If arthritis has progressed to the point where
moving your ankle is difficult and walking more than
a couple of blocks causes pain, you may be a candidate
for ankle fusion surgery. In this procedure, the cartilage
from your shinbone (tibia) and anklebone (talus) is
removed so the bones can be fused together. Those who
choose this option lose motion in the ankle joint, which
greatly limits the ability to engage in sports and activities.
However, the pain is relieved and you can continue walking.
And the other joints in your foot can still bend up
and down, so your foot is not completely fixed in a
rigid position. This surgery is usually considered a
good option for older patients who have suffered debilitating
ankle pain. Younger patients may decide on ankle fusion
surgery if they are suffering from severe arthritis,
but it is typically performed on patients over 50.
Preparing for Surgery
The decisions you make and the actions you take before
your surgery can be every bit as important as the procedure
itself in ensuring a healthy recovery.
to your return home from the hospital, make sure that
you have received any equipment you will need when you
get home. This may include crutches or household items
to make movement around the house easier. You should
receive prescriptions for any of these from your doctor
before you go home from the hospital.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
the potential risks and benefits of the surgery, and
ask your surgeon any questions that will help you better
understand the procedure. It can also help to talk to
someone else who has undergone the same surgery.
possible, discontinue the use of any anti–inflammatory
medicine, especially aspirin, a week prior to surgery,
to prevent excessive bleeding during the procedure.
reduce the risk of infection, improve healing, and decrease
complications, try to quit smoking or decrease the amount
you smoke. In general, smokers have a higher infection
and complication rate overall.
possible, practice walking with your crutches so you
are ready to use them after surgery.
a second opinion from another qualified surgeon is often
advisable, particularly in rare or unique cases.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
At most medical centers, you will go to "patient
admissions" to check in for your operation. There
may be separate check-in areas for ambulatory outpatient
(patients go home the same day after surgery) and for
overnight inpatient surgery, so be sure to ask your
doctor or an assistant about this. After you have checked
in to the hospital, you will go to a holding area where
the final preparations are made. The mandatory paperwork
is completed, and your ankle may be shaved, though this
is not always necessary. You will be asked to change
into a hospital gown and, if applicable, remove your
watch, glasses, dentures, and jewelry. You will have
the opportunity to speak with your orthopedic surgeon
or an assistant and meet the anesthesiologist or nurse
anesthetist (a nurse who has done graduate training
to provide anesthesia under the supervision of an anesthesiologist).
An IV (intravenous) line may be inserted into your arm
at this time. You will then walk or ride on a stretcher
to the operating room. Most patients are not sedated
until they go into the operating room. Here are some
important steps to remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under anesthesia.
for someone to drive you home when you are released.
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your short leg cast or
splint when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Ankle fusion surgery can take between two and three
hours to perform. Spinal anesthesia typically is given
to numb you from the waist down, and you usually are
sedated so you sleep through the procedure.
surgeon may have to make multiple incisions. An incision
about 10 to 12 centimeters long is made on the outside
part of your foot. Usually a smaller incision, about
four to six centimeters, is made on the inside part
of your ankle.
cartilage surface remains on the top of your anklebone
(talus) and the bottom of your shinbone is removed.
The bone surface will only fuse to another bone surface.
shinbone and talus are contoured so that your foot points
out exactly 90 degrees from your shinbone.
or three long screws are drilled from different directions
through the two bones to fix your ankle in position.
The screws usually cross each other to provide better
incisions are closed with stitches and your ankle is
placed into a post-surgery splint. Bandages are wrapped
around the splint to immobilize your ankle.
are taken to the recovery room where you will wake up
from the anesthesia.
After ankle fusion surgery, you will be transported
to the recovery room where you will be closely observed
for one to two hours while the immediate effects of
anesthesia wear off. Your ankle will be elevated and
immobilized in a splint when you wake up. The post-surgery
ankle splints usually are made of a "U-shaped"
plaster splint on the inside and outside of your ankle
that wraps around your heel. This immobilizes your ankle,
but it can be removed more easily than a short leg cast.
You will not be able to see the two incisions wrapped
in the splint, and there usually is minimal bleeding
after surgery. Ankle fusion can cause a substantial
amount of pain, and adequate pain medications will be
prescribed for you. You ordinarily are hooked up to
an intravenous (IV) patient-controlled analgesia (PCA)
device, which delivers pain medications in safe amounts
when you push a button. Some patients may be prescribed
oral or intramuscular pain medications. You usually
can have visitors no sooner than 30 minutes after surgery
if your physician feels you are in a stable condition.
