Ankle is a tough and durable part of the body where the bones of the lower leg and the top of the foot connect. This joint is also prone to injury if bones are weak, cartilage is worn out and tendons are not strong enough or if the person is suffering from arthritis that may be a result of normal wear and tear due to aging which causes pain and stiffness and difficulty in walking. Depending upon the level of severity of injury, doctor may suggest the non surgical treatment option like resting the joint, pain medication (anti-inflammatory medicines), a brace or other support, physical therapy, recommending a new pair of more supportive shoes. In some of the cases, cortisone injection or lubrication injection may also help in relieving the pain. When patient has severe pain and dysfunction of the ankle, doctor may recommend surgical solution such as ankle replacement surgery or ankle fusion (arthrodesis). Some of the common reasons for considering the ankle surgery are as following:
• Osteoarthritis – occurs due to aging or degeneration that can deteriorate cartilage resulting in pain when bones and cartilage rub together.
• Rheumatoid Arthritis – an autoimmune disease that causes severe and chronic inflammation of the joints.
• Bone Injury – joint dislocations, fracture or chronic pain (post –traumatic)
• Infection – such as septic arthritis
Ankle fusion is more common option than ankle replacement as it lasts longer and doesn’t require as many long term activity restrictions. This surgery is more recommended for people at a younger age having more active lifestyles. In this procedure, damaged ankle bones are fastened together with metal plates and screws. Over the period of time, the bones fuse into one combined bone. This may relive the arthritis pain but also reduces the ankle joint movement making patient to walk with a slight limp.
Another surgical option is ankle replacement also known as ankle arthroplasty which is considered to be a safe and very effective solution for the person dealing with persistent ankle pain. Ankle replacement is operation to replace the damaged bone and cartilage in the ankle joint with the artificial joint parts or prosthetics which can relieve pain and motion in the injured or arthritis ankle joint. This surgery provides more mobility but does not last as long as ankle fusion for some people and have more risks of developing arthritis in the nearby joints. It may not be a good option for people having weak ankle ligaments misaligned ankle bones or damaged nerves due to diabetes or other medical conditions. Ankle replacement is generally recommended for 60 years and above patient who doesn’t participate in high impact activities like running and who are not obese.
Ankle replacement surgery may include some risks and complications but not limited to:
• Nerve or blood vessels injury
• Bone fracture
• Blood clots
• Slow healing of the wound due to diabetes or rheumatoid arthritis.
Ankle replacement surgery is performed under a general anesthesia that will put patient to temporary deep sleep and not feel pain, spinal anesthesia in which patient will be awake but will not feel any pain below the waist along with the medicine to keep patient relaxed during the surgery or will be given nerve block. During the surgery, surgeon will make an incision in the front or on the side depending on the type of implant being used to expose the ankle joint. Surgeon will then push the tendons, nerves and blood vessels gently to the side for the placement of the metal and plastic components that re-create the ankle joint. After putting back the tendons into place, surgeon will close the wound using stitches or staples. Post surgery, Patient may require wearing a splint, casting or bracing for a while to keep the ankle in place and needs to stay at the hospital for 2-3 days or till the time he/she can walk safely with the help of crutches or a walker and advised not to put any weight on the ankle for several weeks. Doctor will perform x-rays to see the healing progress and whether to advance weight bearing or continue the crutch usage. In case of swelling, tingling pain or numbness in foot, foul smelling (green or yellow) drainage, high temperature or chills patient should inform the doctor immediately.