Has anyone had ankle fusion surgery?

Question

I am considering ankle fusion surgery for correction of a congenital defect known as tarsal coalition. Please let me know if the fusion corrected your pain and if the surgery was worth it.

Answer 1

i've had both ankles done still have pain but i can move around better thing is i put off surgery till i couldn't walk if i had done it when the doc wanted too(10 yrs earlier) i probaly would be even better

Answer 2

Ankle Fusion Cost

Answer 3

My sister-in-law is going through a lot of trouble right now regarding something like this. She has degenerative bone disorder (a side affect from some medication she was given, no less!) and has had her ankle fused twice now. She was required to have bolts put in the first time, this time they removed the bolts and did something new with something she calls "bone paste"! But neither surgery has eased her pain at all, unfortunately, nor stopped the bone loss. While it is not exactly the same as your procedure, I just wanted to let you know about this.

You might want to contact the surgeon you are considering using and ask if he has people (past patients) that would be willing to give him recommendations by talking with you. Some people will do that and this way it will be more pertinent to your actual situation.

Good luck!!

Answer 4

I shattered my left ankle 12 years ago. My doctor has wanted to do ankle fusion surgery on me for years. There is no cartilage left in my joint so it's bone on bone (I bet you have the same thing) and boy, does it hurt. But I refuse to have it done because I want an ankle replacement. Because of my age (I'm only 41) and the fact that the ankle replacement that is out now is not very good (compared with hip and knee replacements which are REALLY good) I am going to wait.

If you have your ankle fused you will NEVER be able to have a replacement. When they fuse your ankle, they have to remove the joint entirely and fuse the tibia/fibula to the foot. You can't put a joint back in when there isn't one anymore. Just keep an eye on approvals of new/revised medical devices from the FDA's Center for Devices and Radiological Health (CDRH):

http://www.fda.gov/cdrh/index.html

Answer 5

I badly sprained my ankle about 3 weeks ago. I was in a hurry going down the stairs, lost my balance and landed on a bad side of my left foot, causing my left ankle to be stretched going on the inside. The first 48 hours were excruciating and the pain was un-believable. I've never had a serious ankle injury before.

So I immediately treated it using the RICE method. The following day, the bruising and swelling were so horrible. I found out that I got a second degree sprain and immediately panicked after that. I had a football game on that week and it been looking forward to it because I've been training for rt. I had teammates that had similar injuries and it took them months to fully recover, some of them stopped playing altogether. So I kinda had a short-term depression because I can't imagine myself not being able to run and play sports anymore.

Because I was so desperate to recover again, I contacted a lot of people that I know who do sports and asked them if they had similar injuries. One friend of mine, from the boy's football team in my university, told me about H.E.M. Ankle Rehab. I got a copy 4 days after I got injured. I immediately read and followed what was instructed and felt improvement on the first day. I was able to walk a bit, but I was in pain.

A couple of days after that, the swelling and bruising were subsid-ing significantly and on the fourth day, I was walking comfortably again. Although I've had felt a bit of stiffness, I continued doing what was instructed. My sister was surprised that I have recovered this fast. I told her about this book and was shocked on how effective the procedures were. I'm just so happy that this book was shared to me and how effective it is.

Heal your ankle fully & fast?

Answer 6

Ankle fusion

What is it?

This is an operation to "fuse" or stiffen the ankle joint.

Why would it be done?

Ankle fusions are done for two main reasons:

arthritis of the joint, because of a previous injury that has damaged the joint, a generalised condition such as osteoarthritis or rheumatoid arthritis, or because the joint is just wearing out for some other reason

severe deformity of the rear part of the foot, such as a flat foot, high-arched or "cavus" foot, a club foot or other deformity, in which the ankle joint is also deformed, unstable or damaged. Sometimes ankle problems in the presence of major foot deformities can be treated by correcting the deformity by breaking and reshaping the foot bones or fusing the other foot joints, then clearing the out the ankle with a telescope (arthroscopy). In other cases it is best to stiffen the joint in the corrected position, particularly if the joint is already stiff or the foot is weak.

