Ankle fusion (ankle arthrodesis) is an operation to permanently join the bones of the ankle joint together, eliminating the painful arthritic joint. It is the gold standard surgical treatment for severe ankle arthritis.
The damaged cartilage is removed from the ankle joint surfaces. The bones (tibia and talus) are positioned in the optimal alignment and fixed together with screws, a plate, or a nail. Over the following months, the bones grow together to form a solid union. The procedure can be performed as open surgery or arthroscopically. It takes approximately one to two hours.
Ankle fusion is recommended for severe ankle arthritis or significant joint damage from injury, infection, or failed previous surgery. It provides predictable, durable pain relief and is particularly suitable for younger, active, or heavier patients.
Pain medication, ankle bracing, orthotics, rocker-bottom shoes, activity modification, and injections. Ankle replacement is a surgical alternative that preserves movement.
CT scan for planning. Smoking cessation is essential — smoking dramatically increases the risk of the bones not fusing. Plan for non-weight-bearing or limited weight-bearing for six to twelve weeks.
Excellent pain relief in over 90% of patients. The ankle no longer moves, but the adjacent joints in the foot compensate to provide a surprisingly functional gait. Most patients walk without a limp and can manage most activities.
This is expected — the purpose of the operation is to eliminate the painful joint. Foot joints compensate partially.
Prolonged foot swelling is common.
Walking pattern changes slightly, particularly on uneven ground and stairs.
The bones may fail to fuse together. Risk is approximately 5–10% and is significantly higher in smokers.
Increased stress on neighbouring joints may lead to arthritis over time.
Fusion in a suboptimal position.
Wound or deep infection.
Numbness around the ankle.
Screws may cause irritation and require removal.
General or spinal anaesthesia with an ankle block.
A cast or boot for six to twelve weeks. Initially non-weight-bearing, progressing to weight-bearing as fusion progresses. Physiotherapy focuses on foot and ankle exercises. Driving resumes at approximately three months. Full recovery takes six to twelve months.
Regular X-rays to monitor fusion. Reviews at two weeks, six weeks, three months, and six months.
Most patients walk well, though the gait is slightly altered. Walking on flat ground is usually very comfortable. Stairs and slopes require more adaptation.
Light jogging is possible for some patients. High-impact running is generally not recommended.
Rocker-bottom sole shoes can help with walking comfort after fusion.