A healthy ankle lets you live an active life. Whether it's joining in the activities you enjoy or simply doing everyday tasks like walking, running, or going up stairs, your ankle plays an important role in your life.
The ankle joint is where your leg and foot meet. It is made up of the two bones of your lower leg (the tibia and the fibula) and the bone at the top of your foot (the talus). The ankle joint allows your foot to move up, down and other directions.
Ligaments (bands of tissue that connect two bones together) are located on each side of your ankle to give the joint stability. Tendons (strong structures that connect muscle to bone) are located throughout your foot and help you move your foot and toes.
Cartilage is the specialized tissue that covers the ends of your bones and allows them to glide in against each other smoothly.
What causes ankle pain?
Only your doctor can determine what is causing your chronic ankle pain. For many patients, the cause of their pain is arthritis, a disease that damages the cartilage and bones in the joint. As the damage gets worse, the bones can grind against each other causing pain, stiffness and swelling. Chronic ankle pain from arthritis can limit your activities and lower your quality of life.
What is ankle replacement?
Ankle replacement is the surgical procedure. It is used to remove the parts of the ankle damaged by arthritis and replace them with a metal and plastic implant. It is meant to reduce pain and allow for normal ankle motion. Only your surgeon can decide if you are a good candidate for ankle replacement.
Common questions about ankle replacement
- What other treatment options are available to manage my condition?
There are several treatments for ankle pain besides replacement that you should discuss with your doctor. Early treatment options may include rest, walking with a cane in the opposite hand, and over the counter or prescription medications. Physical therapy may also be prescribed in the early stages, although this can become less effective and even damaging as the arthritis advances. In some cases, arthroscopic surgery is used to remove bone spurs and debris from the joint. When these solutions are not effective, your foot and ankle surgeon may discuss other treatments with you, such as ankle fusion or ankle replacement surgery.
- What happens if I wait to have my ankle replacement?
If your condition isn't responding to other treatment options, it may be time to consider ankle replacement surgery. Once you and your doctor decide that surgery is the right choice for you, it is important to act. Putting off the surgery can have consequences. For example, delaying surgery can mean the damage to your ankle will get worse and your range of motion will continue to decline. As a result of delaying, your surgery may be more difficult and your results less certain. It is a good idea to discuss your condition early with a foot and ankle surgeon and learn about the options and timing that might be right for you.
- How much will my range of motion improve?
Because each patient is different, it is impossible to say how much motion you will recover after ankle replacement. The goal of every surgery is to return as much movement as possible. However, patients who have suffered with worsening pain and very limited motion for many years may not get full motion back even though their surgery was performed properly, and they did their physical therapy as prescribed.
- Is the pain going to go away?
Ankle replacement addresses the most likely source of your pain. However, other sources of pain may remain in the ankle and foot. As a result, your pain is likely to be reduced but it is not always eliminated.
- What are the risks with this surgery?
Like all surgeries, ankle replacement has risks. Some of the risks with this surgery can include, but are not limited to:
- Pain and discomfort
- The implant bending, becoming loose, or breaking.
You should discuss all of the risks associated with ankle replacement with your surgeon before making your treatment decision.
Will this affect other medical treatments?
It is important to always protect your new joint from infection. Always notify your physicians and dentists that you have an ankle replacement. You may need to take antibiotics before dental work, surgery, or other medical procedures.
About the implant
Ankle replacement implants are made up of three parts: The top part of the implant is made from metal and replaces the bottom of your shin bone. The bottom part of the implant is also made from metal and replaces the top of your foot. In between these two parts is a plastic insert that's designed to allow the bottom metal part to glide smoothly as your foot moves up and down. These are the same materials used in most hip and knee replacements.
The procedure steps
- Getting to your joint - Your surgeon will get to your joint through an incision in the front of your ankle near the top of your foot.
- Removing the damage - Next, your surgeon will cut away the parts of your bone and cartilage that have been damaged by arthritis. This will make room for the implant.
- Replacing your joint - Once the bone surfaces are prepared, your surgeon will place your new implants in position and make sure that your ankle moves correctly through its range of motion.
- Additional procedures may be performed at the same time as necessary.
- Closing - Your surgeon then closes the incision and bandages the area before placing your foot in a splint or cast.
Recovery from ankle replacement
Every patient is unique and, therefore, every patient's recovery may be different. There are a number of factors that can affect the length of your recovery, your pain level and your outcome. This information is for informational purposes only and each patient should talk to their doctor for additional guidance.
How long is the recovery period?
Recovery can vary from one patient to the next because of many reasons. In general, many patients are in the hospital for one to three nights. The stitches used to close the incision are removed between 10 and 21 days after surgery. Once your stitches are removed you will be allowed to move your ankle. Putting weight on your ankle is generally allowed six weeks after surgery. Once you can put weight on your ankle, your physical therapy will begin. Physical therapy can help with swelling, pain and stiffness, and over time, improve strength and coordination. Protective devices such as a cast, boot or brace, along with physical therapy, are generally discontinued 12 weeks after surgery.
How long until I regain full use of my ankle?
The recovery of full ankle function may take up to 6 months. It is very important that you follow the guidance of your doctor and physical therapist during your recovery. While some swelling may stick around for 6 to 12 months, most improvements are seen 6 months after surgery.
Will I have pain?
It is natural to experience some level of pain after surgery. Many patients are done taking prescription pain medication after five to seven days following surgery. Once the original pain from the surgery subsides, you should not have any chronic pain as a result of the implant. You may have some soreness, but that will begin to improve in the weeks and months following surgery. Call your physician if you have any increased pain, swelling, fever or abnormal incision drainage.
What restrictions will I have using my ankle long-term?
People who have had an ankle replacement are generally advised to avoid contact sports and to refrain from repetitive impact activities that will increase the wear of the implant, as these can place too much strain on your ankle implant. Consult your physician about the specific activities that might affect your new ankle.