Ankle Fusion Surgery

After years of ankle pain and limited mobility, I decided to get ankle fusion surgery on February 23, 2023. I couldn’t find much information on the process or recovery from a patient’s perspective, so this page is my attempt to fill that gap.

Injury History

The first time I broke my ankle I was twelve, playing soccer. I went on to break it again playing basketball, then football, and the last time I was just walking home from school. After that fourth break it never really recovered, and I started developing pain whenever I ran. Into my thirties and forties I began limiting how much I walked to avoid the discomfort that came with a higher step count. I tried physio, various ankle braces, and different shoes to manage the pain.

Fusion Decision

I first met with Dr. Johnny Lau from the Western Hospital Fracture Clinic in 2013. After a series of X-rays and an MRI, the recommendation was to fuse my ankle, a procedure known as arthrodesis. At the time, ankle replacement surgeries were starting to gain popularity in the US, so I decided to wait and see if that route would be practical for me. By 2022 it was clear that ankle replacement technology hadn’t advanced enough. Replacements were generally failing after 15 years, and even sooner for heavier individuals like me. I contacted Dr. Lau again in 2022 and my surgery was eventually scheduled for February 2023.

Surgery and Recovery

The surgery took about three hours and went well. It was early in the morning and involved a nerve block in my leg and a spinal block. After surgery the spinal block was removed, but the leg block was left in to manage pain. Unfortunately the leg block failed, and by that evening I was in a lot of pain. The first 48 hours were the worst of it. After that I was able to manage with Tylenol and Advil.

I was really worried about getting around after surgery. My home has very steep and narrow stairs to the bedrooms, which made it even more daunting. Luckily I had found the iWalk and had practiced with it around the house before the surgery. I was able to use it to leave the hospital within 48 hours and walk up to the second floor on my own. Over the next 12 weeks I used the iWalk almost exclusively, even though I had crutches and a knee scooter available. I loved being able to move around independently and got quite confident with it.

Another concern was bone growth. A successful fusion depends on the bone knitting together properly, and I had read about several ways to support that process. When I asked the surgical team, they immediately recommended a bone growth stimulator and my insurance covered the full cost. These devices have been used by professional athletes for years but are typically expensive. They also tend to have limited usage hours, so be cautious if you’re considering a used one. I used the stimulator every day for four months and had no issues with the fusion.

As I transitioned back to regular shoes I had been warned that not all my old footwear would work well. Before surgery I favoured flat, stable shoes that discouraged any front to back foot roll. After surgery I moved toward rocker bottom shoes with a rounded sole. They work much better with my fused ankle and support a more natural walking motion.

Loose screws…

Almost immediately after my fibreglass cast was removed in April 2023, I started experiencing pain on the outside of my ankle from the screws. At its worst it felt like a knife cutting into the skin whenever anything touched that area. With help from the hospital recovery team, we created a donut shaped padding to prevent the walking boot from pressing on the screws. It worked really well and distributed pressure to areas that weren’t painful. Surgical screws can’t be removed until at least a year after the original surgery, so pain management was the only option in the meantime. I found several desensitizing techniques online and practiced them on my ankle when the boot was off.

Further into recovery I was still having problems with screw pain and came across the concept of “surgical drift,” which can cause screws to loosen over time. As I transitioned to shoes I found I needed a very low cut shoe to avoid putting any pressure on that area.

Walk… don’t run

Overall I am extremely happy with the results. I would have preferred to avoid the hardware pain, but even with it I was walking better than I had in years. Knowing what I know now, I think I would have told my 2013 self to just get the fusion done. I had worried it would be very limiting, but honestly it hasn’t been.

I can’t run after the fusion, but I couldn’t really run before surgery either. I can walk very fast and often outpace plenty of people. Jumping isn’t possible with the fused ankle, so basketball and similar sports are out. Swimming is still my favourite exercise and the ankle has had no impact on my kick at all.

As I write this in 2024, a few weeks after my hardware removal surgery, I’m hopeful that with the screws gone I can try more activities and get back to wearing most of my shoes again.

Timeline

Date	Milestone
February 23, 2023	Surgery Date
March 10, 2023	Temp Cast Removal
April 14, 2023	Fibreglass Cast Removal
May 19, 2023	Walking Boot
June 23, 2023	Start Physio
November 13, 2023	Physio Check-up
October 30, 2024	Screw and Hardware Removal
November 15, 2024	Stitches and Bandage Removal

Ankle