Expert Patient Guide · Foot & Ankle Surgeon · London & North London
Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London
Ankle fusion (ankle arthrodesis) permanently joins the worn-out ankle joint so that the bones grow together into one solid block. It is one of the two main operations for end-stage ankle arthritis, alongside total ankle replacement. It removes the painful joint surfaces and gives a stable, well-aligned foot to walk on. Expect one night in hospital, two weeks with the leg strictly elevated, around twelve weeks in plaster, and four to six months to full recovery.
Ankle arthritis means the cartilage lining the joint has worn away, leaving bone rubbing on bone. Unlike the hip and knee, it usually follows an injury — a broken ankle, a fracture into the joint, or years of instability after repeated sprains — though it can also follow rheumatoid arthritis. Fusion is considered when pain limits daily life and simpler measures such as supportive footwear, braces, painkillers, physiotherapy and injections no longer give enough relief.
The benefits are:
Fusion is not the only option. Total ankle replacement preserves movement and suits many patients with well-aligned ankles and healthy neighbouring joints. The right choice depends on your age, activity, alignment, bone quality and priorities, and is a shared decision made after examination, weight-bearing X-rays and Weight-Bearing CT.
Good preparation shortens recovery and lowers the risk of complications.
Two items make the early weeks far easier. A foam leg elevator holds the ankle above heart level far better than a stack of pillows, and strict elevation is the key to controlling swelling. A waterproof cast protector, such as a LimbO, seals over the plaster so you can shower.
A full list of recommended items, with links, is in our product guide: Stanmore Foot & Ankle Specialists Product Guide (PDF)
The operation is performed under a general or spinal anaesthetic, with a nerve block behind the knee that keeps the foot comfortable for several hours afterwards. Most ankle fusions are done through a single incision at the front of the ankle, working between two tendons so that no muscle is cut. In selected, well-aligned ankles it can be done arthroscopically, through two keyhole openings.
The worn cartilage is cleared away and the surfaces of the shin bone and the talus are prepared down to fresh, bleeding bone — healthy bone must touch healthy bone for a fusion to knit, and bone graft is sometimes added. Any crookedness is corrected and the foot is set in its ideal position: flat to the floor, the heel very slightly outward, the foot pointing straight ahead. That position is what allows a fused ankle to walk well.
The bones are then compressed firmly together and held with screws, or a plate and screws, inside the leg; occasionally an external frame is used where the skin or bone quality is poor. X-rays confirm the position in theatre, the wound is closed carefully and a plaster applied. Surgery usually takes one to two hours.
Most patients stay one night. This allows pain to be controlled as the nerve block wears off, antibiotics and blood-clot prevention to be given, and the leg to be kept elevated through the critical first hours. Some go home the same day; occasionally two nights are needed. You are discharged once your pain is controlled with tablets, you are safe on crutches, and you have your plaster, medication and follow-up appointment.
This fortnight is spent at home with the leg strictly elevated — toes above the nose — for all but a few minutes each hour. Swelling is the enemy of wound healing at the front of the ankle, and elevation is the treatment. Get up only for the bathroom and short essential trips on crutches, keep the plaster dry, and take painkillers regularly rather than waiting for pain to build. You will be seen at ten to fourteen days for a wound check and a new plaster.
X-rays along the way confirm that the fusion is knitting, and timings are adjusted to your own progress.
Once the plaster is off you move into a supportive shoe or boot and begin physiotherapy to rebuild strength, balance and a normal walking pattern. Most people are walking comfortably without aids by four to six months, the usual point of full recovery. Some swelling and end-of-day aching is normal for up to a year, and the result continues to improve over that time.
Ankle fusion is well established and generally very successful, but it is major surgery and no outcome can be guaranteed. The risks specific to this procedure are:
General risks of foot and ankle surgery — anaesthetic risks, blood clots, complex regional pain syndrome, stiffness and scarring — are covered here: Hindfoot Surgery Risks: Patient Information Leaflet (PDF)
Will I walk normally after an ankle fusion?
Most people walk comfortably and without a limp on level ground. The up-and-down movement of the ankle is gone, but the other joints in the foot take over a surprising amount of it. Slopes, stairs and rough ground are where the difference is most noticeable.
Ankle fusion or total ankle replacement — which is better?
Neither is better in every case. Fusion is very durable and is often preferred for younger, heavier or more active patients, for significant deformity, or after previous infection. Total ankle replacement preserves movement and puts less strain on neighbouring joints. The decision is made together in clinic.
Can I still play sport?
Yes, within limits. Cycling, swimming, rowing, gym work, golf and walking or hiking are all realistic. Running, jumping and impact or pivoting sports are not recommended after ankle fusion.
When can I drive?
Usually once you are out of plaster, weight-bearing comfortably and able to perform an emergency stop safely — commonly around twelve weeks for a right ankle. Tell your insurer before driving again.
Will the metalwork set off airport scanners?
It occasionally does. The metal is permanent and is not routinely removed. Flying is generally avoided for about six weeks after surgery because of the risk of blood clots.
Can a fusion be converted to a replacement later?
In selected patients, yes — one reason the bones on either side of the ankle are preserved wherever possible in modern fusion surgery. It is complex revision surgery and not suitable for everyone.
Mr Matthew Welck is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital, Stanmore, one of the UK’s leading tertiary orthopaedic centres, and Honorary Associate Clinical Professor at UCL. He runs a specialist practice across London and North London, with particular expertise in total ankle replacement, complex reconstruction, revision surgery, Weight-Bearing CT and sports injuries of the foot and ankle.
To arrange a consultation, visit the appointments page or email secretary@matthewwelck.com.
General information for patients, not a substitute for individual medical advice; your own treatment, timings and risks will be discussed in clinic. Written and reviewed by Mr Matthew Welck, Consultant Orthopaedic Foot & Ankle Surgeon (GMC registered). Last reviewed: July 2026.
Written by: Matthew Welck | Consultant Orthopaedic Foot & Ankle Surgeon London — last updated 28th July 2026
