator after fusion surgery. However, most clinical studies do not show an advantage in the real world. We typically will utilize this modality if healing is slow or delayed. 

Do you need prescription rocker bottom shoes for ankle fusion?

You can get a prescription, but there are over the counter options as well. 

Does ankle fusion affect driving?

Most patients are still able to drive. There is less ankle flexion/extension. As a result, most people use more of their leg muscle to accelerate and brake. It does take some slight re-training. 

Does ankle fusion limit mobility?

Most patient will have improved mobility, as they no longer are limited by debilitating ankle pain. 

Does ankle fusion take all the pain away?

This is the goal. Most patients have complete resolution of pain at the ankle. However, there is a risk of residual pain with this surgery. Majority of these patients (with residual pain), the pain they experience is vastly better than their arthritic pain. 

Can ankle fusions be done as out patient surgery?

In some cases. Since this is a larger procedure, we will typically do it at a hospital. There is a good chance you may go home the same day. However, it is not atypical for patients to stay one night.

These questions have been personally answered by:

A seasoned orthopedic surgeon and foot and ankle specialist, Dr. Mohammad Athar welcomes patients at the offices of Complete Orthopedics in Queens / Long Island. Fellowship trained in both hip and knee reconstruction, Dr. Athar has extensive expertise in both total hip replacements and total knee replacements for arthritis of the hip and knee, respectively. As an orthopedic surgeon, he also performs surgery to treat meniscal tears, cartilage injuries, and fractures. He is certified for robotics assisted hip and knee replacements, and well versed in cutting-edge cartilage replacement techniques. In addition, Dr. Athar is a fellowship-trained foot and ankle specialist, which has allowed him to accrue a vast experience in foot and ankle surgery, including ankle replacement, new cartilage replacement techniques, and minimally invasive foot surgery. In this role, he performs surgery to treat ankle arthritis, foot deformity, bunions, diabetic foot complications, toe deformity, and fractures of the lower extremities. Dr. Athar is adept at non-surgical treatment of musculoskeletal conditions in the upper and lower extremities such as braces, medication, orthotics, or injections to treat the above-mentioned conditions.