Quick Answer
Most foot and ankle problems respond to conservative care — proper footwear, supportive inserts, activity modification, and targeted stretching — within 4-8 weeks. Persistent pain beyond that window, or any symptom that prevents walking, warrants a podiatric evaluation to rule out fracture, tendon tear, or systemic cause.
Medically Reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Balance Foot & Ankle Specialists, Michigan. Last updated April 2026.
Total ankle arthroplasty (TAA) revision — surgical management of failed total ankle replacement — has become an increasingly relevant clinical entity as the installed base of primary ankle replacements grows and long-term follow-up data reveals the survivorship limitations of current implant designs (10-year survival rates of 70–85% for third-generation implants). Understanding the specific failure mechanisms, the diagnostic workup distinguishing aseptic loosening from septic failure, and the surgical options from component revision through conversion to ankle arthrodesis allows appropriate management of the growing population of patients with failed ankle arthroplasty.
Watch: Dr. Tom Biernacki, DPM
Failure Mechanisms and Diagnosis
Aseptic loosening: the most common failure mode — progressive lucent lines at the bone-implant interface on serial radiographs; tibial component subsidence more common than talar; risk factors: obesity (BMI >35), low activity level, inadequate bone preparation, component malalignment, coronal plane deformity at implantation. Edge loading and polyethylene failure: malalignment producing asymmetric loading of the polyethylene insert; edge loading produces asymmetric wear, osteolysis, and ultimately implant failure; diagnosis: CT assessment of implant position, radiographic osteolysis, and implant subsidence. Periprosthetic infection (septic loosening): less common than hip/knee (1–4%); presents with persistent pain, wound drainage, elevated CRP/ESR; aspiration culture and histopathology mandatory before revision surgery; biofilm formation on titanium/cobalt-chrome implants requires complete hardware explantation for cure. Soft tissue failure: medial or lateral ankle instability around the prosthesis from collateral ligament incompetence; gutter impingement from heterotopic ossification; stress fractures of the fibula or medial malleolus. Diagnostic workup: weight-bearing CT is essential — shows component position, osteolysis extent, and bone stock for revision; bone scan/labelled leukocyte scan to assess infection; joint aspiration for culture.
Revision Surgical Options
Component revision: exchange of one or both metal components and the polyethylene insert — appropriate for isolated component loosening with adequate bone stock; specialized revision implants with stems and augments for bone defects; 70–75% 5-year survival after revision TAA. Conversion to ankle arthrodesis (fusion): the salvage procedure for failed ankle replacement — explantation of all components; bulk allograft or structural cage reconstruction of bone defects; tibiotalar arthrodesis with nail fixation; fusion rates of 70–80% (lower than primary arthrodesis due to bone loss); reliable pain relief even when fusion is difficult. Tibiotalocalcaneal arthrodesis: for combined ankle and subtalar pathology at the time of TAA explantation; intramedullary retrograde nail provides stable fixation across both joints. Dr. Biernacki at Balance Foot & Ankle evaluates failed total ankle replacements and performs revision surgery and conversion arthrodesis at our Bloomfield Hills and Howell offices. Call (810) 206-1402.
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Our board-certified podiatrists treat this condition at two convenient locations. Same-day appointments often available.
More Podiatrist-Recommended Surgery Essentials
Post-Op Walking Boot
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Protected weight-bearing immobilization through the first healing weeks.
Surgical-Scar Healing Lotion
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Reduces scar thickness and tenderness as the incision matures.
Return-to-Activity Insole
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Supports the reconstructed foot during the first months back on your feet.
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When to See a Podiatrist
Foot and ankle surgery in 2026 is dramatically different than a decade ago — most procedures are now minimally-invasive, outpatient, and allow weight-bearing within days. Balance Foot & Ankle surgeons have performed 3,000+ foot/ankle surgeries with modern techniques. If another surgeon has recommended a traditional open procedure, a second opinion may reveal a faster, less-invasive option.
Call Balance Foot & Ankle: (810) 206-1402 · Book online · Offices in Howell & Bloomfield Hills
Frequently Asked Questions
How do I know if I sprained or broke my ankle?
Both cause pain, swelling, and difficulty walking. Key differences: fractures often cause more immediate severe pain, tenderness directly over bone (not just ligament), and inability to bear any weight. X-rays and the Ottawa Ankle Rules help determine if imaging is needed.
How long does an ankle sprain take to heal?
Grade I (mild): 1–2 weeks. Grade II (moderate): 3–6 weeks. Grade III (complete tear): 2–3 months. Chronic instability from improperly treated sprains can persist and may require surgery.
What is the best treatment for a sprained ankle?
RICE protocol (Rest, Ice, Compression, Elevation) for the first 48–72 hours, followed by protected weight-bearing as tolerated. Physical therapy rehabilitation is critical for high-grade sprains to restore strength and proprioception and prevent chronic instability.
Need Treatment at Balance Foot & Ankle?
Dr. Tom Biernacki, Dr. Carl Jay, and Dr. Daria Gutkin see patients at our Howell and Bloomfield Township offices.
Book Online or call (810) 206-1402
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Howell Office
3980 E Grand River Ave, Suite 140
Howell, MI 48843
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Bloomfield Hills Office
43700 Woodward Ave, Suite 207
Bloomfield Hills, MI 48302
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Same-week appointments available at both locations.
Book Your AppointmentMost Common Mistake We See
The most common mistake we see is: Waiting too long before seeking care. Fix: any foot pain lasting more than 4 weeks, or any sudden severe symptom, deserves a professional evaluation rather than more rest.
Warning Signs That Need Same-Day Care
Seek immediate evaluation at Balance Foot & Ankle if you experience any of the following:
- Unable to bear weight
- Severe swelling with skin colour change
- Fever with foot pain (possible infection)
- Diabetes plus any new foot symptom
Call (810) 206-1402 — same-day and next-day appointments at our Howell and Bloomfield Hills offices.
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.
- Diagnosis and Treatment of Plantar Fasciitis (PubMed / AAFP)
- Heel Pain (APMA)
- Hallux Valgus (Bunions): Evaluation and Management (PubMed)
- Bunions (Mayo Clinic)