Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Ankle Fusion: When Eliminating Motion Eliminates Pain

Ankle arthrodesis (fusion) — the surgical elimination of ankle joint motion by fusing the tibia and talus into a single bone unit — has been the gold standard surgical treatment for end-stage ankle arthritis for decades. Despite the seemingly counterintuitive approach of eliminating motion to treat a painful joint, ankle fusion achieves reliable, durable pain relief for appropriately selected patients and is one of the most successful procedures in foot and ankle surgery. At Balance Foot and Ankle in Howell and Bloomfield Township, Michigan, our surgeons perform ankle arthrodesis with an honest discussion of what patients gain and what they give up.

Who Needs Ankle Fusion

Ankle fusion is indicated for end-stage ankle arthritis — the condition in which articular cartilage is completely or nearly completely destroyed, bone contacts bone, and pain with any weight-bearing activity is severe and unresponsive to conservative care. Causes of end-stage ankle arthritis most commonly treated with fusion: post-traumatic arthritis (the most common — following ankle fractures, pilon fractures, talar fractures, or chronic ankle instability), rheumatoid and inflammatory arthritis, primary osteoarthritis (less common in the ankle than the knee or hip), and end-stage Charcot neuroarthropathy. Conservative management (orthotics, bracing, injections, activity modification) must be exhausted before surgical intervention is appropriate.

The Surgical Technique

Modern ankle arthrodesis is performed either open (through an anterior or lateral approach) or arthroscopically. Arthroscopic ankle fusion — performed through small portals with camera and instrument guidance — has become the preferred approach when deformity correction isn’t required. Advantages of arthroscopic fusion: smaller incisions, reduced wound complication rates (significant in patients with poor wound healing from diabetes or prior surgeries), similar fusion rates to open technique, and faster recovery. The fusion is secured with screws crossing the tibiotalar joint in a configuration designed to maximize compression and stability across the fusion site. Some cases require plate fixation in addition to or instead of screws.

Long-Term Outcomes and Life After Ankle Fusion

Successful ankle fusion achieves durable pain relief in 80-90% of patients — the primary surgical goal. What patients give up: ankle dorsiflexion and plantarflexion — the fused ankle cannot flex or extend. What patients retain: subtalar and midtarsal motion that continues to provide some foot compliance (though this motion is accelerated to compensate for ankle motion loss, eventually causing adjacent joint arthritis in some patients). Activities after successful ankle fusion: walking (essentially normal), swimming, cycling, low-impact sports. High-impact running, jumping sports, and cutting activities are significantly limited. The rate of adjacent joint arthritis progression after ankle fusion is significant — the long-term cost of ankle fusion includes the increased rate of subtalar and midtarsal arthritis requiring future surgery. This long-term consideration has increased interest in ankle replacement as a motion-preserving alternative. Contact Balance Foot and Ankle at (810) 206-1402 for end-stage ankle arthritis evaluation including comprehensive discussion of fusion vs. replacement options.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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When to See a Podiatrist About Ankle Fusion Surgery

Ankle fusion (arthrodesis) is a reliable surgical option for end-stage ankle arthritis that eliminates pain by permanently joining the tibia and talus. At Balance Foot & Ankle, Dr. Tom Biernacki evaluates whether ankle fusion, ankle replacement, or conservative management is the best option for your situation.

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Clinical References

1. Coester LM, Saltzman CL, Leupold J, et al. Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am. 2001;83(2):219-228.
2. Haddad SL, Coetzee JC, Estok R, et al. Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis: a systematic review of the literature. J Bone Joint Surg Am. 2007;89(9):1899-1905.
3. Saltzman CL, Mann RA, Ahrens JE, et al. Prospective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int. 2009;30(7):579-596.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.