Ankle Fusion

An ankle fusion, also called an ankle arthrodesis, is an operation to permanently join the bones of the ankle joint together. Once the bones heal into one solid piece, movement at the worn joint stops — and because the movement stops, so does the pain that comes from bone rubbing on bone.

It is a durable and reliable operation that has been performed for many decades, and it remains one of the two main surgical options for advanced ankle arthritis alongside ankle replacement.

When is an ankle fusion considered?

A fusion may be considered when:

• Ankle pain from arthritis is limiting your walking, work or sleep

• Non-surgical treatments such as bracing, activity modification, medication and injections are no longer giving enough relief

• Imaging confirms significant arthritis in the ankle joint

• Your circumstances make a fusion the more reliable option than a replacement

Who is it best suited to?

A fusion is often the preferred operation for younger and higher-demand patients, for people doing heavy physical work, and where there is significant deformity, poor bone quality, previous infection or damaged soft tissues around the ankle. It is also used when an ankle replacement has failed and needs to be converted.

The main trade-off is movement. After a fusion the ankle no longer bends up and down. Most people walk well because the neighbouring joints in the foot compensate to a degree, but that compensation places extra load on those joints, which over many years can contribute to arthritis developing in them.

What does the operation involve?

The remaining cartilage is removed from the joint surfaces and the bones are held firmly together while they heal, usually with screws, plates or occasionally an external frame. The operation can often be performed arthroscopically through small incisions where the alignment of the ankle is reasonable, which tends to mean less disruption to the soft tissues.

Where there is significant deformity to correct, an open approach is generally required. Which approach suits your ankle is determined by examination and imaging.

Recovery

Recovery is longer than for many other foot and ankle operations, because bone needs to heal solidly across the joint. A typical course looks like:

1. First six weeks: The ankle is protected in a plaster then a boot with no weight through the foot. Elevation is important throughout this period.

2. Six to twelve weeks: Imaging is used to check the fusion is progressing. Weight-bearing is introduced gradually in a boot as healing allows.

3. Three to six months: Moving out of the boot into supportive footwear, with physiotherapy to rebuild strength and walking pattern.

4. Six to twelve months: Continued improvement in comfort and walking distance. Swelling commonly persists well into this period and is expected.

Risks

As with any major operation there are risks, which will be discussed with you in detail beforehand. These include infection, wound healing problems, blood clots, nerve injury, and ongoing pain. The risk particular to fusion is non-union — where the bones do not join solidly and further surgery is needed. Smoking substantially increases this risk, and stopping before surgery makes a genuine difference to the outcome.

Over the longer term, the extra load carried by the neighbouring joints can contribute to arthritis developing in them, sometimes many years later.

Dr Janan's approach

Dr Janan completed fellowship training in Bristol, a major United Kingdom foot and ankle centre, and in Tokyo under Professor Satoru Ozeki, past president of the Japanese Society for Surgery of the Foot. He performs both ankle fusion and ankle replacement, including arthroscopic fusion techniques where the ankle is suitable.

Because both operations are available to you here, the recommendation is based on your ankle, your work and activity, and your priorities — not on a preference for one technique over the other.