Ankle Fusion, Replacement or Amputation?

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Hi all, looking for someone with first hand experience and thoughts - but feel free to add any updates!

 

?About 16 years ago I had a bad accident when I was knocked off my motorbike. I suffered multiple fractures of Tib + Fib, Talus and Medial Mellolus of the left leg/ankle. Over the years I have had internal nailing and fixation, tendon graft, tendon lengthening and a successful subtalar fusion. All the metal work has been removed.

?My ankle joint (tib/fib to talus) is in a very poor state of osteoarthritis. In Feb 2016 I had a debridement to remove spurs and to tidy things up. At that point I had 10 degrees of movement (plantarflexion) and could get the foot to neutral. Obviously not movement side-to-side following subtalar fusion.

?Now my foot is getting more painful again as the ankle joint is becoming more deformed and is pretty much bone-on-bone. My Consultant has ruled out doing any further debridement as just being a bit of a waste of time/money. My options seem to have come down to 1) Do nothing, take painkillers which can't go on forever, 2) a Total ankle replacement - which my Consultant is a bit hesitant about, I'm too active, tib/fib/talus alignment isn't as good as it could be and given I now only have about 5 degree of movement I'm unlikely to find any improvement in range of movement 3) Ankle fusion - most stable and pain free but with the subtalar already fused I'll have a solid foot with problems going up/down gradients, risk of further joints becoming arthritic etc 4) perhaps consideration to have BTK amputation, possible to recover to be able to run and walk and good function but of course not an easy route to take and has its own cons.

?I'm really struggling to make a choice. I know everyone is different but as someone who is active - gardening, running, cycling, walking the dogs and still young (46) I'm really worried about the outcome of a fusion. I'll not have the pain but how much will I be able to do? An ankle replacement might keep some motion but runs the risk of further surgery quite soon because of my activity levels (or at least desired activity). Maybe an amputation would ultimately result in a better outcome, no pain, learn to walk/run again and be quite active albeit with modifications to support living at home/work etc.

?If anyone has any thoughts or advice please share! Thank you!

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  • Posted

    Hi Jonathon. I will reply to you later as I am sure we can help each other.

    Mine was failed surgery 40 years ago which left my ankle in a state like yours.

    I had TAR 10 years ago.

    This had to be revised to ankle fusion in March as joint was too bad to try revision.

    The consultant has also made it clear that BRK amputation could have been, and may be in future an option.

    My problems have been getting my head round it as well as the physical impact it has. I too am active.

    I will message later as just off to do some gardening work

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    • Posted

      Hi Jude,

      ​Thanks for your reply....hope the gardening went as well as you hoped for!

      ​So curious if your TAR and subsequent fusion were just for the ankle or included the subtalar joint as well? 

      ​Seems similar concerns about getting my head around the options and physical/mental impacts. Be good to hear back from you! Thanks Jon

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  • Posted

    Hey Johnathon,

    I am 61 had my ankle fusion 18 months ago all good, Still improving after all this time have weird feeling in my foot, however, able to do most things now.  As you said it is different for everybody. Really happy I had ankle fusion.

     

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    • Posted

      Hi Marian,

      ?Really pleased to hear that the fusion has worked out well for you - that's always good to hear!

      ?Was it your ankle joint that was fused? or have you had other joints in the foot involved too?

      Thanks,

      Jon

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    • Posted

      Hi Jon,

      It was my ankle joint that was fused, no other joints involved. I did have the hardware removed approximately 4 months later.

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    • Posted

      Ah very good  - did the screws come out because they were hurting? I had all my metal work taken out after  while too. Thanks
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  • Posted

    Hi Jonathan.

    I had ankle fusion a year ago after years of oa pain after foitball injuries in my youth - I'm now 56. Best thing I ever did. I do powerlifting and a couple of weeks ago I was in Mexico and trekked through the jungle and climbed up a Mayan pyramid. I couldn't have done that before the fusion. I can't run any more but I get about much better now and have no problems at all.

    I hope this helps with your thoughts on options and good luck.

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    • Posted

      Wow great. What exercises did you do. I am 5 and half months. Still a lot of pain and swelling.
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    • Posted

      Hi Jude,

      I'm really fortunate as I had an excellent surgeon and no complications.  I stared physio after the cast came off and I was still in the boot - just gentle manipulation to get the remaining foot joints moving.  After that it was light exercise on a static bike for w few weeks before easing into walking.  I didn't start weight lifting again until Feb this year (had op in Aug '17).  I made sure I kept to foot elevated for the first 3 months as much as I could and took calcium supplements to help bone growth.  I'm sorry you're still in pain, I remember what it was like -I needed my GP to prescribe oral morphine.  If you haven't tried phisio yet it is worth a try, but at least speak with your surgeon to see why it is still swollen.

      Good luck, and never give up.

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    • Posted

      Sounds like you've had some really good care and attention and wow, you're doing so well with the exercise! 

