What is it?
A fusion (arthrodesis) removes the remaining worn cartilage from an arthritic joint and holds the bones together with screws or plates until they heal into one solid bone. Because the painful joint no longer moves, the pain from it is relieved. The same principle can be used for the ankle and for the joints of the hindfoot and midfoot.
Who might it help?
- Advanced arthritis of the ankle, hindfoot or midfoot
- Pain that still limits daily life despite non-surgical treatment
- Arthritis combined with deformity, or after previous injury or surgery
- Some cases where an ankle replacement is not suitable
Is it right for you?
Treatment is tailored to your individual needs, symptoms and goals. Surgery is only recommended when it is likely to help, and non-surgical options are always discussed first.
Mr Jeyaseelan will talk you through the benefits, risks and alternatives for your situation at your consultation.
What does it involve?
- It's done under a general or regional anaesthetic, often with one or two nights in hospital.
- Depending on the joint and its alignment, it may be done as keyhole (arthroscopic) surgery or through an open incision.
- The joint surfaces are prepared and the bones fixed in the best position for walking.
Before your operation
- You'll have a pre-assessment check, usually a week or two before surgery, including blood tests if needed
- Stop smoking, ideally at least six weeks before, as it slows bone and wound healing
- Arrange help at home for the first couple of weeks, and someone to take you home
- Prepare your home: clear walkways, and put everyday things within easy reach
- If you'll use crutches or a knee scooter, practise beforehand
On the day
- You'll be asked not to eat or drink for a few hours beforehand
- The anaesthetist will discuss the anaesthetic with you, often a general anaesthetic with a nerve block to keep the foot numb for several hours afterwards
- Mr Jeyaseelan will see you before the operation to answer any questions and mark the leg
- Before you go home, you'll be shown how to use crutches and given pain relief and written instructions
Recovery
You'll usually need to protect the foot in a plaster or boot, with limited weight bearing, for around six weeks or more. The bones typically take around three months to fuse. Most people go on to walk comfortably on level ground, though the joints next to the fusion take more strain over time.
Foot raised most of the time, in a plaster, with limited or no weight bearing.
In a plaster or boot, with weight bearing as advised.
X-rays check healing. Weight bearing is increased in the boot.
Once the bones have fused, you move into normal shoes and build up walking and activity.
These times are typical only. You'll be given a personal recovery plan.
Getting back to normal
- Driving
- You can usually drive once you're out of a boot and can do an emergency stop safely. After right-foot surgery this is often six to eight weeks or more. Check with your insurer.
- Work
- Desk-based work is often possible after two to six weeks if you can keep the foot raised. Jobs that involve standing or walking take longer.
- Sport
- Low-impact exercise, such as cycling and swimming, usually comes first. Running and contact sport come later, once strength and movement have returned.
- Flying
- Long-haul flights are usually avoided for at least six weeks after foot and ankle surgery because of the risk of blood clots. Ask before booking travel.
Possible risks
As with any operation, there are risks. They include:
- The bones not joining (non-union), which is more likely in smokers and people with diabetes
- Infection or wound healing problems
- Nerve damage causing numbness
- Blood clots in the leg or lungs
- Healing in a less than ideal position
- Arthritis developing in nearby joints over the years
Alternatives
Non-surgical options include activity changes, pain relief, supportive footwear, braces and injections. For some ankles, an ankle replacement may be an alternative that keeps movement.
Conditions this may treat
Common questions
Where can I have ankle and hindfoot fusion in London?
Mr Lucky Jeyaseelan, a consultant orthopaedic surgeon who specialises only in the foot and ankle, sees private and insured patients with problems that may need ankle and hindfoot fusion at Align Orthopaedics on Harley Street, The London Clinic on Devonshire Place, HCA London Bridge Hospital, HCA UK at The Shard, HCA UK City of London on Old Broad Street and The Holly Hospital in Buckhurst Hill, Essex. See all clinic locations or request an appointment. If surgery is right for you, he will discuss which hospital suits you best.
How long is recovery after ankle and hindfoot fusion?
You'll usually need to protect the foot in a plaster or boot, with limited weight bearing, for around six weeks or more. The bones typically take around three months to fuse. Most people go on to walk comfortably on level ground, though the joints next to the fusion take more strain over time. Your own recovery plan will be tailored to you.
Is it covered by health insurance?
Mr Jeyaseelan is recognised by major insurers including Bupa, AXA Health, Aviva, Vitality and WPA. Cover depends on your policy, so please get an authorisation code from your insurer before your appointment.
Do I need a GP referral?
Self-funding patients can book directly, though a GP letter is helpful. Most insurers need a GP referral before they authorise your consultation, so check with yours first.
This information is general and is not a substitute for a medical consultation. Your diagnosis and treatment plan will be tailored to you.