Ankles play a crucial role in our mobility by providing stability, support, and flexibility to the lower body. These hardworking structures are integral for movements and activities involving the legs and feet, such as weight-bearing, balance and stability, propulsion, and coordination. 
However, the advent of arthritis can disrupt these intricate mechanisms, leading to pain, inflammation, stiffness, and instability that can severely impede walking and make completing even the most basic tasks difficult.
While conservative treatment methods are typically the first line of defense against ankle arthritis, if these approaches fail to provide sufficient relief, total ankle replacement surgery might be what it takes to get rid of your pain and get back on your feet. Here’s what you should know about this complex surgical procedure, how Annapolis Foot & Ankle Center’s skilled professionals can help you decide if it’s right for you and, if so, what you can do to ensure an optimal recovery.
Arthritis and Your Ankle Anatomy
Your ankles are comprised of three main bones:
- Tibia (shinbone)
- Fibula (the smaller of the two lower leg bones)
- Talus (the lower bone of the ankle joint)
These bones are covered with cartilage, a flexible connective tissue that cushions and lubricates the joint, allowing for smooth articulation and reducing friction during movement.
Both the bones and connective tissues in the ankle joint are susceptible to arthritis—an umbrella term encompassing more than 100 progressive, degenerative conditions causing joint pain, inflammation, and stiffness. While numerous types of arthritis may affect the ankles, the most common forms include:
- Osteoarthritis. When the cartilage in your ankle joint wears down, the bones rub against each other as you move, resulting in osteoarthritis joint pain and inflammation. Joint stiffness and bone spurs also occur as bone surfaces wear away. This type of “wear and tear” arthritis typically affects older adults and people with jobs or hobbies requiring frequent repetitive movements.
- Post-traumatic arthritis. A form of osteoarthritis, post-traumatic arthritis occurs due to a previous ankle dislocation, ankle fracture, or other ankle joint injury.
- Rheumatoid arthritis. A system-wide autoimmune disease, rheumatoid arthritis affects joints throughout the body, including those in the ankles and feet. This chronic inflammatory disorder causes your immune system to attack its own tissue, creating painful swelling in the membrane lining your joints. Over time, this inflammation leads to bone erosion and ankle joint deformity. Though rheumatoid arthritis is most common in adults, it can affect people of all ages.
When to Consider Total Ankle Replacement Surgery
Total ankle replacement, also known as ankle arthroplasty, is a major surgical procedure that involves a lengthy recovery. Though it can provide substantial benefits for severe ankle arthritis, if your condition is mild or moderate, your podiatrist will likely treat you with more conservative therapies before recommending surgery. Treatment often includes a combination of noninvasive methods, such as:
- Activity modification
- Anti-inflammatory medication
- Physical therapy
- Corticosteroid injections
- Custom orthotics, such as shoe inserts or insoles, or foot or lower leg braces
However, if you’re still struggling with ankle pain and dysfunction despite conservative care, it might be time to consider a surgical solution. Total ankle replacement surgery can help alleviate pain, restore ankle strength and stability, and preserve the joint’s natural range of motion, allowing you to get back to the active lifestyle you enjoy. At Annapolis Foot & Ankle Center, our skilled Central Maryland podiatrists can guide you through the surgical options and help you decide if a total ankle replacement is the right decision.
Why Ankle Arthroplasty Isn’t Suitable for Everyone
Total ankle replacement surgery isn’t suitable for all patients. Your podiatrist might recommend an ankle fusion procedure called arthrodesis instead if you have any of the following issues:
- Severe ankle deformity
- Dead bone in the talus
- Bone too soft to support the replacement ankle joint
- A history of deep ankle infections
- Poorly controlled diabetes
- Severe peripheral neuropathy, which is abnormal nerve function or sensation
- Absent or poor leg muscle function
- Poor circulation to the lower limbs
For patients with the above conditions, an ankle fusion procedure—which permanently joins the bones in the ankle joint—may better suit your unique needs.
Ankle Arthroplasty: A Look Inside This Complex Surgical Procedure
A total ankle replacement procedure removes the damaged parts of the ankle joint, replacing them with plastic or metal prosthetics designed to work together and move just like your natural joint. At Annapolis Foot & Ankle Center, these surgeries are performed by our experienced and highly skilled board-certified podiatric surgeons and a caring and capable team that includes an anesthesiologist, nurses, and other podiatric professionals.
Usually an inpatient procedure, total ankle replacement surgery typically takes two to three hours to complete. Here’s a brief overview of what happens during a typical ankle arthroplasty.
- The anesthesiologist administers general anesthesia or a nerve block to prevent you from feeling any pain or discomfort during the procedure.
- Our team monitors your heart rate, blood pressure, and other vital signs throughout the operation.
- We prep the surgical site, thoroughly cleaning and disinfecting your ankle.
- The podiatric surgeon makes an incision through the skin and muscle at the front of your ankle to access the ankle joint.
- Then, we remove the damaged bone and cartilage and prepare the joint’s surface for the new prosthetic joint.
- The surgeon attaches the prosthetic to the bone and tests the new joint to ensure range of motion.
- We close the layers of skin and muscle and immobilize and elevate your ankle.
What to Expect Before and After Your Total Ankle Replacement Surgery
Our adept podiatric team helps you prepare for your ankle arthroplasty surgery. Before the procedure, we might recommend that you stop taking certain medications, quit smoking, start physical therapy, and plan for your recovery.
Total ankle replacement recovery typically takes up to one year. Immediately following surgery, your leg is immobilized in a cast or split. Though the cast or splint may come off several weeks after surgery, you won’t be able to put full weight on your foot for a few months. Crutches or a walker can help you get around during this time—modify your home and work spaces as needed before surgery to accommodate these devices. You may also need assistance with transportation, completing daily tasks, grocery shopping, or caring for children or pets after the procedure. Medications can help ease post-surgical pain and discomfort, which fade as you recover.
We’ll monitor your progress in follow-up appointments throughout your recovery. Carefully adhering to your treatment plan and continuing physical therapy ensures your ankle heals properly.
What to Know Before Scheduling a Total Ankle Replacement Surgery
At Annapolis Foot & Ankle Center, we understand that opting to undergo total ankle replacement surgery is a significant decision. When discussing your treatment options, our podiatrists thoroughly explain the ankle arthroplasty procedure, the potential benefits and risks, and what to expect during the recovery process. We’re happy to walk you through it all again—or address any questions or concerns you have—anytime. We want to make sure you’re informed, comfortable, and confident in your podiatric surgical treatment plan.
Additionally, we encourage you to ask about:
- The reason for the procedure and the anticipated results
- The surgery’s risks and benefits
- Potential side effects or complications
- The qualifications of the surgeon performing the procedure
- What to watch for after surgery and when to contact us right away
Total ankle replacement isn’t the right option for everyone. However, for those who are good candidates for the procedure, it can be an effective long-term solution that significantly improves quality of life. Don’t put up with arthritis-related ankle pain, inflammation, and stiffness without talking to a skilled podiatrist about whether total ankle replacement surgery could help you live a more active lifestyle.
