Ankle/Subtalar/Foot Fusion Surgery
Fusion surgery is indicated for severe arthritis in ankle, subtalar, or foot joints that causes significant pain or impacts your function. The surgery involves removing damaged joint surfaces and using plates and screws to hold bones in position while they fuse together. This eliminates joint movement but typically provides significant pain relief and improved function, particularly walking.
Understanding the problem
Foot and ankle joints bear full body weight with each step. When cartilage is worn away, bone-on-bone contact occurs which can cause pain and stiffness. When conservative treatments, including anti-inflammatory medications, injections, bracing, or activity modification fail to provide adequate relief, fusion surgery becomes an option.
The technical aspects
After your anaesthetic, often a spinal anaesthetic (needle in your back to numb your legs), Dr Brooker prepares your foot and leg with a sterile wash and makes a cut over the affected joint. Once the joint is exposed Dr Brooker removes all the damaged bone and cartilage and puts plates and screws across the joint to hold it together. Sometimes a bone graft is required to encourage healing, and this may be taken from another area of your body such as your pelvis. The important part of the operation is that bone grows across where the joint used to be to create a solid fusion. The plates and screws simply hold the joint in place until this occurs.
Once Dr Brooker is happy with the position of the plates and screws the wound is washed and closed, often with non-dissolvable sutures, and a dressing applied. Dr Brooker may put a plaster or a boot on your ankle to keep it still while the bones heal. You are then moved to the recovery area of the operating theatre before returning to the ward.
Recovery process
Recovery from fusion surgery requires strict adherence to weight-bearing restrictions. This is required to allow bone to grow across the old joint. If this doesn’t happen then the plates and screws will eventually break and pain will recur. The time you are not allowed to weight bear (walk) on your foot depends on the joint involved and the speed of bone growth but is typically 8 – 12 weeks. This may be longer in certain situations such as patients with diabetes, soft bone or larger (ankle) joints.
No weight can be placed on the operated foot during this period. Mobility aids including crutches, walking frame, wheelchair, or knee scooter are required. Premature weight-bearing may disrupt fusion and cause complications including revision surgery.
The hospital stay ranges from same day surgery to multiple nights in hospital, depending on which joint is fused and how mobile you are with crutches or a frame. You may have a plaster, boot or special walking shoe on discharge and for multiple weeks.
The general recovery timeline is a period of non weight bearing for 8-12 weeks followed by gradual return to weight-bearing and then weaning boots or special shoes. Physiotherapy is often useful during this period. Full recovery typically takes 4-6 months and longer for large joint (ie. ankle) fusions, with improvement continuing up to one year.
Movement considerations
The impact of this depends on the joint being fused. Loss of ankle joint movement, for example, is usually quite evident and may require shoe modifications to walk comfortably. Subtalar joint fusion is less noticeable and may only cause discomfort on uneven ground. Midfoot joint fusion in isolation is rarely noticeable but often benefits from arch support insoles.
Long-term considerations
The plates and screws typically remain permanently in place, becoming incorporated into your bone structure, although they may be removed if required after 12-18 months, once bone healing and fusion is complete. Joint fusion and associated stiffness increase the stress placed on the adjacent joints which potentially leads to adjacent segment arthritis over time. This requires consideration but does not contraindicate surgery. Success rates of fusion surgery are high, with most patients achieving significant pain relief and functional improvement.
Potential complications
The primary complication of joint fusion surgery is non-union, or failure of the bones to fuse (bone to grow across the old joint). Risk factors include smoking, diabetes, and previous joint infection. Smoking significantly impairs bone healing, to the point where Dr Brooker will insist that you quit smoking prior to any fusion surgery. Other potential complications include infection, nerve damage, and hardware problems. Most complications are manageable but may extend recovery and require additional procedures.
Surgical consultation
At your consultation, Dr Brooker will assess your condition, identify the affected joints (which may require a scan), and discuss treatment options. If surgery is indicated or considered then realistic post operative recovery, including non weight bearing timeframes, will be discussed. The reality of joint fusion surgery is that success requires strict adherence to weight bearing restrictions over many weeks or months, which can be difficult, and this is important to recognise and plan for before any operation.
