Ankle fusion FAQs

When I began posting about my accident and recovery on social media, I started to receive fairly regular messages from people who were contemplating or facing an ankle fusion. They had questions that they were unable to find online or had been too hesitant to ask their surgeon. Let’s face it, who would really be comfortable discussing their post-fusion shoe options in a serious medical appointment? I found the same questions kept coming up, so I have compiled a list of those most frequently asked.

Usual disclaimer here; Obviously I am not a medical professional and my answers are purely subjective. If in doubt, consult an orthopedic specialist.

How much does it hurt?

The bad news is it does hurt. However, I know that those for whom an ankle fusion is being suggested, is probably no stranger to ankle pain already.  The fusion was definitely not the worst thing I have had done to me medically, but there was significant post-operative ache. I was discharged with codeine, but I found I could manage the pain effectively with ibuprofen.

How long before I can start weight bearing?

A fusion is a big operation and ensuring that the bone heals in the correct position is crucial.  A lack of pain is no indication that the bone is fusing and there is no way to know that a successful fusion is occurring without an x-ray. Early or imprudent weight bearing can affect the success of the outcome of your fusion, so just don’t do it. I did not bear weight for 12 weeks and this is a  fairly average time frame.  The most important thing is to listen to your surgeon and don’t be impatient.

When can I start running again?

As with the above question, this is one for your surgeon. Do not try to rush the process and literally run before you can walk. Not only could you damage your chances of a successful fusion, but it will also really hurt. Take your recovery slowly and build up your strength. Your ankle will let you know when you’ve pushed it too far with a deep bone ache that will make sleep impossible. The most I can manage is a lopsided jog even now, but I have other orthopedic issues that compound my ability to run.

When will it stop hurting?

That intense bone on bone grinding pain that most of us live with before an ankle fusion will be gone, but a deep arthritic ache in the joint will initially replace it. As your ankle heals and your recovery continues, this ache will lessen over time. I am now 4 years on and my ankle now only aches deeply in cold, wet weather or if I have over exerted myself. It grumbles to itself but not enough to need pain relief.

Will I walk with a limp?

There will be a slight limp when you walk, but this will be imperceptible in the right shoes. I only limp visibly when walking barefoot or on hills. Slowing down and concentrating on reducing your stride length can improve a limp. A professional gait analysis can help you identify bad habits in your walking pattern that make an uneven gait more pronounced. Stairs can present a challenge if the tread is too narrow or high, so make sure that you use a handrail. 

Will I have to wear orthopedic shoes?

There’s some good news and bad news. Thankfully, the catalogue of orthopedic shoes that you may have seen in the waiting room is not your only option. In fact, I bought a pair of those hideous rocker bottom shoes at great expense and found them wildly uncomfortable. The bad news is that some shoe compromises have do to be made. I have become slightly obsessed with tracking down the perfect post-fusion shoe, which you can read about here.

Will my ankle look ugly?

This is one question that I was too embarrassed to ask my surgeon, lest he think me full of foolish vanity. The surgery leaves minimal scarring, in fact most of the visible damage to my ankle was caused by the accident and repeated trauma surgery to my lower leg. If you have no trauma injury or existing metalwork, then the only scarring should be two small incisions. 

What about my leg?

About one year after the fusion, I realised that my calf muscle had completely wasted away through inactivity. My lower leg is now, in stark contrast to my good leg, the same width from knee to foot. Is this noticeable to anyone but me? Probably not, but it still makes me self conscious. Cosmetic calf implants are available if this is something that you feel will significantly affect your confidence.

Are there any unexpected side effects?

One problem that I was unprepared for is the constant cramps in my foot and calf. I jump out of bed at least twice a week and hobble desperately around the bedroom relieving a cramp to the bemusement of my husband and startling the dog.

The other more serious issue is the start of arthritis in my big toe joint. This is caused by the added pressure that the ankle immobility places on it.

Will I still be able to do yoga / pilates / rock climb..?

You should be able to continue with most sports, but modifications will be necessary. The only sport that would be ill-advised is gymnastics or other activity that involves a high impact shock absorption in the joint. Your knees are now going to be working extra hard to compensate for the lack of ankle movement, so protect them. Your roller derby weekends and ice skating will be at end. Bear in mind also, that balancing will be more difficult post fusion, so perhaps give up slack lining and trampolining and take up paddle boarding instead.

Is it the right decision for me?

Unfortunately no-one can answer that question for you. An ankle fusion is an irreversible decision, so take your time. Remember the journey that brought you to this point and it is most likely one of pain and limited mobility, a fusion can free you from this.  

Do you have a question that is not covered above? You can reach me via direct messages on Instagram or by contacting me through the website. If you have any experiences of a fusion that you would like to share, I’d love to hear from you.

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