Ankle Fusion

You’ll meet with one of our orthopaedic consultants first. During this appointment, the consultant will discuss your medical history, evaluate your physical health, and may order imaging tests, such as X-ray or MRI to assess the condition of your ankle. It is crucial to choose an experienced surgeon to ensure the best possible outcome.

Our team will also walk through the general preparation instructions for an ankle fusion. These can include:

• Stopping certain medications, including any blood thinning medication
• Stopping eating or drinking for 8 hours before the procedure
• Discussing your anaesthesia

During ankle fusion surgery, you will be placed under general anaesthesia, meaning you’ll be completely asleep and pain-free throughout the procedure.

There are a few different ways to perform an ankle fusion. Open ankle fusion involves making a larger incision to fully access the ankle joint, while minimally invasive techniques use smaller incisions and specialised instruments to achieve the same goal with less disruption to surrounding tissue.

At the start of surgery, the surgeon makes an incision based on the location of the damaged ankle bones. They may use X-ray imaging during the procedure to help guide proper bone alignment and minimise the risk of complications. Most ankle fusion surgeries are performed using the open technique to provide better access to the joint.

The goal of ankle fusion is to permanently join the three main bones of the ankle — the tibia, fibula, and talus. To do this, the surgeon first removes any damaged cartilage and prepares the bone surfaces. The bones are then carefully positioned for fusion.

To hold the bones securely in place and ensure proper healing, the surgeon inserts strong, medical-grade metal screws or bolts into the ankle joint. Once in position, you will not be able to feel these screws.

In cases of severe ankle arthritis or significant bone loss, a bone graft may also be needed to encourage bone healing. The graft can come from another part of your own body (called an autograft) or be sourced from a donor (allograft).

To support your recovery, we recommend working with our physical therapy team. Physical therapy will help you safely rebuild strength and movement in your leg, foot, and ankle — without causing further pain.

In the first two weeks, it’s especially important to keep your leg elevated above heart level as much as possible. This helps reduce swelling and promotes wound healing.

During your recovery, you will also be advised to:

• Avoid prolonged standing
• Stop smoking (as it slows healing)
• Wear a walking boot as directed
• Use shoe inserts if recommended
• Watch for signs of infection, unusual pain, or changes in blood flow
• Use assistive devices, like crutches or a walker, to avoid putting weight on the ankle too soon

Putting weight on your foot will be a gradual process. Always follow your surgeon’s instructions and use assistive devices as needed to protect the healing joint and prevent complications.

In rare cases, a second surgery may be necessary, but this is uncommon and would only be considered if absolutely needed.

You may experience some numbness or tingling after surgery — this is usually temporary. A plaster cast or brace that covers the leg from the knee to the toes is often needed for about 3 to 4 months to help protect the ankle as it heals.

Risks and complications of ankle fusion surgery

Like any surgery, ankle fusion carries certain risks. These can include:

• Infection, usually treatable with antibiotics
• Bleeding during or after the procedure
• Nerve damage, which may cause numbness or tingling
• Non-union, where the bones do not fuse properly and may require additional surgery
• Malunion, where the bones heal in a poor position
• Adjacent joint arthritis, due to changes in how the foot moves after fusion

Minor infections are usually manageable, but in rare cases, more serious infections could require further surgical treatment. Occasionally, screws or plates inserted during surgery may also need to be removed if they cause discomfort or complications.

Your surgical team will discuss these risks with you beforehand and closely monitor your recovery to ensure the best possible outcome.

Long-term outcomes and expectations

The long-term outcomes of ankle fusion surgery are generally positive, with most patients experiencing significant pain relief and improved function. However, it’s important for patients to understand that a fused ankle will result in some degree of stiffness and limited mobility in the joint. To accommodate these changes, patients may need to make lifestyle modifications, such as avoiding high-impact activities and wearing special shoes designed to support a fused ankle. With proper care and rehabilitation, most patients can expect to return to their normal activities within a few months of surgery. It’s also crucial for patients to follow their surgeon’s post-operative instructions and attend all follow-up appointments to ensure the best possible outcome.

Rehabilitation and physical therapy

Rehabilitation and physical therapy are crucial components of the recovery process after ankle fusion surgery. Initially, patients will need to wear a cast or brace for several weeks to protect the fused ankle and allow it to heal properly. During this time, physical therapy will focus on maintaining the range of motion and strength in the surrounding joints and muscles. As the healing progresses, the rehabilitation program will gradually introduce weight-bearing activities to improve mobility and function. Patients will work closely with their physical therapist to ensure they are performing exercises correctly and safely. With dedication to their rehabilitation program, most patients can expect to achieve optimal outcomes and return to their normal activities within a few months of surgery.