Arthritis in the ankle joint, or damage to the joint, can cause some pretty big problems. The range of motion is diminished and it is extremely painful. If all other methods of treatments do not offer any relief than more extreme measure may be considered. Ankle fusions and amputation are the most common solutions to ankle joint problems. It is vital that you make a decision that fits you and your particular case.
Facts About Ankle Fusion
1. What It Is
Ankle fusion is a surgical procedure that involves removing surfaces of one of the ankle joints in order to cause a fusion between the talus and the tibia. It is done as a way to relieve pain from severe arthritis or joint damage to the ankle.
2. Open Method
An ankle fusion can be performed two different ways, one of them being the open method. In the open method procedure the skin on the ankle is cut open in order to gain access to the joint. Once the incision has been made then the joint is opened and a surgical saw is used to remove articular cartilage. The removal of this cartilage forces the body to heal by fusing the joints together. Screws are put in place in order to hold the bones together, and are typically never removed.
3. Arthroscopic Method
This is the second method that is used to perform an ankle fusion. In the arthroscopic method a very small incision is made and a arthroscope, which has a tiny camera, is put into the joint. They then use other tools to removed the cartilage and place the screws in the bones. This method is primarily the same as the open method except for the fact that a much small incision is made.
After the surgery is completed successfully the ankle is put into a padded plaster cast. This cast remains on the ankle for two weeks before it can be removed. After this it is replaced with a shorter cast, which remains on until it is sure the fusion has occurred, usually 8 to 12 weeks. While it is healing you cannot put weight on the ankle so the use of crutches is necessary.
As with any surgical procedure there are complications that can arise. Some of the most common problems that occur with an ankle fusion are nounion, which is when the bones do not fuse and a second operation is necessary, nerve injury, infection, or malunion, which is when the bones do not heal in the correct position and may require another surgery to correct.
What About Amputation?
If pain or damage to the ankle joint is so severe that the pain cannot be managed, them you may be looking at the options of amputations. There are two common forms of amputation that are done in this case, a below the knee amputation or an ankle amputation. A below the knee amputation is just what it sounds like, the removal of the leg from just below the knee. Ankle amputation is the removal of the foot, just above the ankle.
An amputation is a very serious surgical procedure and there are many steps taken for a successful outcome. Firstly blood flow, pulse, and pain will be monitored in both the healthy limb and the limb being amputated so that the proper place of removal can be determined. The surgeon will then cut the skin and use surgical saws in order to remove the bone. As much healthy skin as possible is left so that the stump can be properly covered. The skin will then be sutured together and wrapped.
Recovery from an amputation begins with observation to ensure that blood flow is still healthy to the area. Physical therapy will then begin, which includes massages, gentle stretches, and learning how to bear weight on the remaining limb. Full recovery time is hard to estimate because each person deals with the procedure differently. Emotional grief is the hardest thing to recover from after losing a limb. It may take many weeks of therapy to fully get back to yourself.
Complications with a surgery of this caliber are not out of the ordinary. The main causes of complications include problems with anesthesia, blood clots or heavy blood loss, the risk of infection is much greater with amputations, nonhealing, and persistent or “phantom” pain are the main risks.
Differences Between Ankle Fusion and Amputation
1. Extent of Surgery
An ankle fusion surgery requires only a small incision, however the problem may not be solved. Amputation is a last ditch effort to preserve the quality of life and is much more dramatic, the loss of an the entire ankle or limb can be difficult to cope with.
2. Activity Level
For a person that lived a highly active life before having issues with their ankle joints may be very eager to return to that same lifestyle. With an ankle fusion the chances of being able to have full range of motion in their ankle and return to their normal activities is low. Amputation, while more dramatic, does give a person the option to get moving again. Prosthetics can be used in order to perform physical activities.
3. Level Of Risk
One big factor when choosing which procedure is right for you is the risks that are associated with each. An ankle fusion, while still having some hefty possibilities, has significantly less serious risks associated than an amputation.
4. Pain Management
When severe pain is present it can debilitate your quality of life. With an amputation pain is often cut out all together, or nearly all together. An ankle fusion, however, does not guarantee pain relief. The problem is technically still there, and if severe pain does continue it may end with an amputation either way.