Ankle fusion surgery is a procedure that fuses, or combines, the bones of the ankle using plates, screws, or bone grafts. It’s also called ankle arthrodesis. The surgery is done to treat pain caused by end-stage ankle arthritis.
Ankle arthritis causes inflammation in the ankle joint. It can make movement and daily tasks, like walking, uncomfortable. An ankle fusion helps by limiting movement, thus relieving ankle pain.
Ankle fusion surgery may also be used to treat ankle pain caused by other conditions, like deformities or infections.
Read on to learn what the procedure involves, as well as potential risks and alternative procedures.
Ankle fusion surgery is used to treat several conditions that affect ankle function.
Most notably, it’s done to treat end-stage ankle arthritis. This stage of arthritis involves complete loss of cartilage between the bones, causing them to touch.
The procedure is also done to improve pain caused by:
- other degenerative joint diseases
- neuromuscular conditions
- ankle deformities
- Charcot foot
- bone infection
- failed ankle replacement
The surgery may have several benefits, including:
- pain relief
- improved foot stability
- increased ability to perform weight bearing activities
- improved walking gait
- increased ability to do daily tasks, like climbing stairs
These benefits can help improve quality of life and reduce the risk of disability.
An ankle fusion, like other surgeries, presents some risks. This includes:
Ankle fusion scars
During an ankle fusion, your surgeon will make incisions in your skin to access the bone. This will create scars.
Swelling after ankle fusion surgery
After ankle surgery, it’s common to experience swelling in the area. This is your body’s normal response to surgery.
Change in gait
An ankle fusion may limit the mobility of your ankle, resulting in a limp. This might change the way you walk.
All surgeries present the risk of infection. This can occur if bacteria enter your incision during surgery or recovery. An infected incision can delay proper healing.
Another possible complication is excess bleeding. If you’re at risk for excess bleeding, your doctor may take extra steps to prevent this side effect.
Difference in leg length
When the bones in your ankle are fused together, your leg might become slightly shorter. This might make your legs uneven and change your gait, especially if there’s a difference of more than an inch.
Bones failing to fuse
If the bones fail to fuse, it’s called a nonunion. This can lead to disability and poor ankle function. It might also require another surgery to fix the problem.
Preexisting conditions, habits and other factors that can increase the risk for nonunion include:
There are various types of ankle fusion surgery, but they involve the same general steps:
Before the procedure
Before the surgery, your surgeon will use X-rays to take measurements of your ankle joint. This will help them determine the best placement for the screws, plates, or bone grafts.
You might also need to avoid certain activities, like drinking alcohol.
Just before the surgery, you’ll be given a nerve blocker and local or general anesthesia.
During the procedure
Here’s what usually happens during the actual procedure:
- Your surgeon makes an incision on your ankle to expose the bones and cartilage.
- Next, your surgeon removes the cartilage from the bones in the joint.
- Using surgical tools, your surgeon roughens the surface of the bones to help them fuse.
- Your surgeon aligns the bones, then fuses them together with plates, screws, or bone graft material.
- Your surgeon closes the wound with stitches.
After the procedure
Right after surgery, your medical team will place a cast around your ankle to limit movement. They’ll also give you pain medication.
Before you go home, your medical team will explain how to care for the incision, along with other precautions.
The two standard types include:
- Open ankle fusion surgery. Your surgeon makes an incision and uses surgical tools to remove cartilage. It’s often used for people with moderate to severe ankle deformity.
- Arthroscopic ankle fusion surgery. A surgeon makes small incisions and inserts a tiny camera, called an arthroscope, into the ankle. This procedure is less invasive and is used for people with little to no ankle deformity.
From there, there are more than 40 techniques for ankle fusion. Common techniques include:
Ankle fusion with internal fixation
Internal fixation uses screws or plates to internally hold bones together. In some cases, a surgeon might use both.
An ankle fusion with internal fixation and screws is the most common type. However, if you have osteoporosis, screws might not be ideal. Bones with osteoporosis are less likely to fuse with screws.
Ankle fusion with external fixation
External fixation also uses screws or pins to hold your ankle bones in place. But unlike internal fixation, the screws or pins are placed on your skin around the surgical site. They’re held together by a bar.
This type of surgery is often used for people who have:
- severe bone defects
- limb length differences
- poor bone quality
- active or previous infections
Ankle fusion with bone graft
A bone graft is transplanted bone material that’s used to fuse ankle bones together. It can be used with internal or external fixation.
