Ankle fusion. Can anyone share their experience please?

[BringmeGin]

Hi. I have been advised I may need ankle fusion surgery for an arthritic ankle following a nasty break when I was 17, (27 years ago). Has anyone had this done who could share their experience with me please? I'm concerned about how I will walk afterwards and if it will affect other joints as I'm hyper mobile and already have permanent left hip pain from limping all the time. Thanks in advance x

My dad had it done. Obviously there is reduced mobility but it saved him a lot of pain and discomfort so he was pleased he'd had it done. He can walk absolutely fine.

Can he wear normal shoes and drive? I'm in the uk and it's my right (braking and accelerating) ankle. This is one of my concerns. TIA x

I have two dodgy ankles - both shattered and dislocated pinned and plated both sides. Basically did the same thing to both but at different times.

I had a period of a couple of years when I had the same as you in the left ankle, severe pain, limping, sudden give ways etc and went back to GP and the only thing I was offered was fixing the ankle. But I felt it wasn't boney that was the issue - I couldn't get him to see that it seemed to be soft tissue, tendon and ligament but also some muscle in terms of easy cramping and so on. I have found sports massage and manipulation have helped and I don't get anywhere near as much pain and it does not give way any longer. I also have confirmed arthritis in both and they are sore and stiff sitting long periods and after sleeping

Thanks RB68, I'm hoping any tissue damage will show up on the MRI as that is a possibility too x

@JelleyKat

I hope you've seen a foot and ankle surgeon - The vast majority of GPs are not best qualified to determine whether an ankle fusion (or any other treatment) is likely to work.

@BringmeGin

I'm an orthopaedic foot and ankle surgeon - the most important thing is to find somebody who has an established practice in foot and ankle surgery and who is prepared to talk to you about the options and potential success rates - things to ask are:

1. Potential alternative treatments - ankle replacement, debridement / cheilectomy, and fusion, plus the non-operative things like splints, pain killers, injections etc.

2. What their personal success rates for each of the treatments are - importantly - infection, ongoing pain, non-union (very important) and need for re-do or revision surgery.

3)How the rehabilitation differs between the different treatments - some people keep you non-weightbearing on an ankle fusion for 12 weeks - i do for 2 weeks.

4. How they prefer to do their fusion surgery (and then look up the latest data) there's some early evidence that using a hindfoot nail is more likely to fail than plating or arthroscopic fusion (gold standard if it's technically feasible in my opinion)

5. If you do go down the route of a fusion - ask can it be done arthroscopically (keyhole), and if they say no, ask why not, and if it's because they don't do arthroscopic surgery, ask if they think you would benefit from being referred to a colleague that does.

Best of Luck!

@BringmeGin

I forgot to say - a lot of people worry hugely about reduced movement - but in reality an ankle joint that requires fusion is usually so stiff that almost no movement is lost, the movement you see normally comes from the midfoot joints.

Thank you Fixthebone, I will certainly come back to you when I've seen him again now that I've had the MRI. The surgeon I've seen is an established orthopaedic foot and ankle surgeon and having researched his experience I am happy so far. I do however still have a lot of movement in the ankle and strength is good too. It is just the sharp pain on weight bearing that is the problem. Hence my reluctance re fusion. I also practise yoga which I love and sorts out the rest of my body and I'm concerned it will restrict that. He has asked for an MRI to get the whole picture but diagnosis so far based on X-ray alone is severe arthritis. He is prepared to try an arthroscopy to clean it up if the MRI shows it to be feasible but I will discuss all that you have said when I see him next and let you know how I get on.

Hi Fixthebone, I value your opinion and hope you are still around to discuss when it comes to making a decision. In a bit more detail in response to the points you raised: the surgeon I saw is seeing me on the NHS but also is a private foot and ankle surgeon with his own established practise with much experience including military. I have read all the info on his private practice website and it seems they do everything arthroscopically. He initially said I was too young for replacement but he did raise his eyebrows when I said I had just turned 45, was 44 when referred. I later noticed on his website info that 45 is the youngest they would usually consider it. I guess I am hoping he may consider this depending on what the MRI shows. Although I am aware that fusion is the gold standard treatment, with the best success in pain relief, I am hypermobile and concerned about the effects on the rest of my body and joints of walking with an uneven gait. Even using crutches or a stick for a day causes other bits to hurt. So I do home yoga and stay strong and try to walk normally without limping, Dr has said if it looks like it might be successful he is prepared to try arthroscopic debridement which may buy me a few more years. I have 2 boys aged 7 and 14 and he seemed keen to improve my quality of life ie: pain! I don't know what cheilectomy is so will research that. I have tried an aircast splint (the one Andy Murray wears! A60 I think) but it's not comfortable in my shoes and the arch of my foot and hurts by the end of the day although I think it helps the ankle a bit. Injections don't seem to be recommended, my physio said there were risks in such a complex joint and risk of infection, also is there a limit to how long you can have them or that they are affective? Sorry if tmi!!! Been in bed with flu thinking about everything you said! TIA

