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Arthrodesis (Foot and Ankle Fusion)

Other Popular Names

Who does it affect?

Probably the most common cause of degenerative arthritis of the ankle is an ankle fracture. Many years after a serious fracture, the joint may wear out and become painful. Just as an out-of-balance piece of machinery wears out faster, a joint that is out of balance after it heals from a fracture can wear out faster than normal. This process may take many years. Other types of arthritis can lead to a painful ankle joint as well. For example, rheumatoid arthritis can destroy the ankle, leading to a painful joint.

Surgical Treatment

Arthrodesis is a surgical procedure that is usually done when an ankle joint becomes worn out and painful, a condition called degenerative arthritis. Arthrodesis fuses the bones of the joint completely, making one continuous bone. The surgeon uses pins, plates and screws, or rods to hold the bones in the proper position while the joint(s) fuse. If the joints do not fuse (nonunion), this hardware may break.

A bone graft is sometimes needed if there is bone loss. The surgeon may use a graft (a piece of bone, taken from one of the lower leg bones or the wing of the pelvis) to replace the missing bone.

This surgery is typically quite successful. A very small percentage of patients have problems with wound healing. These problems can be addressed by bracing or additional surgery. The biggest long-term problem with fusion is the development of arthritis at the joints adjacent to those fused. This occurs from increased stresses applied to the adjacent joints.

 

Post-Surgery Rehabilitation

After surgery, your ankle will be wrapped in a padded plaster cast. This will be removed after two weeks and replaced with a short-leg cast. Your consultant will take X-rays frequently to see if the bones are fusing together. You will probably need to use crutches for most of the time you wear the cast. As the fusion grows stronger, you will begin to put more weight on your foot when walking. This usually takes between eight and 12 weeks.

You should keep your leg elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting up.

Once the fusion has completely healed, you will be fitted with several special shoe modifications to make walking easier. An insert in the shoe called a SACH foot is sometimes useful to help you walk more normally. This heel cushion compresses as you put your weight on the foot and allows the foot to roll more normally as you step. Another useful modification of the shoe is a rocker sole. Unlike a typical flat shoe sole, the rocker sole is rounded, allowing your foot to roll as you move through a step.

Return to normal routine:

Bathing

Do not soak incision for 2 weeks.  After 3 days you may shower but do not let the skin by the incision become macerated.  Since dirt from your body runs downhill you should clean this area last and dry it first.  You may bathe at 2 weeks.

Dressing

Keep dry and intact for 3 days then change it twice daily until drainage stops. After that use a Pedifix Compression Sleeve or Ace Wrap.  Use the fracture brace or post-op sandal until bony healing is complete at an estimated 6-8 weeks.

Return to work 

Return depends on specific demands.  It is safe to return to sedentary work at 10 days post-op.  Return to heavy labor will take at least 3 months.

Return to driving

Patients with left foot surgery may drive an automatic transmission.  Patients with right foot surgery must wait until healing is adequate and they feel safe.

Risks

Complications are rare, but no procedure is completely free of risk. If you are planning to have an arthrodesis, our consultants will review a list of possible complications. Some of the most common include:

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