Orthopaedic Surgery - Ankle Fusion (Tibiotalar Fusion)

What is an Ankle Fusion?

The ankle joint is made up of 3 bones, the tibia, fibula and the talus.

An ankle fusion involves permanently stiffening the tibia and talus bones, which will prevent the up and down movement of your foot. An ankle fusion can be performed on its own, or at the same time as fusing other joints in the foot.

Why do I need this operation?

The main reason the operation is performed is due to arthritis causing pain and stiffness. Arthritis results in the soft protective cartilage layer around the end of the bones becoming worn away. This can occur through wear and tear of the joint, as well as due to other conditions such as rheumatoid arthritis and fractures.

As the joints are removed and the bones are fused together, there is no more movement of the ankle. This will improve the pain and correct any deformities.

How is a diagnosis made?

You will have a clinical examination by a foot and ankle specialist, and x-rays will be taken of your ankle.

Depending on the diagnosis, a steroid injection may be offered. It helps to determine if your ankle would benefit from a fusion and whether other joints in your foot need to be fused. It is also at this point that any available alternative treatments will be discussed.

Are there any alternative treatments?

Non-surgical treatment may be offered initially if appropriate. This depends on the severity of the pain and stiffness in your foot along with any other medical conditions you may have, such as diabetes or circulatory problems.

The alternative treatments may include painkillers, steroid injections, insoles provided by orthosist and orthotics such as special shoes and calipers. Adapting footwear to provide more support to your foor can often help. Once these options have been explored then a fusion may be offered.

What does the operation involve?

The operation usually involves a general anaesthtic (asleep) with a local anaesthetic block to provide good pain relief following surgery.

The ankle fusion is often performed using an arthroscopic technique (keyhole). Two small incisions (cuts) are made at the ankle.

Traction is applied by pulling the ankle and fluid is injected to create a space for the camera and small instruments to be inserted into the ankle.

The surfaces of the joint are cleared away to create the edges of the 2 bones. These edges are held together and positioned carefully to correct any deformity. Screws will then permanently fix the bones in the correct position, allowing the bones to heal and fuse together.

If the ankle is deformed, the procedure may need to be performed by opening up the ankle.

What are the risks?

There are general risks relating to all surgery of the foot which includes infection, scarring, swelling, numbness and blood clots.

The main specific risks are failure of the bones to fuse. This risk is increased in patients who are diabetic, have rheumatoid arthritis and in those who smoke. It is therefore important to stop smoking prior to the operation and during recovery.

You will be given medication to reduce the risk of developing blood clots for the whole time that your leg is in a plaster cast.

What happens after the operation?

Following the procedure, a dry dressing will be applied to the wound with a plaster of paris (POP) backslap and bandage.

It is important that this remains intact, clean and dry until you are seen in clinic in about 2 weeks after your operation, where the dressing and stitches will be removed.

You will be placed in a full below knee POP and remain non- weight bearing for another 4 weeks. At the 6 weeks point, you will be put in a boot and you will be able to minimally put weight through the leg for a further 6 weeks.

It is imperative that you keep your foot elevated above the level of your heart to control the swelling. After 12 weeks you will be able to gradually increase the amount of weight you put through your leg.

How will I be able to walk and wear normal shoes?

Although this operation involves removing the ankle, you will likely be able to move and walk more than you could previously.

Prior to the operation your ankle joint would have already been quite stiff and painful which would have limited your walking. After the operation, although your ankle will be stiff, you will be pain free.

Once your foot has fully healed and the bones have fused you will be able to wear normal shoes. It is recommended that you wear stiff soled shoes for support.

Further information

Please inform staff of any concerns or questions you may have. We will do our best to answer your queries quickly.