Ankle Arthrodesis

Like all joints the ankle can be affected by various types of arthritis. With the passage of time arthritis leads to increasing pain, swelling and stiffness resulting in an ankle that does not function well. Ankle fusion is a very effective way to relieve the pain of ankle arthritis. Ankle fusion involves joining the two main bones of the ankle (the tibia and the talus together). After an ankle fusion most patients can walk without a limp and have minimal pain.

There are a number of steps to ankle fusion surgery. These include:

• Nerve block, general anaesthetic, intravenous antibiotics
• Multiple incisions around the ankle
• Removal of remaining cartilage
• Insertion of bone graft and other cells to stimulate fusion
• Fixation with screws
• Check x-ray
• Closure of wound with stitches
• Back slab

All surgical procedures carry some risk. The risk of complications with ankle fusion surgery is low. Some of the risks of surgery include:

• Infection
• Problems with wound healing
• Nerve injury causing numbness, tingling and/or pins and needles
• Non-union (when the bones don't join together)
• Mal-union (when the bones fuse in the wrong position)
• Deep venous thrombosis/pulmonary embolism (the risk of DVT is increased with smoking, the oral contraceptive pill and hormone replacement therapy, immobility and obesity)
• Anaesthetic complications
• Drug allergy
• Ongoing pain

Rest

• You will have a cast on your leg. Keep foot elevated as much as possible, especially for initial 72 hours. Keep dressings dry and intact until post operative appointment.
• Mobilise short distances as pain allows, aim to remain in your own home for the first few weeks limiting long periods of standing or mobilising
• Do not bear weight for the first six weeks

Pain

• Pain relief may be required for up to 2 weeks; depending on your other medications this may include:
• Regular paracetamol, anti-inflammatory drugs and break through opiate type medications
• A regular blood thinning medication will also be prescribed for 2 weeks

Driving

• Any surgery performed on the right foot or both feet will mean no driving for a minimum of 6 weeks
• If surgery was performed on the left foot then driving in an automatic is possible, but Dr Phegan would recommend waiting a minimum of two weeks before attempting to drive

Driving any vehicle with a cast or boot is potentially hazardous and you should consider this before getting behind the wheel.

Follow up

• Keep all dressings dry and intact for the first two weeks
• Removal of stitches/sutures typically occurs at an appointment with Dr Phegan and his in-house therapists at 10-14 days at first post operative appointment. Very occasionally some sutures need to stay in for longer
• Your appointment will be booked by Dr Phegan and a confirmatory SMS will be sent informing you of the time and date for follow up

Typical milestones

• 2 weeks: Wound review and removal of sutures, change from cast to boot
• 2-6 weeks: continue to non-weight bear but work on swelling reduction and scar massage
• 6 weeks to 3 months: begin to weight bear as tolerated in boot
• Full recovery 6-12 months

Every patient's recovery is individual and depends on the severity of the injury and the complexity of the surgery.