Overview

Ankle and hindfoot fusion (arthrodesis) is the permanent stiffening of the bones, together with plates, screws and/or staples. The aim of fusion is to improve pain and function by removing arthritis and joint instability. After surgery, the pain caused by instability is eliminated as a result of complete motion restriction in the joint. Most patients find that losing range of motion in their ankle, is a fair trade off for pain relief and shoe wear modification with a rocker bottom shoe can help normalize their gait

Indications / Candidacy

Arthrodesis (bone fusion of 2 or more bones) of the ankle and hindfoot is commonly used to treat ankle and subtalar osteoarthritis and many types of painful foot deformities. With these conditions patients may experience severe pain, inflammation, and stiffness. Arthrodesis is indicated for patients who have been unsuccessful with more conservative forms of treatments.

Good Candidates for Arthrodesis of the ankle and hindfoot may have:

  • Ankle or subatalar osteoarthritis
  • Pain, decreased range of motion and swelling
  • Wearing away of the articular cartilage
  • Hardening of the surrounding bone
  • Damage to the cartilage cells
  • Failure to respond to more conservative treatment measures

Treated Conditions

The Canadian Limb Lengthening Center offers a team of experienced surgeons, nurses and physiotherapists that make patients feel supported throughout their entire treatment process. Our ability to treat complex orthopedic conditions with a holistic approach gives our patients the best possible outcomes. We pride ourselves in providing highly specialized, expert care. To learn more about ankle arthritis follow the links below:

Condition

Hindfoot arthritis and deformity

Surgical Technique

Arthrodesis can be performed either arthroscopically (with a camera) or with a traditional open approach. Arthroscopic fusions are done using two small incisions at the front or back of the foot. An open technique may be performed from the front, back or lateral aspect of the foot.

  1. You will be given general anesthesia to ensure your comfort throughout the surgery. Once inside the ankle/foot, any remaining cartilage is removed from the targeted joints.
  2. The bones will then be joined in the correct position using compression screws or other hardware such as plates or hindfoot nails.
  3. If necessary, other acute deformity correction/osteotomies can be made in the area to ensure the foot and ankle are in a good position at the end of surgery.
  4. Local or regional anaesthetic agent may be injected, in order to reduce post-operative pain.
  5. Your surgeon will then close the muscle and skin layers of your ankle and foot with stitches and your leg will be placed in a cast.

Results

A normal side effect from ankle and hindfoot fusion is reduced range of motion in the joint. For most patients this isn’t a major problem, as they are happy to have minimized or eliminate arthritic pain. Though range of motion is lost, pain relief allows most patients to return to activities that have been limiting. This increases function and mobility as well as tolerance for walking and decreased use of walking aids. A full recovery may take up to a year.

Potential Complications

As with any surgical procedure, arthrodesis to treat ankle arthritis and foot deformities can have difficulties and complications. In most cases, our team of specialists can address these concerns without compromising the end results or outcome. Complications and side effects may include:

  • Infection
  • Non-union
  • Damage to nearby nerves
  • Blood clot
  • Misalignment of the bones
  • New arthritis in nearby joints (this happens slowly over time and is a secondary effect of the fusion)

Pre-Operative Care

  • An extensive medical history will be taken during your initial assessments
  • It is recommended that you stay active, eat a healthy diet, and stop smoking prior to any operation
  • Certain medications and vitamins may need to be stopped several weeks before
  • Discuss all medications and over the counter drugs with your surgeon
  • Use a calendar or agenda to organize your pre and post appointment dates
  • Make arrangements for personal care givers

Post-Operative Care

  • Patients wear a cast for the first 1-2 weeks, the cast is then changed in clinic and a new cast is placed for another 4 weeks.
  • During the first 6 weeks, crutches are to be used and no weight is to be put on the foot
  • After the first 6 weeks in a cast, the patient is transition into a boot and allowed to weight bear
  • After 12 weeks, the boot and other walking aids should be removed
  • Once successful union has occurred, normal activities can be started

Follow-ups after surgery

  • Follow up one week after surgery to change the cast and verify that the wound is healing
  • Serial x-rays are performed to ensure fusion of the bones is achieved every 6 weeks
  • Consecutive follow-ups every 6-12 weeks throughout treatment course

Case studies

35 year old lady with ankle pseudarthrosis
70 year old man with pain with tennis and other activities

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Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.

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