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What is ankle and foot fusion surgery?

Ankle and foot fusion surgery consists of procedures that fuse two or more bones together in the ankle or foot.

Why it's done

Ankle fusion

The most common reason an ankle fusion is performed is to correct damage due to degenerative arthritis in the ankle. Degenerative arthritis of the ankle wears down the protective cartilage surrounding the joints in the ankle. The cartilage allows the bones to glide in and out of the joints smoothly, so loss of the cartilage causes the bones to rub against each other painfully. Loss of cartilage can lead to other problems in the ankle, such as bone fractures and bone spurs. A bone spur is a bony growth that usually forms on the edge of an irritated joint. It is caused by the loss of cartilage and is formed as the body attempts to grow more bone to protect the irritated area. Bone spurs can cause further damage to the surrounding tissue and become a very painful symptom of degenerative arthritis in the ankle. Ankle fusion is also performed to correct misalignment of the ankle bone and to repair severe bone damage due to injury.

Foot fusion

Foot fusion surgery is also typically performed due to degenerative arthritis or injury in the foot. The joints in the foot most commonly affected by degenerative arthritis are the hindfoot, midfoot and the great toe. Each area of the foot works individually to provide balance, support and mobility for the rest of the body. When joints become damaged it can be very painful and debilitating and often will need to be corrected with foot fusion surgery.

Types of treatment

Ankle fusion surgery

  • Open ankle fusion surgery—The surgeon makes an incision in the ankle, then surgically removes the damaged cartilage surfaces from the joint. This creates a level bone surface to help aid in fusion. Then the surrounding bones that attach to the joint are aligned properly against the joint. Large metal screws are then inserted into the bone to hold the bones together while they fuse.
  • Arthroscopic ankle fusion surgery—During this procedure, the surgeon uses an instrument called an arthroscope to help with the fusion. The arthroscope is a miniature camera inserted into the ankle joint through a small incision. The surgeon then inserts other instruments into the ankle to remove the cartilage surfaces from the joint. Once the surface of the joint is prepared, screws are then inserted through small incisions into the bone to support them as they fuse together.

Foot fusion surgery

  • Hindfoot fusion—In the hindfoot section, there are three joints: the subtalar joint, talonavicular joint and the calcaneocubid joint. This type of foot fusion surgery consists of fusing one or more of the three joints in the hindfoot region. If only the subtalar joint is being fused, then one incision will be made on the outside of the foot below the ankle. Double and triple fusion will require an extra incision to be made on the inside of the foot. After the surgeon removes the damaged cartilage and aligns the joints and bones properly, metal screws are inserted to keep the bones in place while they fuse.
  • Midfoot fusion—The joint in the midfoot joins together the smaller midfoot bones to the forefoot bones. This procedure involves fusion of one or more of the joints in the midfoot section. The surgeon will remove the damaged cartilage, realign the bones properly and insert metal fixations to keep the bones in place as they heal together.
  • Great toe fusion—The great toe joint is where the great toe bone connects to the first metatarsal (big toe). This foot fusion surgery aims at properly aligning and making the great joint solidly immobile. After the cartilage is removed from the affected joint, the bone is prepared for fusion. The joint is then positioned in order to maximize walking ability and maintain weight bearing position. The joint is fixated with screws or a plate to maintain proper placement as the bone fuses.

Each individual fusion surgery will often use bone graft material to cover the joint and surrounding bones to augment the fusion process.

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