| Ankle Fusion Operations
How Long Does It Take For An Ankle to Fuse?
The time to fusion can vary considerably between different conditions, different operative techniques and different patient related factors. Generally, under the optimum circumstances an ankle should be well on the way to uniting by six weeks and be united by 12-14 weeks. Just as after a fracture, the bone will continue to strengthen beyond this time.
What Sort of Operations Are Available For Ankle Fusion?
The main ways to fuse an ankle are either with an arthroscopic (keyhole) technique, with a traditional open technique or using the Ilizarov frame (a circumferential external fixator). It is also possible to fuse the ankle, together with the joint beneath it (the sub-talar joint) by inserting an intramedullary rod through the heel to compress both of these joints. This last technique is not however simply for ankle fusion.
Generally your own surgeon will have various techniques and should be able to discuss with you which are most successful in his hands and appropriate in your case.
Each technique has its own pros and cons. There are specific sections on each technique to be found in www.footsurgeryatlas.com but in brief, the relative merits of each are as follows:
- An arthroscopic ankle fusion produces minimal soft tissue disruption and generally results in the lowest level and shortest lived post-operative pain.
With this technique it is possible for patients to start partially weight bearing immediately (with an Aircast boot). The minimal soft tissue disruption means that it is possible to operate in areas with very poor soft tissue cover such as skin grafted areas or where other plastic surgery procedures have occurred. The union rates are probably highest for this technique.
- An open ankle fusion has its main advantage that greater degrees of fixed deformity around the ankle joint can be corrected than with the arthroscopic technique.
In addition, with an ankle which is tilted inwards (known as varus) the fibula bone can become very enlarged and produce a problem with shoe wear. This can be entirely excised with an open technique which brings more normal dimensions back to the ankle than would be possible with an arthroscopic technique. Both bone surfaces are cut back to healthy non-arthritic bone and parallel to each other.
- Fusion of the ankle with an Ilizarov frame allows the greatest degree of correction and in addition, avoids any screws routinely being required immediately at the level of the ankle joint. This has a significant advantage if infection is present as screws and other metalwear placed across the infected site tends to encourage the persistence of local infection.
What Position will my ankle be fused in?
The most functional position of a fused ankle is with the foot fused at right angles to the tibia (Diagram 1) and sitting squarely underneath it (Diagram 2)
Diagram 1
Diagram 2
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