It is now possible to treat some arthritic ankle joints by replacing the joint, in the same way as arthritic hips and knees can be replaced. However, this is only suitable in older patients without major foot deformities, or people with rheumatoid arthritis or similar diseases. It would not be suitable if:

you are young (usually under 45) or very physically active

you have a severe foot deformity

your ankle is very unstable

you have had infection in the ankle or the bones around it

the bone under the ankle (the talus) has collapsed

In these situations a fusion would be advised instead. If you have a severe foot deformity you may be advised to have this corrected at the same time as your ankle fusion by fusing other joints and/or breaking and realigning the foot bones. This would be discussed at the same time as your ankle fusion and we have other information sheets which give information about major foot fusions. The only extra operation which will be discussed here is the combination of a fusion of the ankle and the joint below the ankle (the "subtalar" joint). This operation is called a "tibiotalocalcaneal fusion" as it fuses the shin bone to the main bones in the back of the foot (tibia, talus and calcaneum). It is included here because it changes the way the ankle operation is done.

We are sometimes asked if a fusion can be changed to an ankle replacement later. This is not possible, as the foot becomes too stiff for an ankle replacement to work.

We often inject local anaesthetic or steroid into damaged joints, before any surgery is considered, to see whether this helps the pain. In some poeple, this gets rid of the pain and surgery is not necessary. In others, pain relief does not last but the results of the injection helps us to decide which joints to fuse.





What does it involve?

A cut is made on each side of the ankle. Usually the inner cut is about 3-4 cm long and the outer cut is about 10cm. The bony bumps on each side of the ankle ("malleoli") are removed to allow the surgeon to get into the joint. The joint is opened up and the joint surfaces removed and, if necessary, reshaped to correct a deformity. The joint is then put in the correct place and fixed with two or three screws. If you have a tibiotalocalcaneal fusion the bones are usually fixed together with a large metal pin or "nail" inserted through a cut in the bottom of the heel and sometimes with a screw passed through the back of the heel as well.

It is usually necessary to put some extra bone into an ankle fusion to get it to heal and to fill any gaps in the fusion left by correcting deformity. Often this extra bone can be obtained from the bone that is cut out to prepare the fusion. Sometimes there is not enough bone from this and bone has to be taken from the pelvis just above the hip.

Some people who have foot deformities have a tight Achilles tendon ("heel cord"), or weak muscles, or both. The Achilles tendon may be lengthened during surgery by making three small cuts in the calf and stretching the tendon. Weak muscles may be compensated by the tendons of normal muscles to do the work of the weak ones. This might be done at the same time as a ankle fusion, or it may be best to do it at another operation. These "tendon transfer" operations are planned individually and your surgeon and physiotherapist will discuss this with you.

Some people with deformities of the foot also have deformed toes. Again, these may be corrected at the same time or at a later operation.



How long would I be in hospital?

Most people who are reasonably fit can come into hospital on the day of surgery, having had a medical checkup 2-3 weeks beforehand. After surgery your foot will tend to swell up quite a lot, especially if you have had extra surgery such as a tendon transfer or toe straightening procedure. You will therefore have to rest with your foot raised to help the swelling to go down. This may take anything from 2 days to a week. If you get up too quickly this may cause problems with the healing of your foot.

Once the swelling goes down and the cuts on your foot are healing your foot will be put in plaster and you can get up with crutches and go home. The physiotherapist will teach you how to walk with crutches. We will get you up as soon as possible! Most people are in hospital for 2-3 days.



Will I have to go to sleep (general anaesthetic)?

The operation can be done under general anaesthetic (asleep). Alternatively, an injection in the back can be done to make the foot numb while the patient remains awake. Local anaesthetic injections do not always work and in that case you may have to go to sleep if the operation is to be done. Your anaesthetist will advise you about the best choice of anaesthetic for you.

In addition, local anaesthetic may be injected into your leg while you are asleep to reduce the pain after the operation even if you go to sleep for the surgery. You will also be given pain-killing tablets as required.





Will I have a plaster on afterwards?

You will need to wear a plaster from your knee to your toes until the ankle has fused - usually 3-4 months. For the first 6 weeks you should not put any weight on your foot as it may disturb the healing joint. (Occasionally touching your foot to the ground for balance is OK, but no more.)



What will happen after I go home?

By the time you go home you will have mastered walking on crutches without putting weight on your foot. You should go around like this for a month. If you will have problems coping at home on crutches, please discuss this with Sister Scott in the Pre-assessment Clinic before surgery. We can than see what arrangements could be made to help you.

