Q. I am 60 years old and I have developed severe arthritis of both my ankles. I have very little ankle motion and severe pain with walking. I have tried orthotics in my shoes, cortisone injections and braces. Several foot and ankle specialists whom I have seen have given me different opinions. My options are to continue to live with the pain, have ankles fusions or have ankle replacements. What do you think is best?
A. When the cartilage on the end of your ankle wears out to raw bone, it is known as bone-on-bone arthritis. This can be the result of trauma, a genetic condition or arthritic conditions such as rheumatoid arthritis.
You have tried the various non-surgical options and it appears that now surgery is indicated. Most people with ankle arthritis have very limited motion.
Therefore, an ankle fusion that prevents ankle motion is usually well tolerated since patients are used to limited motion. Fusions are usually successful in relieving pain but are difficult surgeries to perform and take a long time to heal. Patients usually require limited weight bearing and casting or bracing for a couple of months and up to six months total to heal. Since you will need surgery on both ankles, this will be a long recovery process.
With technological advances, ankle replacements have improved greatly over the years and usually result in good pain relief and improved motion and function. The recovery process is usually faster than a fusion. Ankle replacement is a difficult operation to perform and you need an experienced surgeon for this procedure to minimize the risk of the ankle replacements loosening.
There are two orthopedic surgeons in Coral Gables who have had foot and ankle fellowship training that helped pioneer this procedure, Dr. Thomas San Giovanni and Dr. Christopher Hodgkins.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net.