Your temperature, blood pressure, and heartbeat will
be monitored by a nurse who, with the help of the doctor,
will determine when you are ready to leave the recovery
room and be transported to the hospital ward for further
post-operative care. In some cases, you may be transported
to a ward for intensive care or heart monitoring if
you have special post-operative medical needs. Most
patients spend two to three days in the hospital before
|Post-op in Hospital
After ankle fusion surgery, most healthy patients
remain in the hospital for two to three days. However,
some patients may require a longer stay due to pre-existing
medical problems or medical issues that may arise after
surgery. There are small risks of infection after major
ankle surgery. Though it happens in less than five percent
of patients, your ankle’s blood supply may not
be as good as other body parts and you may be prone
to infection. Because you cannot see your incision inside
the cast, it is important to notify your physician if
you feel discomfort. Each patient is different and may
have different criteria for being able to go home. In
general, the length of your hospital stay is based on
the amount of pain management you need. You will receive
fluids and medications, through an intravenous (IV)
line until you can drink an adequate amount of fluids
without nausea or vomiting. Most patients can drink
something the night after surgery and eat something
more substantial the following morning. Be sure to ask
for pain medications as soon as you feel pain coming
on, because medications are most effective on pain that
is building rather than on pain that is already present.
Your nurses will not give you more than your doctor
has prescribed and what is considered to be safe. Physicians
prescribe crutches to help you move around without putting
weight on your ankle. The day after surgery, you typically
meet a physical therapist who teaches you about using
crutches and helps you walk around the hospital. You
will likely be unable to bear weight on your ankle for
six to eight weeks after surgery. Your physician may
have X-rays taken of your heel and ankle before you
leave the hospital. You should arrange for someone to
drive you home when you are discharged.
For four to five days after ankle fusion surgery,
you should keep off your feet, elevate your ankle above
heart level, and move around the house as little as
possible. You should try to rest and avoid too much
movement for at least a week. Crutches usually are prescribed
for about eight weeks so you can keep your body weight
off your ankle. Rest as much as possible with your ankle
elevated. This helps blood drain away from your ankle
and controls swelling. The more weight you put on your
ankle, the greater your chances of disrupting the healing
process in your anklebones. Household tasks that require
you to be on your feet may be difficult for eight weeks.
It can be helpful to have someone around the house to
help with any physical chores. The dressing covering
your wound inside your post-surgery ankle splint usually
does not need to be changed until the splint is removed
about 10 to 14 days after surgery. A typical follow-up
schedule after you leave the hospital may go as follows:
to 14 days – Stitches are removed and your ankle
is put into a short leg cast. Casts need to be kept
dry when bathing.
weeks later – Return for a check-up. Possibly
receive X-rays and, if necessary, a new cast.
weeks after surgery – If your physician sees signs
of healing in your ankle, you usually can start bearing
some weight while using your crutches. Weight bearing
increases as you can tolerate the pain.
to 12 weeks after surgery – The cast is removed
and you receive a removable brace that can be worn inside
your shoes. When the cast comes off, you usually are
used to bearing weight on your ankle, but you may continue
using a cane as needed if your ankle hurts or feels
weak. Your physician may provide with you with shoe
modifications to make walking easier.
Depending on how well you are able to strengthen your
own foot and lower leg, your physician may prescribe
physical therapy to help you feel comfortable walking.
Though your arthritic ankle joint has been fused in
surgery, the other bones in your foot still bend a little.
You should be able to walk and get around. After 10
to 12 weeks in a cast, your leg muscles usually feel
weak and you may need a few months of exercise before
your leg feels strong again. Most of the strength you
need to feel stable on your feet can be achieved by
walking and weight bearing on your own. Try to walk
a few blocks a day. Increase the length of your walks
as your leg feels stronger. If you have difficulty,
a physical therapist can help you start walking again
on your fused ankle. Most patients can restore muscle
strength and feel comfortable walking within four months
After ankle fusion surgery, you no longer have cartilage
in your ankle. Though arthritis can no longer trouble
your ankle joint, you may have to worry about preventing
arthritis in your other foot joints. With the ankle
joint fused, more stress is placed on the bones in your
foot. It typically takes years for other foot joints
to become arthritic, but if you feel pain in your foot,
you should visit your physician. Maintaining cardiovascular
fitness has been an effective method for preventing
the progression of osteoarthritis. Light, daily exercise
is much better than occasional, heavy exercise. After
your ankle has been fused, stationary cycling is a great
way to maintain cardiovascular fitness. You will probably
not be able to run on your fused ankle, which makes
returning to sports difficult. However, your ankle pain
should go away and you will be able to walk around town,
through the park, and in general be comfortable getting
around. You should be able to play golf and do other
light, walking activities.