Fusion, also called arthrodesis, is a surgical technique used to treat painful, end-stage arthritis in the foot or ankle joint. In ankle fusion, the tibula and the talus (the two bones at the base of the ankle joint) are fused together, eliminating the joint itself. In foot fusion, three bones in the back of the foot are fused together. Fusion surgery is performed in patients whose joints have eroded or been destroyed by osteoarthritis or rheumatoid arthritis.
There are two different ways to perform fusion surgery. In most cases, the surgeon fuses the bones together with rods, pins, screws or plates. These remain in place after healing has occurred. In cases of severe bone loss, a bone graft may be needed to support the arthrodesis and aid healing. The graft is usually taken from the pelvis area or lower leg.
If the arthritis is in the ankle, a total ankle replacement is a possibility. In a replacement, damaged bone and cartilage is removed and plastic versions take their place.
Anatomy
The foot is extremely complex, with 28 bones and more than 30 joints. Tough bands of tissue, called ligaments, keep the bones and joints in place and allow the complex movements needed for motion and balance. The Achilles tendon connects the heel to the calf muscle and is essential for running, jumping and standing on tiptoe.
The ankle joint enables you to move your foot up and down. It is formed by the connection of three bones. The top of the talus (the bone that connects the ankle and the foot) fits inside a socket at the lower end of the tibia (shinbone) and the fibula (the small bone of the lower leg). The bottom of the talus sits on the heel bone.
When is surgery recommended?
If you have foot or ankle pain that limits your everyday activities, secondary to arthritis, and all non-surgical methods of treatment have failed—including weight loss, anti-inflammatory medications, cortisone injections, physical therapy, and custom orthotics and braces—then you should consider fusion surgery or total ankle replacement.
Most patients with advanced foot or ankle arthritis are good candidates for arthrodesis or for total ankle replacement. However, it’s important that you are carefully screened by an orthopedic specialist to determine the most appropriate treatment.
What is the recovery time?
Recovery varies by patient and demand. Minimally invasive approaches and refined surgical techniques have dramatically reduced recovery time. For these patients, the typical recovery period is now weeks rather than months.
You may need to wear a splint or cast at first, or a special boot or shoe. You will do physical therapy to regain strength and flexibility in your foot and ankle after the surgery.
Time off from work depends on your profession and location of your job. If your work is sedentary and local, you may return as early as two to four weeks after your surgery. If your job is more rigorous and involves travel, your time off from work may be longer. Complete recovery may take six months to a year.