Specifically, the combination of bone grafting and internal fixation is recommended if there’s a risk for nonunion. This may occur if you have bony defects or bone tissue death in some parts of the ankle.
Anterior ankle fusion
This involves a horizontal incision across the front of your ankle. Your surgeon then removes the cartilage from your ankle bones. Depending on your surgeon’s technique, they might add a pre-contoured ankle plate before adding screws.
An open ankle fusion with an anterior approach is a common technique.
Transfibular ankle fusion
A transfibular ankle fusion involves a vertical incision on the outer side of your ankle. Your surgeon removes the bottom portion of the fibula, or the outer bone connecting your knee and ankle. Next, they remove cartilage from other ankle bones, then fuse the fibula to these bones using screws.
This method is associated with a high rate of fusing and a better outlook. Also, compared to the anterior approach, it offers a better view of the ankle bones.
After surgery, you’ll go home to start recovery. You’ll need to take pain medication at first.
During the first 1 or 2 weeks after surgery, you’ll need to elevate your affected foot to reduce swelling.
You’ll also need to avoid weight bearing activities for 3 to 4 months. After this point, you may be able to return to normal activities. But you’ll need to use a brace or supportive boot, along with crutches or a knee scooter.
As your ankle heals, you might attend physical therapy. A physical therapist can help you walk smoothly and improve your ankle strength.
It can take 4 to 9 months to fully recover. The exact timeline depends on:
- the severity of your condition
- the specific surgery
- your overall health
During recovery, you’ll have regular checkups with your surgeon. They’ll take X-rays to make sure your ankle is healing and aligned.
Walking after ankle fusion
It can take 3 to 4 months to start walking after an ankle fusion. Weight bearing activities like walking should be avoided during this time.
You may walk with a slight limp, but every person is different. For best results, work with a physical therapist.
An ankle fusion is recommended for people who have severe ankle pain due to conditions like arthritis or infection. This includes arthritis that doesn’t respond to standard treatment like physical therapy.
The surgery might also be ideal for those who are unable to get an ankle replacement. This includes people who have:
In contrast, an ankle fusion isn’t right for people with mild to moderate arthritis. Noninvasive, nonsurgical treatment would be best.
If you have multiple underlying medical conditions, the surgery might be too risky. This includes conditions like:
- significant bone loss
- active infection
- ankle deformity
Your doctor can determine if you’re a good candidate for ankle fusion.
The cost of an ankle fusion can vary widely, depending on where you live and the complexity of your particular surgery. According to one 2019 survey of 21 foot and ankle centers in the United States, the mean cost of an ankle fusion was $41,756.
Ankle fusions are only done when medically necessary. Therefore, your health insurance should cover some or all of the costs. However, every health insurance plan is different. It’s important to talk to your provider first.
If you don’t have health insurance, ask your doctor about financial programs. You may qualify for financial assistance depending on your health or employment status.
Your doctor might offer a payment plan. This won’t reduce your overall cost, but it may be easier to pay for the surgery in smaller portions.
Possible alternatives to ankle fusion include:
- Ankle replacement. An ankle replacement, or ankle arthroplasty, replaces the ankle joint with an implant that provides full range of motion. It allows you to walk more naturally, making it ideal for people who want to lead active lifestyles.
- Arthroscopic debridement. If your ankle arthritis is not severe, an arthroscopic debridement may be best. A surgeon uses an arthroscope and tiny tools to remove inflamed tissue and cartilage from the ankle joint.
- Supramalleolar osteomy. This procedure is used for ankle deformities with mild or moderate arthritis. It involves breaking the ankle bones and reducing joint pressure caused by an asymmetrical deformity.
In most cases, an ankle fusion can successfully treat end-stage ankle arthritis.
Nonunion occurs after
You might also need a second surgery if the hardware in your bones cause discomfort.
Some people might develop arthritis in nearby joints years after getting an ankle fusion. This is caused by the reduced ankle movement, which adds stress to other joints.
To improve your overall outlook, work with your medical team to ensure proper recovery after surgery.
Ankle fusion is used to relieve ankle pain caused by severe arthritis, deformities, infection, or neuromuscular conditions. It fuses the ankle bones together, which limits ankle movement. This can reduce pain and improve stability.
However, the surgery can also reduce ankle movement, causing you to walk with a limp. A physical therapist may be able to teach you how to walk smoothly.
Recovery can take 4 to 9 months, depending on your specific condition and surgery. If you think you might be a good candidate for the surgery, speak with a doctor.