Ankle fusion

[Mon Ami Mate]

Anybody here had an ankle fusion?

I'm about to have my right ankle fused after years of problems and five major operations. I'm looking forward to it from the point of view that it isn't going to hurt any more, but I'm quite anxious from the point of view of wondering what it's going to be like afterwards, what I'll be able to do, what I won't be able to do and what I might find difficult but achievable.

My consultant has been quite evasive when I've asked him specific questions, essentially saying that the results vary greatly from person to person.

I used to be very fit and active and during the course of the last five years I've been able to do very little. I want to get back to doing as much as I can. I'm not going to be able to run at all but it would be interesting to know if anybody has any experience of a fusion and can say if they are able to cycle, row, hike on uneven ground or play golf. The consultant has told me I don't need to notify the DVLA, although I'm struggling to understand how I'll be able to rapidly come off the accelerator of a car and apply the brake. I don't think motorcycling should be too much of a problem because the right foot operates the rear brake, and I hardly ever use that anyway. Can't think how I will be able to swim front crawl again or walk up steep, uneven slopes.

My other main concern is what it will mean for the rest of my body. What will happen to my calf muscle and hamstring and what effect might it have on my knee joint and back.

Any first hand information will be very gratefully received!

[dave_s13]

Mon Ami Mate said:

.....

My consultant has been quite evasive when I've asked him specific questions, essentially saying that the results vary greatly from person to person.....!

I don't think you'll get too much a response to this question as ^^^ is the answer really.

It's not that common a procedure too afaik.

You'll very like have a limp. You need the ankle motion in order to allow the leg to go through the stance/swing phases of gait so it will change the centre of pressure of the foot and may cause issues with callus build up underneath, might not though as well. It may also cause overloading of the forefoot joints as they compensate for the ankle and you could end up with arthritis over time, might not though too!!

Your calf muscle will likely reduce in bulk but it will still be pulling on the calc insertion and also at the femoral head so won't just disappear as such. the other muscles in that complex will still be acting on the mid/forefoot too.

I would think running would be very hard, it will put stress on the knee/forefoot that may cause problems. You might be able to cycle but it will feel weird until you get used to it and it may cause knee problems.

Basically, when you walk the lower leg rotates internally and externally, this movement is fcailitated at the subtalar joint (which you'll no longer have) and at the knee. If this moment is blocked it causes a dysfuction further up/down the kinetic chain and can cause problems. Then again, it might not too!! We are very adaptable creatures really.

You'll just have to suck it and see. One thing that can help with general walking about is a rocker bottom sole on the shoe. Once you're all healed up it's something an orthotist could help you with if it's a bother (via the GP).

You just have to accept that in order to get rid of the painful ankle you are not going to be competing in this years olympics.

Edited by dave_s13 on Tuesday 13th March 13:01

[Mon Ami Mate]

Thanks Dave, I think...

Out of interest, from where does your knowledge emanate?

[dave_s13]

Bloke down the pub.


actually I'm a podiatrist....I see a lot (too many) of pairs of feet/legs every day.

[sawman]

To slightly contradict Dave, your sub talar joint should not be affected by the fusion, so you will be able to have some movement in adjacent joints (unless they are fubared already)

Have a look at this link footandankleclinic

I dont know these chaps, but their website is excellent, with some great intra operative pics and good advice

[996 sps]

Mon Ami Mate said:

Anybody here had an ankle fusion?

I'm about to have my right ankle fused after years of problems and five major operations. I'm looking forward to it from the point of view that it isn't going to hurt any more, but I'm quite anxious from the point of view of wondering what it's going to be like afterwards, what I'll be able to do, what I won't be able to do and what I might find difficult but achievable.

My consultant has been quite evasive when I've asked him specific questions, essentially saying that the results vary greatly from person to person.