      ?To be honest, after my subtalar fusion, it took some months for the pain and swelling to go down but that was done in 2007 and since then I've been cycling (60/80 mile sportives) and running (up to 10k). So its been a good experience in recent years. My concern now is what happens with a full hindfoot fusion (ankle and subtalar) thus I lose all platar/dorsi flexion and I have no inversion/eversion. I'm pretty sure the other ankle joints are already showing a degree of arthritis (I'll get another CT scan on Tues day next week) so I'm  really worried about lose of movement and ongoing pain.... It sounds like you've had an ankle fusion but not involving the other joints in the foot?

      Thanks,

      jon

       

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  • Posted

    Johnathan , David here and in the same basic predicament I also have to decide if I do the TAR or fusion and I have written on this chatroom that I'd love to "talk" to anyone in my shoes for sharing support and info. Can you call me at my cel ? I am dying to talk to anyone so if you are a TAR or fusion person call me please ...David

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    • Posted

      Hi David,

      ?Its a difficult position to be in for sure. Have you got multiple joints involved or just looking at the ankle joint itself? 

      ?I had a subtalar fusion by itself back in 2007 and its been a good experience since recovery having lost the pain of arthirits but been able to cycle and run. My concern now is that I'm having (perhaps!) a second joint fused or maybe TAR and how that will affect physical and mental impacts...

      ?Jon

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  • Posted

    I had an ankle replacement. When I was young I was in a bad accident. Told my mom they did not know if I would wake up. If I did they did not know if I would be a vegetable or not. If I woke up and not a vegetable, they did not know if I would ever walk again. Well guess what? I walked. I walked pretty well for over 30 years. In that accident I broke a lot. In 2016 I had a left knee replacement. But even before that I was looking for an ankle surgeon. I am picky. I don’t let just anybody operate on me. I found the one ankle surgeon in my state that had had the most successful replacements. But before I found him, about 5 different surgeons told me I had to do a fusion. I was too young for a replacement. And that was at about 46. I waited and by the time I found my surgeon I was 50 and even at that age a few still think I am too young. But I knew my surgeon had done one for someone at 35. So I was sure he would be able to do mine. Reason why I did not give up is that all my pain was not in my ankle joint. So fusing it would have fixed that but made the other pains in my foot worse because I would not be able to stretch things like you are supposed too. When I schedued my surgery I had a 2 month wait and with 3 weeks to go my ankle went out completely. Could not put any pressure on it and that was with all the norcos I could safely take. The ended up fusing my sub-taler joint when they did the replacement. I was never sure they would be able to do it because in  my accident I shattered my talus.  So if you find a good surgeon I would do a replacement. But I told my wife if this does not work I am cutting it off. Sometimes I wish they just cut off the whole left leg. When I was young.  If it would have been done when I was young I would have forgone some of the pain I went thru. But then I think the technology was not to great so it might have not been as good as I imagined it. 

    Surgery was done March 28th of this year. So far the out come is good. I had a real good day today. I was walking great. I do have pain but I also have fibromyalgia. Both feet hurt bad sometimes. But I can walk. And the pain in the ankle joint is barley there. I still have a ways to go to get back. Up to a year to heal completely. All I can do is keep pushing forward. 

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    • Posted

      Hi , thank you for replying and sharing,

      ?Sounds like you are making good recovery and I wish you all the best, keep going forward as you say!

      ?You've been through such a lot already! Thank fully I believe I have a really good Consultant/Surgeon here in the UK. I've been operated by a few of them and they're all leading surgeons, looks after national teams (like Rugby) and indeed they all know each other and review the cases amongst them. I spent an hour or so discussing options with my Consultant yesterday and I'm feeling a bit happier. 

      ?The plan is to have a steroid injection just now, tidy up the osteophytes and correct the position of the heel bone. Then next year have a TAR and work forward from that. I truly believe this will be the best option at this time and I have much faith in my Consultant.

      ?I wish you al the very best with your recovery and progress. Please keep us informed of how things are going for you! All the best.

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    • Posted

      If I remember right you already have the subtaler joint fused and it worked out well when it was done. I was not sure how it would be having that fused and I am pleasantly surprised on how much I do not really notice. I love to ride and have not been in a bicycle yet. So I will come back and let you all know how I do. Been on an indoor bike and that was a non issue at all. So I am assuming I won’t have any problems other than my stamina. Lol. Being total Bed ridden for a little over 3 month did a number on me. But I am getting back. It seems like you have it covered. The technology now makes a replacement a better idea than it used to be. It seems like you have done your research on doctors and that is the biggest thing I can say to anybody thinking about doing any surgery. Research, Research, Research. I have read too many stories of bad replacements. You have to see a doctor who has the experience. You do not want them to use you as experience. My doctor told me that mine was way more complicated that most. It took a lot out of him and my wife said he looked it when he came to talk to her. So having the experience is a must because you never know what they are going to find. Plus if they are going in to fix your heal they should be able to look around and see what they are in for. I think that is a plus. I almost wonder sometimes an exploratory surgery is not a must if the has ever been some teams previously to the ankle. But now I am rambling. So.  If anybody wants to keep in touch and or talk more about my replacement you can Private Message me. Otherwise I will try to come back and post. 
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