Ankle Fusion Recovery: Week by Week, Walking and Shoes After Fusion

If ankle arthritis has taken away your walks, your work or your sleep, an ankle fusion can give them back. We perform ankle fusion for end-stage arthritis. This guide covers ankle fusion recovery stage by stage, how to walk after ankle fusion, which shoes help, and the long-term results. Still choosing? See our comparison of ankle fusion and ankle replacement.

Is ankle fusion worth it?

For most people with end-stage ankle arthritis, yes. When pain still limits you after nonsurgical care, fusion is typically quite successful: once the bones grow together, the painful joint stops moving.^[4] The results hold up:

• In 66 fused ankles followed for an average of nine years, the bones healed after the first operation in 91%, and 91% of patients were satisfied.^[3]
• In 26 patients studied nearly four years after fusion, 20 were satisfied or completely satisfied, and all but one said they would have the surgery again. Their hindfoot pain scores matched those of healthy people their age.^[5]
• In a randomized trial of 303 people aged 50 to 85, both fusion and ankle replacement improved walking and quality of life at one year, and the main walking score did not differ significantly between them.^[6]

How is an ankle fusion done?

The surgeon removes the worn cartilage, sets the bones in a corrected position, and holds them with screws, plates or rods while they knit together like a healing fracture.^[4] The operation can be done through an incision on the front or the side of the ankle. In 38 studies, the approach and the type of hardware made little difference to the results.^[1]

Surgeons can also fuse the ankle through small incisions with a camera (arthroscopic fusion). In seven retrospective comparison studies, it was linked to better scores, fewer complications and shorter hospital stays, with similar healing.^[7] Read more about joint fusion and ankle replacement.

Ankle fusion recovery, week by week

Schedules vary with the hardware and your bone. Here is what studies describe.

The first 2 weeks. You will most likely be in a cast or splint. Keeping the foot raised above the level of your heart for the first 1 to 2 weeks is important to reduce swelling.^[4]

Weeks 2 to 12. In 20 patients whose fusion was held with crossed screws, partial weight-bearing in a removable walking boot started at 2 weeks and full weight-bearing at 12 weeks. The bones healed in 19 of 20, and in those whose fusion healed, ankle scores rose from about 14 to 90 out of 100 at one year.^[8] Your surgeon sets your own start date.

About 3 to 4 months. On average, people walked without a cane or crutch at about 14 weeks, and the fusion healed at about 16 weeks.^[2] Most people are back to daily activities in 3 to 4 months, sometimes in a supportive shoe or brace for a while.^[4]

About 4 to 5 months. The same 61 patients went back to work at about 18 weeks and to exercise at about 21 weeks.^[2]

Up to 9 months. Full recovery can take 4 to 9 months.^[4]

For crutches, scooters, bathing and driving, see recovery after foot and ankle surgery.

How to walk after ankle fusion

A fused ankle no longer bends up and down, so the joints around it take on more of the work.^[4] A review of 17 gait studies with 883 patients (after fusion or ankle replacement) found that walking speed improved after ankle fusion, and the hip moved more, which likely helps make up for the stiff ankle.^[9]

Compared with healthy people, patients’ stride length and step rate differed, yet 5 of 26 did not notice any change in their walk at all.^[5] Twelve of the 26 wore orthotics, and every one of them felt the inserts improved their gait.^[5] Later in recovery, physical therapy helps you regain strength.^[4]

Which shoes work after ankle fusion?

• Running shoes. In 126 patients after ankle fusion or replacement, standard running shoes raised walking speed compared with going barefoot, and the benefit was greater for fusions and replacements than for healthy people.^[10]
• Rocker soles. A rocker-bottom sole is curved from heel to toe so the shoe rolls you forward. In 9 fusion patients, rocker shoes added about 5 degrees of motion to the step, bringing it closer to normal, although walking speed did not change.^[11] In the larger study, they added little beyond a good running shoe.^[10]
• Orthotics. Custom or supportive inserts helped the patients who used them.^[5]

A supportive running shoe is a practical start, adding a rocker sole or an insert if your step still feels abrupt.

Can you be active after ankle fusion?

Yes. In 61 patients about a year after fusion, 64% had returned to higher-impact activity, and most rated their recovery as good.^[2] Across 12 studies, sports participation stayed high after fusion (70%), led by swimming, hiking, cycling and skiing; running, tennis and soccer were more limited.^[12]

Can an ankle fusion be reversed?

In selected patients, yes. A surgeon can take down a fusion and convert it to a total ankle replacement. In seven studies of 223 ankles followed for about five years, every pain and function score improved after conversion.^[13] It is a major operation: 12.8% had a fracture of an ankle bone, 8% needed revision, and four patients ended up with a below-knee amputation.^[13]

What are the limits?

Healing is not universal. When fusions of the ankle, hindfoot and midfoot were checked with CT scans in 26 studies, 78.7% had fully fused, lower than the more than 90% reported in earlier studies.^[14] In the randomized trial, 12.1% of fusions had not healed on X-ray at one year, but only 7.1% of patients had symptoms from it; a fusion that does not heal may need a second operation.^[6,4] Complications occurred in 14% to 16% after front or side approaches, and infections in 4% to 6%.^[1] Arthritis in neighboring joints is a real concern: in the nine-year study it progressed in all of them, though its importance was unclear.^[3] A review of 24 studies found no agreement on whether fusion causes that arthritis, and several studies did not find that X-ray changes matched symptoms.^[15] If you smoke or have diabetes, see smoking, diabetes and foot surgery healing.

Common questions

How long is ankle fusion recovery?

Most people walk without support at about 3 to 4 months, return to work around 4 months, and reach full recovery in 4 to 9 months.^[2,4]

How do you walk after ankle fusion surgery?

In a boot at first, then in supportive shoes. Walking speed improved after fusion in gait studies.^[9]

How should I sleep after ankle fusion surgery?

Rest with the foot raised above the level of your heart, especially in the first 1 to 2 weeks, to keep swelling down.^[4]

Can ankle fusion be reversed?

Sometimes. Conversion to an ankle replacement improved scores in reviewed studies, but it is a major operation with real risks.^[13]

The bottom line

Ankle fusion is a reliable, lasting answer for an arthritic ankle that no longer responds to braces, shoes or injections. Most people walk without support by about 3 to 4 months and stay satisfied years later. Dr. Ozturk is a double board certified Foot and Ankle Surgeon and podiatrist who sees patients in Lyndhurst, Paramus and Millburn. Our parent practice explains foot and ankle arthritis care (external site), and you can request an appointment here. Please call our office at 908-215-5953 to inquire about your insurance.