I used to be very fit and active and during the course of the last five years I've been able to do very little. I want to get back to doing as much as I can. I'm not going to be able to run at all but it would be interesting to know if anybody has any experience of a fusion and can say if they are able to cycle, row, hike on uneven ground or play golf. The consultant has told me I don't need to notify the DVLA, although I'm struggling to understand how I'll be able to rapidly come off the accelerator of a car and apply the brake. I don't think motorcycling should be too much of a problem because the right foot operates the rear brake, and I hardly ever use that anyway. Can't think how I will be able to swim front crawl again or walk up steep, uneven slopes.

My other main concern is what it will mean for the rest of my body. What will happen to my calf muscle and hamstring and what effect might it have on my knee joint and back.

Any first hand information will be very gratefully received!

Mate do you know what movement you will lose? Inversion/Eversion?

[996 sps]

sawman said:

To slightly contradict Dave, your sub talar joint should not be affected by the fusion, so you will be able to have some movement in adjacent joints (unless they are fubared already)

Have a look at this link footandankleclinic

I dont know these chaps, but their website is excellent, with some great intra operative pics and good advice

Hey good link that, looks like you'll lose some plantarflexion/dorsiflexion and to be honest i'm no subject matter expert to comment but what I will say from a motivational aspect look at what guys and girls are getting up to after the loss of limbs, however ever it affects your life you'll find something to keep your fitness up.

Would be interesting to hear what movement they said you would lose though?

[Mon Ami Mate]

Fundamentally I will have no movement in a vertical plane, up or down, whatsoever. Interesting link, thank you for that.

[dave_s13]

Sagittal plane.

They do sometimes fuse the subtalar joint too.

Def a case of suck it n see mate. There's no way of predicting the exact outcome apart from there being a resolution to your pain.

[The_Doc]

dave_s13 said:

Sagittal plane.

They do sometimes fuse the subtalar joint too.

Def a case of suck it n see mate. There's no way of predicting the exact outcome apart from there being a resolution to your pain.

Ankle fusion:

1) Tibio talar (ankle)
or
2) Subtalar (Talar-calcaneal)
or
3) Triple fusion (subtalar, calcaneocuboid, and talonavicular joints;)
or
4) Tibial-Talar-Calcaneal Fusion (hindfoot fusion)

all slightly different

your surgeon will have picked the right one, and can tell you what he's planning, but can't tell you how it will pan out in the long term, apart from making you better if it's a success.

Will
Orthopaedic surgeon

[Rikk]

Out of interest why is it being fused rather than replaced? Yes the replacement only has a finite life but you retain the ankle movement.
Having it fused will force the front of the foot to mobilise to compensate almost certainly causing arthritis in the area.
I had mine replaced due to arthritis last January, they wanted to fuse it due to my age (46 at the time) even though I have a tin leg the other side but after some discussion and a lot of research on my part I pushed for a replacement.
BTW, On the replacement side there is also allograft(joint replaced from a donor body)still very rare but coming along. No one was doing this in the UK when I was looking.

[dave_s13]

Rikk said:

Out of interest why is it being fused rather than replaced? Yes the replacement only has a finite life but you retain the ankle movement.....

Worth asking. Will might have a view on replacement joints. Not very common though

You could also ask on here

http://www.podiatry-arena.com/podiatry-forum/forum...

You should get some responses from podiatric surgeons.

[996 sps]

The_Doc said:

dave_s13 said:

Sagittal plane.

They do sometimes fuse the subtalar joint too.

Def a case of suck it n see mate. There's no way of predicting the exact outcome apart from there being a resolution to your pain.

Ankle fusion:

1) Tibio talar (ankle)
or
2) Subtalar (Talar-calcaneal)
or
3) Triple fusion (subtalar, calcaneocuboid, and talonavicular joints;)
or
4) Tibial-Talar-Calcaneal Fusion (hindfoot fusion)

all slightly different

your surgeon will have picked the right one, and can tell you what he's planning, but can't tell you how it will pan out in the long term, apart from making you better if it's a success.

Will
Orthopaedic surgeon

There is your subject matter expert then, interesting what can be done, I was born with unilateral talipes so lack inversion and eversion. Starting to pay the price at 37 but hey ho.