Injections useful as a diagnostic tool to simulate what the pain relief might be like.

My experience is that most people with ankle replacement have some level of pain, and your age will almost certainly need a complex fusion later.

Like I say, see a surgeon who knows what they're doing and who can talk in detail about the options.

Cglheilectomy is just removing bone spurs...

Ok, will bear that in mind re injections and replacement. Thank you.

@BringmeGin sorry for the delay in responding. Re my dad who had the successful ankle fusion: yes he wears normal shoes and can drive.

Thank you Cloudpop 😊

Seeing the surgeon this afternoon for the results of my MRI. Grumpy in anticipation!!!

Don't know if anyone's still around but I'll update just in case! Diagnosis still the same and long term, fusion is still on the cards but next step is a steroid injection for the reason you said 'fixthebone'. Hoping it will give me not only some relief but some time before I need to consider surgery as I could have up to 3 of them and it's possible they could last up to 18 months each. Results vary so time will tell but I'm happy for now

Sounds like you're seeing someone sensible.

My last piece of advice is that now you know what the diagnosis is - whatever treatment you have is there for pain relief - if the pain isn't bad enough, put any operation off for as long as you feel comfortable with.

All the best with it all

I wonder if I'm actually seeing you Fixthebone!!!! But yes, looking forward to some pain relief . Thanks for your advice x

Hi all, (if any of you are still watching this thread!). The long awaited steroid injection in the ankle joint is due next Friday and I'm wondering how long I will need to be off it afterwards for it to settle before I can walk on it again. Can anyone advise please? @FixTheBone maybe?
TIA x

Depends on your job, but, it should in theory be much better for 6 hours or so after the injection, then a bit worse once the local anaesthetic wears off, then better a few days later once the steroid kicks in...

You should be able to walk and work same day, certainly by Monday. Make sure you keep a pain diary before and after.

Thank you, I was under the impression I needed to rest it for a period of time after the injection to let it settle. I might have to keep that to myself and rest up anyway as was I quite looking forward to a day of everyone one else running around after me for a change!!! 😂 although I must admit they have had to do more and more recently as it is only getting worse ☹️, and using crutches is surprisingly exhausting!

Silly question if you are still about @FixTheBone , having my steroid injection tomorrow 😁😁😁, should I remove my toenail varnish or is that only necessary for surgery? TIA x

I'd remove it if it isn't a massive hassle.

I don't think there's any evidence it'd make any difference to anything, but that won't always stop an admissions nurse with a checklist to follow from applying common sense....

No problem, have removed it, thank you. 👍🏻

I had my ankle fused 3 years ago. It really was the only option for me as my ankle joint was so damaged and walking was extremely painful.

Not going to lie, it was a massive op and a long, painful recovery but it has made a massive difference to my life. I can now walk without pain.

Downsides - I can't kneel or lie on my front as the toes just push painfully into the floor. No yoga anymore. My calf muscle has wasted away so no shapely legs anymore! Shoes are an issue - you can't wear completly flat shoes, wellies (you can't get them over the ankle) or any heels over an inch. I can't run (but I also have a buggered knee). Terrible toe cramps and now arthritis in my big toe joint as it takes all the impact for foot movement when walking

Upsides - no pain.

Thank you Ida, this is exactly what I was after when I posted x I think you are right, by the time you need a fusion you just want the pain gone and will take the consequences. I am getting there, went to bed early like it was Xmas eve I was so looking forward to my injection tomorrow but I'm up again taking painkillers for my hip on the other side because it's fed up with taking all the weight from limping & using a crutch. I feel as time goes on I have less and less to lose! No pain sounds good right now!!! I just hope the injection works for now but if not I am seriously considering the fusion x