Chronic Ankle Pain? You May be a Candidate for Replacement

**By Eric Heit, DPM**

More than 30 years ago, Michael Diorio fell from a palm tree while trimming fronds at a San Diego apartment. The three-story fall crushed his left heel and fractured his right ankle. Over the years he’s had seven surgeries on his feet and suffered pain on a regular basis.

Michael Diorio_Total ankle replacement patientv2

Michael Diorio

After moving to the Pacific Northwest three years ago, Diorio, 56, was referred to a podiatrist with Virginia Mason Orthopedics and Sports Medicine. Diorio soon learned he was a candidate for a relatively new procedure – total ankle arthroplasty, also known as total ankle replacement. 

Last December Diorio underwent the three-hour outpatient surgery on his right ankle at Virginia Mason Hospital and Seattle Medical Center. He was able to return to full-time work in March, where he spends several hours a day on his feet.

“I used to limp and regularly experience pain,” says Diorio.  “Now I walk almost as well as I did before my injury and without any discomfort. I’m glad I was a candidate for total ankle replacement and have been very satisfied with the experience and outcome.”

The procedure

Total ankle replacement is similar to hip and knee replacements – patients receive a new ankle joint made of precisely engineered metal and plastic parts that replace the old ankle joint.

The surgery is typically performed without the need for an overnight hospital stay and patients usually go home the same day. Patients should expect a period of limited weight-bearing, followed by a gradual return to daily activity as their ankle heals. Most patients will have physical therapy after the procedure to help regain mobility.

The benefits — and some risks

Total ankle replacement relieves discomfort in the joint that older adults sometimes experience during weight-bearing activities. It might also ease occasional ankle pain when not moving the joint.

However, like every surgery, there are risks such as infection and wound healing problems, although this risk is low, occurring in less than 2 to 3 percent of cases.

The American Orthopaedic Foot & Ankle Society recommends people try non-surgical options for pain relief before considering total ankle replacement. Some patients get relief through treatments such as bracing, cortisone or steroid injections and changing to non-weight bearing or low-impact activities.

sr.coupleIf non-surgical approaches do not provide relief, total ankle replacement might be appropriate.

Getting the green light
Your physician will consider a few things before recommending surgery, such as:

  • Age
  • Activity level
  • Other potential medical complications
  • Severity of arthritis in your ankle
  • The potential for arthritis in other foot joints

In general, surgeons recommend total ankle replacement for people 55 or older. The thinking is that older adults will likely not stress the ankle as much as a younger patient, extending the life of the implant. Runners, or people who do other high-impact activities, are not good candidates for the surgery.

A person’s overall wellness before total ankle replacement is important. People should see their primary care physician before surgery to help ensure they are in optimal health.

Even if someone doesn’t think they’re a candidate for total ankle replacement, they  should get a referral from their primary care provider to consult with a foot surgeon. This is important because even if someone isn’t a candidate for the procedure, the specialist can discuss other treatment options that might help.

If you have health issues

Certain conditions can increase the risks associated with surgery and recovery, such as:

  • No ankle movement
  • Poor ankle-bone quality
  • Unstable ankle ligaments
  • Significant ankle alignment problem
  • Infection, especially in an ankle

If you have diabetes, your doctor will want to make sure you have good circulation and healthy blood-sugar levels before surgery. If your condition is not well-controlled, it increases the chance of complications, including infection.

Outcomes

According to the American Orthopaedic Foot & Ankle Society, there is a 90 to 95 percent chance that total ankle replacement will be successful and without complications.

Based on our experience at Virginia Mason, most people are doing well within about three months after surgery, and full recovery usually takes six months to a year.

Dr. Eric Heit


Eric Heit, DPM, is a board-certified podiatrist with Virginia Mason Orthopedics and Sports Medicine. His specialties include podiatry, foot and ankle surgery, podiatric surgery and sports medicine. He practices at Virginia Mason Hospital and Seattle Medical Center

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