[Mon Ami Mate]

Rikk said:

Out of interest why is it being fused rather than replaced? Yes the replacement only has a finite life but you retain the ankle movement.
Having it fused will force the front of the foot to mobilise to compensate almost certainly causing arthritis in the area.
I had mine replaced due to arthritis last January, they wanted to fuse it due to my age (46 at the time) even though I have a tin leg the other side but after some discussion and a lot of research on my part I pushed for a replacement.
BTW, On the replacement side there is also allograft(joint replaced from a donor body)still very rare but coming along. No one was doing this in the UK when I was looking.

Because of the nature of the damage to the ankle and the surrounding area and because I'm "only" 43 years old. I should explain, I first had the ankle broken in 1989 when I was 21 years old. I was knocked off a motorbike by a mad taxi driver. It was quite a messy break but it happened where the ankle ligaments join the ankle. At the time I had my hopes focused on playing rugby and I was earmarked for some success in this. I was told that I should stop playing rugby, but I didn't want to listen to this so I kept going regardless. The result was that I broke the ankle three more times before being forced to retire and the ligaments kept ripping away from the joint. Eventually I was forced to stop playing rugby, and no sooner had I done this than I completely ruined the ankle again by stepping into a rabbit hole in the dark in the middle of nowhere and then having to walk three miles home across country with my foot hanging off. Following this I had a complicated restructuring of the joint, which has left it with very little movement and arthritic. I was in plaster for months and during the course of this was sacked from my job by text message.

Since then the ankle has been getting worse and worse. I've had a couple more ops to tidy it up and remove floating bone and osteophytes, but as things stand it's all held together with metal pins, I'm in constant pain, living on painkillers which mess up my stomach, I can't sleep well and I can't do most of the things I love doing. It has held back my career and my social life and affected every part of my activities. I've gone from being a fit, active, strong, optimistic, outgoing bloke with a great career to being a fat, miserable, largely housebound, permanently broke, cynical mess. I'm fed up with it.

Apparently the replacement technology has a long way to go to provide a long term solution, especially on somebody of my age, and the consultant thinks a fusion will give me better results.

[dave_s13]

http://www.podiatry-arena.com/podiatry-forum/showt...

[Mon Ami Mate]

Thanks Dave, that has seriously made me wonder if I should run away.

[Mon Ami Mate]

My consultant has said that a replacement may only last for a maximum of five years. I'm a biggish bloke - 18.5 stone and over 6ft. He has said that he would consider it if I was a small woman who didn't aspire to an active lifestyle.

[bucksmanuk]

Mon Ami Mate said:

no sooner had I done this than I completely ruined the ankle again by stepping into a rabbit hole in the dark in the middle of nowhere and then having to walk three miles home across country with my foot hanging off.

I feel a bit queasy now....
Hope it all goes OK, I know someone who has had parts of both wrists fused in some manner. She struggles every now and again but is making excellent progress all things considered.

[RRS_Staffs]

dave_s13 said:

Worth asking. Will might have a view on replacement joints. Not very common though

You could also ask on here

http://www.podiatry-arena.com/podiatry-forum/forum...

You should get some responses from podiatric surgeons.

Would a podiatrist be able to give better advice than an orthopaedic surgeon?

[dave_s13]

RRS_Staffs said:

Would a podiatrist be able to give better advice than an orthopaedic surgeon?

It depends who you ask.

A plain podiatrist, no. A podiatric surgeon, maybe.

A podiatric surgeon is a podiatrist that undertakes several years (5-7) post grad training to gain the title and they do hold consultant posts in some NHS trusts. I'm not claiming to be the expert in this though.

If it were my ankle and I wasn't 100% sure about what was being offered I would probably seek a second opinion from a pod surgeon. I really would hate the thought of having my ankle fused and I feel for the OP, it's not nice, especially wehen you've been very fit in the past. Depending on where in the country the op is it may be worth asking on the forum I listed before for a recommended ankle specialist?

Saying that the OP consultant might know exactly what he's on about and fusion may be the only option.