Ankle Fusion
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The ankle joint is between your shin bones (tibia and fibula) and your ankle bone (talus). Where the bones meet, they are covered by a smooth cartilage lining in the joint that allows you to move the ankle freely.

Why might I need ankle fusion surgery?

In people who have severe arthritis or possibly a previous injury or ankle fracture, the cartilage in the ankle joint becomes damaged; gradually the space in the joint narrows, with bone on bone contact causing pain and stiffness and, in some cases, a deformity of the ankle. Ankle fusion is carried out to permanently join the damaged bones, preventing them from rubbing against each another and causing pain.

What does it involve?

The surgeon permanently connects the two main bones of your ankle joint (tibia and talus), having first removed damaged cartilage. The bones are then held together with metal screws which stabilise the bones while they heal and fuse (join) together. Occasionally some extra bone material is required to help with the healing; this can be taken from your own hip area or from donor bone.

How is it carried out?

You may have to stay in hospital for a night or two. The operation is performed under a general anaesthetic with an added injection in the leg to numb the foot after surgery and reduce pain.

Recovery

Immediately after surgery:

  • Your foot will be in a plaster cast to the knee. It will be numb and pain free
  • You will be referred to a physiotherapist who will advise on walking without taking your full weight
  • You will be sent home only when you are comfortable, when you will be given a follow-up appointment and painkillers if required

During the first few weeks:

  • Elevate your foot (raise it above your heart) as much as possible to reduce the swelling
  • Move around only when you need to, for example to wash or use the toilet. Don’t put weight on the operated leg
  • Some blood ooze can be expected in the bandage. If you are worried, contact the Fortius Clinic
  • Take painkillers as prescribed
  • Avoid smoking and taking anti-inflammatory medications as this may delay or even prevent the bones from fusing together

Follow-up appointments:

Everyone is different, so healing and post-operative programmes vary from person to person. However, the schedule of follow-up appointments below is typical:

  • Two weeks - your wound will be checked and X-rayed and you will be fitted with a new lightweight plaster cast
  • Six weeks - you will have an X-ray and new cast or boot
  • 12 weeks - you will have an X-ray, and can start to wear normal shoes
  • Six months - final appointment and X-ray

When can I start to walk?

Patients can respond differently to the surgery with some patients being able to cope better than others with walking, especially in the early stages post-operatively. Below is a guide to what may be advised:

  • 0-2 weeks - you will have a plaster cast and be non-weight bearing with crutches
  • 2-6 weeks - you will have a cast or boot and be non-weight bearing with crutches
  • 6-12 weeks - you will have a cast or boot so you will be able to take some of your weight with crutches if advised by your consultant
  • 12 weeks onwards - you should be able to take your full weight and wear normal shoes

How do I wash and shower?

It’s important to keep the plaster cast totally dry. However, you will be able to shower with a waterproof cover over the plaster. Once the plaster is removed you can shower without the cover if the wound is healed but gently dab it dry.

How can I look after the operation wound?

Once out of the cast, don’t pull at scabs but let them fall away naturally. If your wound becomes red, swollen or sore, contact the Fortius Clinic and arrange to see your consultant to check there isn’t an infection.

When can I start to drive again?

The DVLA states that it’s the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car in an emergency stop then you are ready to drive. Being able to do this will take at least 12 weeks.

Although your specialist will advise you about when it’s safe to start driving again, it remains your responsibility to drive safely and you should also check with your vehicle insurer to confirm you are covered.

When can I return to work?

This is very individual and depends on the type of work you do. If your job mostly involves sitting down, you can usually return to work by around six weeks. If you are more active at work, it may take up to 16 weeks to get back to normal.

What long-term outcome can I expect after surgery?

  • You should notice much less pain straight away and this will continue to improve as the bones fuse after around three months
  • You should be able to start to return to your normal activities and sports between six and 12 months after the operation although you may still have some swelling in your foot and ankle
  • Although you should notice a great improvement in being able to walk, the way you walk may change slightly because your ankle will now be completely stiff
  • The operation is successful in over 90% of cases, allowing people to return to their usual sporting activities

What are the risks?

Below is a guide to the risks of this type of surgery. However, your surgeon will discuss these with you before your procedure, and answer any questions you may have:

  • Infection
    • The risk of infection is around 1% and this can usually be effectively treated with antibiotics
  • Nerve damage
    • Nerves that supply feeling to the skin are near the incision site. Permanent damage is rare (less than 5%) but if your toe stays numb after surgery, it may be because the nerve is bruised and this should gradually improve
  • Non-union
    • The risk of the bones failing to fuse (join) is around 5-10%. If this happens, the decision about whether you need further treatment will depend on whether you continue to experience any pain and further options can be discussed with your surgeon
  • Prominent metalwork
    • Sometimes the metal used to fuse the joint can be prominent. However, once the bones have fused (between six and 12 months) the metal can easily be removed as a minor day case procedure
  • Deep Vein Thrombosis (DVT)
    • You may be given blood-thinning medication after the surgery if you are at a higher risk of DVT (where a blood clot forms in a deep vein in the leg). However, DVT is fairly unusual after ankle surgery (less than 5% of cases)

Important:This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery