Mr Tristan Barton

Consultant Orthopaedic Surgeon

All aspects of foot and ankle surgery including complex hindfoot reconstruction, Arthroscopic (keyhole) surgery, Forefoot reconstruction including bunion surgery

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Ankle fusion

Osteoarthritis can occur as a result of general wear and tear of the cartilage in your joints. This is often a consequence of a previous ankle injury. Cartilage covers the ankle joint like a carpet, and protects the joint as you move. When this cartilage starts to wear out, it can result in pain and stiffness. If osteoarthritis develops within your ankle, you may notice some swelling around the joint, and it may become increasingly difficult to walk. If a patient comes to see me with these symptoms, I have two main priorities:

Address your pain
Improve your quality of life by enabling you to be more mobile and helping you to regain function.

There are various treatments available, and I tend to start off non-operatively. We will initially discuss your ankle and the effect this is having on your mobility. This will be followed by an examination of your ankle and obtaining further x-rays of your ankle if needed. These x-rays will confirm and indicate the severity of any osteoarthritis in your ankle. With a confirmed diagnosis, we can then discuss all the treatment options available to you.

If your osteoarthritis is advanced and hasn’t responded to non-operative treatments, the best option may be a surgery. The two main surgical options available to you are an ankle fusion or an ankle replacement. Both of these options will reduce the pain from your ankle. A fusion will result in a stiff ankle, whilst a replacement will maintain some ankle movement. Both operations have a high success rate, and there are pros and cons to each procedure. I will discuss each procedure with you, so that we can find the best solution that is tailored to your needs and expectations.

An ankle fusion is a reliable method to reduce pain from an arthritic ankle, and improve your general mobility. Although the ankle is stiff as a result of this surgery, your pain is significantly decreased. This improves both your mobility and your quality of life.

How is ankle fusion performed?

In the past, ankle fusion was typically performed under general anaesthetic as an open procedure and was considered to be major surgery. With recent improvements in both techniques and instrumentation, we can now perform ankle fusion surgery using arthroscopic (keyhole) techniques. I specialise in such techniques, so will typically opt for this less invasive approach. By operating arthroscopically, I only have to make small incisions that reduce both the risk of complications such as infection and your overall recovery time. Smaller incisions mean less pain, and enable you to leave the hospital much sooner.

X-rays and other diagnostic scans will be used first to ensure a safe and effective surgery is planned in advance.

When performed arthroscopically, I would make two small incisions at the front of your ankle, allowing access to your ankle joint for the camera (arthroscope) and surgical instruments. I then remove what remains of the cartilage and align the bones, using a motorised shaver to remove parts of the bone. Once aligned, it is held in place by two screws placed across the ankle joint. Any incisions are then closed and held with stitches, before I apply a below-knee half cast.

Normally you will need to stay in our facility overnight to make sure there are no immediate concerns, and to check that your post-operative pain is under control. Our dedicated physiotherapy team will be on hand to help show you how to safely mobilise using either crutches or a walking frame.

What does the recovery process look like?

I will see you again after 2 weeks to assess your progress, removing the plaster and any sutures. I will then fit you with a full fibreglass cast, which will allow you to begin bearing some weight on the affected foot.

After 8 weeks, I will take another x-ray to confirm that the ankle fusion is healing. You will be placed in a removable walking boot that you can put all your weight through when standing and walking. I will then see you again after another 4 weeks and, if all is well, allow you to start walking in normal shoe-wear. My physiotherapy specialists will again work with you as you get used to the new position of your ankle. Although running will be difficult, most patients find they have more mobility than before the surgery, and walking is significantly easier.

A full recovery will often take around 6 to 9 months, so any swelling up until this point is to be expected and is no cause for alarm.

What are the risks of surgery?

As with any surgical procedure, there are certain risks to be aware of. Blood clots, heart problems, infection, and stroke are all potential risks of general anaesthetic, albeit very low.

Issues can arise around your scars, particularly just after the operation, where there may be some residual numbness. Later on, your scars may feel sensitive, and massage of the scars with bio-oil will help this to settle down.

A ‘non-union’ is where the bones fail to heal together, and occurs in around 5% of patients. The risk of this increases if you smoke, which is why I advise all patients facing ankle fusion surgery to give up smoking beforehand, so as to maximise the potential for success. Very occasionally the ‘non-union’ is painful and the fusion surgery needs to be repeated.

Your ankle joint will be rigid following the surgery, and you may find that other joints around the foot and ankle will be stiff too as a result of having been immobilised for a long period. This should improve over time and is helped by physiotherapy. It is possible that arthritis will develop in some of the neighbouring joints due to these joints compensating for the fusion, but this only tends to occur after 10 years.

Why should I book a consultation at Sulis Hospital Bath?

Every patient is unique, coming to me with their own specific needs. This is why we prioritise personalised care at Sulis Hospital Bath. Backed up by a multi-disciplinary team at every juncture, I can get you a prompt diagnosis, developing a treatment plan to improve your quality of life efficiently and effectively.