Ankle Fusion Problems
Ankle fusion is a procedure that is mostly performed for end-stage ankle arthritis. It joins the tibia (leg bone) with the talus (ankle bone). The bone surfaces are surgically prepared to expose bleeding bone and usually screws are placed to press the surfaces togeather. Fusion alignment usually is set with the foot at 90 degrees.
PAIN AFTER FUSION
Ankles can become painful after fusion for the following reasons:
1. Adjacent foot joint arthritis. This commonly is seen a few years after fusion or sooner if there was arthritis already developing in the adjacent foot joints.
2. Non-union of ankle fusion (also called pseudoarthrosis). When bone growth across the fusion is incomplete. Screws will often loosen or break when there is a non-union.
3. Malunion. Ankle fusions are sometimes not fused in a perfect position. The foot itself can have deformity in other bones or joints. Likewise, the leg can be malaligned making it difficult to optimize the fusion position, or the joint being fused can have distorted anatomy that makes fusion difficult. Any or all of these factors can lead to a painful malunion.
4. Loss of gait symmetry. If the adjacent joints in the foot do not move well after ankle fusion, an altered gait pattern can occur which can lead to leg, pelvis, or back pains all induced by the lack of movement at the ankle level.
TREATING PAIN AFTER FUSION
There are some treatment options for patients with a symptomatic ankle fusion.
1. Rocker shoe modification.
2. Arizona brace.
3. Off loading Ankle-Foot Brace.
4. Surgical revision of the non-union or malunion.
5. Ankle Fusion Reversal and placement of total ankle.
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