Arthritis of the ankle means the smooth surface that covers the end of the bone (cartilage), has been lost and there are usually bone spurs around the joint. This often occurs after and injury or from diseases like rheumatoid arthritis, but it sometimes happens without any known cause. There are three choices for treating ankle arthritis:
- Do nothing or wear a plastic brace for comfort.
- Ankle fusion (making two bones grow together).
- Ankle replacement (in some patients).
Ankle fusion makes the tibia or shin-bone grow together with the talus, the bone immediately under it. This stiffens the ankle. You lose much if the up and down motion of the back of your foot, but you still have some from the other joints around the ankle. In addition, you will still have the side-to-side rocking motion that comes from the joint below the ankle. Ankle fusion is about 95% successful in getting the ankle bones to grow together. Once healed, the fusion is very durable and you can even do heavy labor with the foot. Most patients walk without a limp and get excellent relief of pain.
The downside of ankle fusion is that it places extra stress on the other joints around the ankle, and these develop at least some arthritis within about 15 years.
The surgery is done through an incision on the outside of the ankle. We usually add a very short incision on the inside of the ankle as well. Two or more screws are put in; they usually do not bother patients but occasionally need to be taken out later.
Smoking keeps from bones healing well, especially in the foot. You should not smoke for at least 3 months. Also, if you take anti-inflammatory drugs like Advil, Naprosyn or Asprin, you should stop then 5 days before surgery because they can thin your blood.
One night’s stay is usually required.
After the Surgery: You will have a large, bulky dressing that comes up to just below the knee. Keep your foot elevated above your heart as much as possible for the first week. YOU CANNOT WALK ON THE FOOT. Some patients like to practice on crutches before having surgery.
2 Weeks: We will take out your stitches and put on a fiberglass cast. Keep the cast dry, and if you accidentally get a little water on it, use a blow dryer. If it gets really wet, call us.
6 weeks: If your X-rays show healing, we will change your cast and let you slowly start putting weight on the foot.
3 Months: Most patients can start using a removable cast boot (with full weight on the foot).
3-6 months: When your X-rays show complete healing, we will let you get back to normal activities and wearing shoes. The exact timing varies between patients.