Tag Archive for: ankle pain

Ankle Fusion

Pain caused by ankle arthritis can become severe and unrelenting, greatly impacting one’s quality of life. An ankle fusion, also called ankle arthrodesis, aims to relieve the pain and maintain or improve function by fusing two or more bones in the ankle. The procedure can help treat a number of different underlying problems in the foot by limiting mobility in the joint. Whatever the cause, no one should have to suffer debilitating pain. The highly-skilled foot and ankle specialists at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado, have vast experience treating all ankle and foot conditions and can get you treatment to help you get back to life.


Ankle fusion is for people who want a permanent solution to their ankle pain so they don’t have to think about it again. It is also recommended to people for whom total ankle replacement is not an option. Ankle fusion has also become a more popular way to treat end-stage ankle arthritis in younger adults. It’s a way to save the ankle and preserve some function. Thus, the operation is also called a salvage procedure. By fusing the bones, an ankle fusion stops the ankle joint from moving at all. It takes a stiff, painful ankle and converts it to an unbending, relatively painless, or in some cases, totally pain-free ankle. An ankle fusion can often last a lifetime compared to a total ankle replacement.


The ankle joint is a complex mechanism. It is also called the tibiotalar joint, and although typically referred to as a single joint, it is actually two joints; the subtalar joint and the true ankle joint. The true ankle joint is composed of three bones: the lower end of the tibia (shinbone), the lower end of the fibula (the smaller bone of the lower leg), and the talus (the bone that fits into the socket formed by the tibia and fibula and rests on the heel bone). It is responsible for the up-and-down motion of the foot. Beneath the subtalar joint is the second part of the ankle, composed of two bones: the talus on top and the calcaneus on the bottom. The subtalar joint allows side-to-side motion of the foot. The ends of the bones are covered by articular cartilage. The space in the joint is lined with a thin membrane called the synovium, which cushions the joint and secretes a lubricating fluid called synovial fluid. These components of the ankle, along with the ligaments, muscles, and tendons of the lower leg, work together to handle the stress the ankle endures when walking, running, and jumping.


The ankle is the least likely area of the body to be affected by arthritis. Ankle arthritis happens when there is a breakdown of the cartilage that covers the ends of the bones that form the joint. Moving the arthritic ankle tends to make the pain worse. There are three main types of ankle arthritis:

  • Osteoarthritis, which develops from wear and tear on the joints over time
  • Post-traumatic arthritis occurs after a significant ankle injury, such as a fracture
  • Rheumatoid arthritis is an autoimmune disease that damages the joints.

Symptoms usually develop gradually and worsen with time and overuse. These include:

  • Pain with motion
  • Pain that flares up with vigorous activity
  • Tenderness when pressure is applied to the joint
  • Joint swelling, warmth, and redness
  • Increased pain and swelling in the morning or after sitting or resting
  • Difficulty in walking due to any of the above symptoms


Ankle fusion involves cleaning the worn-out ankle joint and fusing the tibia and talus bones together with screws, plates, and bone grafts. By doing so, the bones are stabilized and can no longer rub together, reducing pain. Fusion of the ankle does result in the loss of approximately 75% of ankle motion, but some motion is kept through the joints underneath the ankle and into the mid-foot. Limited mobility can change how you walk, and that can cause wear and tear and, ultimately, painful arthritis in other parts of your ankle, knee, and foot. Recovery is longer with ankle fusion than with ankle replacement.

Read more about ankle fusion on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with an ankle specialist today.

When does chronic ankle pain require total ankle replacement?

When does chronic ankle pain require total ankle replacement? If you are experiencing ankle pain, inflammation and stiffness that impedes walking or living your desired active lifestyle, it’s time to evaluate your options. There are many causes of ankle pain, but some conditions produce joint damage severe enough to consider total ankle replacement, such as severe arthritis that was a result of a past joint injury, osteoarthritis in older adults that is the byproduct of wear and tear over time, or rheumatoid arthritis – an autoimmune disease that affects the body’s joints.

Total ankle replacement is not generally considered for cases of mild or moderate arthritis. At Colorado Center of Orthopaedic Excellence, our ankle specialists frequently recommend conservative treatments for these cases such as orthopedic shoe inserts, physical therapy regimens or pain management treatments that include oral pain medicines or corticosteroid injections.

When conservative treatments to not resolve the pain or support the needed activity level, other surgical procedures that include arthroscopic debridement or ankle fusion are considered. Individual conditions require individualized care and CCOE foot and ankle surgeons offer a wide range of solutions to meet each patient’s needs.

Total Ankle Replacement Surgery

Total ankle replacement surgery is the process of replacing a damaged ankle joint with an artificial implant. The tibiotalar joint within the ankle is where tibia comes to rest on the top of the talus. Arthritic conditions damage the body’s joints, including the tibiotalar joint. Arthritis causes the cartilage on the surface of the bone to wear away and lead to joint inflammation, which can, in turn lead to unbearable pain.  