10-14 days after your operation you will be seen again in the clinic. Your plaster will be removed and the cut and swelling on your foot checked. If all is well you will be put back in plaster. You should continue walking with your crutches.

About 6 weeks after your operation you will come back to the clinic for an Xray. If this shows the joint is healing in a good position you can start putting about half your weight through the plaster. The physiotherapist will teach you how to do this. Later you will probably be allowed to put your full weight through the plaster. Your surgeon will advise you when this is possible.

You will have further Xrays over the next few weeks: exactly when and how often will be determined by how well your foot is healing. When the Xrays show that the joint is fused enough to take your weight, the plaster will be removed and you can start walking without it. We usually give people a brace to wear at this point to give them some support as they get used to walking without the plaster. This is usually worn for about a month.



How soon can I....



Walk on the foot?

As explained above, you should not walk on the foot for at least 6 weeks after surgery. Your surgeon will advise you when you can start taking some weight on the foot.

When you start putting weight on your foot we will give you a special shoe that you can wear over your plaster.



Go back to work?

If your foot is comfortable, and you can keep your foot up and work with your foot in a special shoe, you can go back to work within 3-4 weeks of surgery. On the other hand, in a manual job with a lot of dirt or dust around and a lot of pressure on your foot, you may need to take anything up to six months off work. How long you are off willl depend on where your job fits between these two extremes.



Drive?

If you have only your left foot operated on and have an automatic car you can drive within a few weeks of the operation, when your foot is comfortable enough and you can bear weight through it. Most people prefer to wait till the plaster is removed and they can wear a shoe.



Play sport?

After your plaster is removed you can start taking increasing exercise. Start with walking or cycling, building up to more vigorous exercise as comfort and flexibility permit. Obviously, the foot will be stiffer after surgery and you may not be able to do all you could before. However, many people find that because the foot is more comfortable than before surgery they can do more than they could before the operation. Most people can walk a reasonable distance on the flat, slopes and stairs, drive and cycle. Walking on rough ground is more difficult after an ankle fusion because the foot is stiffer. It is rare to be able to play vigorous sports such as squash or football after a ankle fusion.



What can go wrong?

The main problem is the swelling of the foot, which may take many months to go down fully, and some people’s feet always remain slightly puffy. You may find that only trainers are comfortable for several months. Keeping your foot up, applying ice or wearing elastic stockings may help to keep the swelling down. Swelling is part of your body’s response to surgery rather than the operation "going wrong" but it is a nuisance to many people who may be concerned that something has indeed gone wrong. If you are worried about the swelling of your foot, ask one of the foot and ankle team ( your physiotherapist, chiropodist, nurse or surgeon) whether the amount of swelling you have is reasonable for your stage of recovery.

If you need to have a bone graft taken from your pelvis, this is often quite painful for a couple of weeks, and some people have a little numb area beneath the scar. Again, this is normal, but can be irritating.

The most serious thing that can go wrong is infection in the bones of the ankle. This only happens in about 1% of people, but if it does it is serious, as further surgery to drain and remove the infected bone and any infected screws or pins will be necessary. You may then need yet more surgery to get the ankle to fuse in a satisfactory position. The result is not usually as good after such a major problem as if the ankle had healed normally.

About 10-15% of ankle fusions do not heal properly and need a further operation to get the bones to fuse - basically another ankle fusion.

Minor infections in the wounds are slightly more common and normally settle after a short course of antibiotics.

Sometimes the cuts, especially the one on the outer surface of the foot where the blood supply is not so good, are rather slow to heal. This usually just requires extra dressing changes and careful watching to make sure the wound does not become infected.



Research shows that 10% of ankle fusions do not heal in exactly the position intended, either because the position achieved at surgery was not exactly right or because the bones have shifted slightly in plaster. Usually this does not cause any problem, although the foot may not look "quite right". Occasionally the position is a problem and further surgery is required to correct it.

Sometimes the screws become loose as the bone heals and cause pain or rub on your shoe. If this happens they can be removed - usually a simple operation which it is often possible to do under local anaesthetic. We find that about 10% of our patients need the screw taken out. It is unusal for a nail to need to be taken out, but if it does this is a bigger operation needing a full anaesthetic and sometimes an overnight stay in hospital.