When is an Ankle Fusion a Better Idea Than an Ankle Replacement?

Ankle arthrodesis or fusion procedures have been around for many years. They were previously considered the gold standard to treat end-stage arthritis of the ankle before ankle replacements were developed and became more reliable and popular.

Although ankle replacements have become much more common, ankle arthrodesis procedures are still a good option to treat arthritis and deformity in the ankle in certain patients. Some of the common reasons we recommend an ankle fusion over replacement are severe valgus deformities of the ankle, neuropathy or lack of feeling in the foot and ankle, Charcot ankle deformity, and severe obesity.

Varus type deformities of the ankle can typically be corrected pretty well with an ankle replacement, but valgus deformities are more difficult for an ankle replacement to really stabilize well. Valgus deformities of the ankle typically present with a flatter foot type and loss of arch height. The valgus deformity is unstable medially over the deltoid ligament, so an ankle fusion can give patients a more stable ankle to walk on and be more reliable long-term than an ankle replacement.

Diabetic Charcot neuroarthropathy also predisposes ankle replacements to fail and subside and typically the bone quality is not as strong to accept the ankle replacement well. We typically recommend ankle fusions in these cases as well to try to make the hindfoot and ankle more stable for patients to walk on.

Specialized, custom braces called ankle-foot orthoses (AFO) can be utilized to try to stabilize the hindfoot and ankle to avoid surgery. If this does not work and patients still have pain with the brace, ankle and hindfoot fusions can sometimes be helpful.

If you are having any foot and ankle pain, call our expert Colorado Springs foot and ankle surgeons today at 719-488-4664. Dr. Hinderland, Dr. Cameron, and Dr. Dominick are all part of our team at Foot and Ankle Institute of Colorado, to help keep you active and on your feet!

Author

Dr. Matthew Hinderland Board Certified Podiatrist and Foot and Ankle Surgeon