In these situations, total ankle replacement surgery replaces the damaged joint to provide relief from the pain and swelling.

Typically, the procedure takes place under general anesthesia. Your surgeon will make an incision in your ankle to access the affected joint. Although individual cases vary, generally, total ankle replacement surgery includes making a cut in the front and sides of your ankle to remove damaged or worn cartilage and the affected portions of your tibia and talus bones before smoothing the remaining bone surfaces to receive artificial replacement parts.

The risks of the multi-hour surgery vary depending on the patient’s health and circumstances and CCOE surgeons thoroughly discuss each patient’s treatment plan prior to surgery. Imaging tests such as X-rays, CT scan, or MRIs provide essential visual tools to ensure the optimal treatment solution for each condition.

Total Ankle Replacement Surgery Recovery

Total ankle replacement surgery typically requires a multi-day hospital stay to ensure proper care of pain management, post-surgery healing monitoring and ample mobilization. Once the patient can tolerate activity, movement is an important part of recovery process. Splints and crutches are common recovery tools that ensure that your new ankle joint does not bear your full body weight for a few months. Your CCOE ankle expert will prescribe a full post-surgery rehab plan that guides your recovery. 

That plan includes pain management, gentle range of motion exercises, follow up appointments to remove stitches and imaging to assess progress milestones that enable approval for weight bearing action and your resumption of daily activities.

Each patient’s successful total ankle replacement story is unique and CCOE is here to help you write yours when your circumstances require a solution for your chronic ankle pain. Learn more or make an appointment with one of our foot and ankle specialists.

Dr. John Shank specializes in foot and ankle conditions and reconstructive procedures, arthroscopic and open fusion, ankle replacement, ankle arthroscopy, fracture care, ankle cartilage restoration procedures, bunion removal, and sports medicine.

Podiatrist vs. Orthopedist

When you have a problem with your foot or ankle that needs medical attention, where do you go – to a podiatrist or an orthopedic surgeon? And does it make a difference?

To answer those questions, let’s first look at what each of these specialists do.

A podiatrist is a doctor of podiatric medicine (DPM), specifically a specialist whose focus is strictly on foot and ankle care. That includes treatment of such conditions as:

·       Bunions

·       Toe and hindfoot fractures

·       Diabetic ulcers and wounds

·       Plantar fasciitis (inflammation of connective tissue on the bottom of the foot)

·       Hallux rigidus (stiff big toe)

·       Flat feet

·       Gout

·       Toenail disease

·       Heel spurs

·       Athlete’s foot

·       Corns

An orthopedic surgeon is a medical doctor (MD), specifically a specialist whose focus is on the care of bones, muscles, ligaments, tendons and nerves throughout the body – including in the foot and ankle. In regard to the latter, that includes treatment of such conditions as:

·       Achilles tendon tear and repair

·       Ankle replacement and cartilage restoration

·       Bunions

·       Flat feet

·       Plantar fasciitis

·       Heel spurs

·       Morton’s neuroma (nerve inflammation near the toes)

·       Hammer toe, mallet toe, and claw toe deformities

·       Stress fractures

·       Toe fractures

·       Hindfoot fractures

·       Metatarsal (forefoot fracture)

As you can see, both podiatrists and orthopedists perform many of the same foot and ankle procedures. Both are highly trained and qualified to treat foot and ankle conditions both surgically and non-surgically. The only discernible difference between them is that an orthopedist manages parts of the foot and ankle that pertain to the bones, soft tissues and joints, while a podiatrist manages the same areas, but also the biomechanics and dermatology of the foot and ankle. For instance, a podiatrist is often an integral care provider for people with diabetes who have serious concerns about foot health.

So, who do you choose for diagnosis and treatment of your foot or ankle problem?

It often depends on your particular foot or ankle problem – and how comfortable you are with one doctor over another. But it’s a dilemma you don’t have to face at Colorado Center for Orthopaedic Excellence in Colorado Springs. That’s because our practice specializes in both podiatry and foot and ankle orthopedics.

Our board-certified podiatric surgeon Dr. Frederick Hainge is highly skilled in diagnosing and treating structural and biomechanical issues, wounds, toe and foot deformities, nerve pain, and much more.

Meanwhile, fellowship-trained Dr. John Shank and our team of orthopedic physicians help patients manage their foot and ankle conditions through reconstructive procedures, arthroscopic and open fusion surgeries, physical therapy, and other procedures. And it’s all done under one roof.

The Colorado Center for Orthopaedic Excellence in Colorado Springs regularly treats injuries to bones and joints, providing the best of care. If a foot or ankle injury or pain is cause for concern, our board-certified orthopedic surgeons will quickly diagnose and treat the condition. Call us at (719) 623-1050 today for an appointment.