A Stronger Step Forward: Total Ankle Replacement & Traditional Ankle Fusion

When ankle arthritis becomes severe, it can start to take over more than just your joints; it affects how you move, how you sleep, and how fully you’re able to enjoy everyday life. Simple activities like walking the dog, running errands, or standing for long periods can become painful and frustrating. While bracing, injections, and other non-surgical methods often provide relief early on, they may not be enough as the condition progresses. For patients experiencing debilitating ankle arthritis, surgical solutions like a total ankle replacement (arthroplasty) or a traditional ankle fusion can offer lasting pain relief and a path back to mobility.

At Orthopedic ONE, our fellowship-trained foot and ankle surgeons work with each patient to thoughtfully explore these options, helping them find the path that best fits their health, goals, and lifestyle.

Understanding Total Ankle Replacement vs. Traditional Ankle Fusion

“Total ankle replacement uses metal and plastic implants to replace the damaged arthritic joint,” explains Dr. Scott Van Aman, Orthopedic ONE foot and ankle surgeon. This procedure is typically recommended for patients with severe arthritis who have already explored and exhausted non-invasive treatments, such as bracing, anti-inflammatory medications, or cortisone injections, without lasting relief.

The most common causes of ankle arthritis include wear-and-tear osteoarthritis, post-traumatic arthritis following an injury, and inflammatory conditions like rheumatoid arthritis. When symptoms such as stiffness, chronic pain, and difficulty walking begin to interfere with daily routines, or even disrupt sleep, many patients find themselves ready to explore long-term solutions. In these moments, a total ankle replacement can offer something invaluable: a return to mobility, comfort, and a more active lifestyle.

One of the key advantages of ankle replacement over fusion is the ability to maintain joint movement. “The benefit of ankle replacement compared to ankle fusion would be restoration of more normal motion through the ankle and restoration of a more normal gait pattern afterwards, because the ankle moves as opposed to being fused in place,” says Dr. Van Aman. Preserving this motion not only supports natural movement but also helps reduce strain on surrounding joints, which can be a game-changer for maintaining long-term function.

That said, fusion can be the optimal choice for some patients. “Fusion is sometimes a better option for patients who have had prior infections in that area, soft tissue injuries coming from open fractures or burns, more destructive arthritis, damage to bone structure, or neuropathy,” he explains. Treatment decisions are never one-size-fits-all. “I’m looking at their overall functional level, desired function, how much ankle motion they currently have, as well as how they got here.”

Ultimately, though, the decision to pursue surgery is a deeply personal one, and at Orthopedic ONE, it’s never rushed. “There’s no such thing as an emergent total ankle replacement,” Dr. Van Aman emphasizes. “This is a quality-of-life surgery. So, for me, it’s about when patients are having pain affecting their quality of life on a daily basis, and non-invasive options are just no longer helping them.”

For many patients, reaching this point is not the end of the road, but the start of something better: a chance to move again, rest more comfortably, and return to the things they love with confidence.

Recovery, Rehab, and Long-Term Expectations

Here at Orthopedic ONE, the recovery process following total ankle replacement is gradual yet carefully structured, resulting in significant improvements in mobility compared to pre-surgery levels. Patients typically begin with two weeks of rest with no weight-bearing activity, followed by another month of no weight-bearing activity in a walking boot. After that, they undergo physical therapy for about six weeks. “Physical therapy is pretty critical to the restoration of function and a more normal gait pattern after the ankle replacement,” says Dr. Van Aman. “It plays an integral role in the patient’s recovery.” As such, most patients begin feeling significantly better within a few months, and “it’s usually only about 10 to 12 weeks until they’re back to feeling like themselves again.”

Additionally, thanks to advancements in technology, current ankle implants are lasting longer than ever. “We’re usually telling people that this current generation of implants is likely to last 10 years.” With this improved durability, many patients can return to the everyday activities they enjoy, such as walking, hiking, traveling, and simply moving without pain.

After surgery, gentle movement and low-impact exercise are not only safe but encouraged as part of a healthy recovery and long-term success. While patients are advised to avoid high-impact or explosive activities, including running, jumping, and cutting, most find they can stay active and independent without placing unnecessary stress on the new joint.

With the right care and guidance, total ankle replacement can offer long-lasting, life-changing improvement in both comfort and mobility, giving patients the freedom to move forward with confidence.

Sally’s Story: A Return to Movement

One of Dr. Van Aman’s patients, Sally Meier, knows firsthand the life-changing impact of a total ankle replacement. After years of suffering from joint pain caused by rheumatoid arthritis, Sally tried cortisone injections and physical therapy. Unfortunately, these methods weren’t enough to bring lasting relief. Following Dr. Van Aman’s expert guidance, she decided to move forward with a total ankle replacement in 2021, despite being nervous about surgery. Just weeks after surgery, Sally began experiencing dramatic improvements, and her ankle continued to rapidly progress thanks to targeted physical therapy, including stretching, massaging, and calf work. Today, Sally is back to doing what she loves most in life: biking, swimming, and walking without “even having to think about [her ankle]!”

Sally’s story is just one example of how total ankle replacements at Orthopedic ONE can restore mobility, alleviate pain, and help patients return to an active lifestyle. Whether you’re initially hesitant like Sally, or excited for new possibilities, our team is here to guide you through the process every step of the way.

Expert Care and Personalized Options

Orthopedic ONE is uniquely equipped to provide patients with the full range of ankle care, from conservative treatments like bracing, injections, and physical therapy to advanced surgical procedures, including both total ankle replacement and traditional ankle fusion. This comprehensive approach allows our team to tailor treatment plans that align with each patient’s goals, lifestyles, and medical history.

“We offer the complete spectrum of orthopedic care from non-operative care through surgery, through physical therapy and rehabilitation, back to normal function,” says Dr. Van Aman. “We do enough volume to be experts in managing total ankle replacement and their care pathways, and we do a higher volume than most other care centers.”

For patients unsure whether they’re ready for surgery, or even what options exist, Dr. Van Aman encourages starting that conversation. “We’re an expert resource for any part of the care continuum for arthritis of your ankle, from the most basic conservative care to the most complex surgical care.”

Whether you’re just beginning to explore next steps or ready to take action, Orthopedic ONE is here to listen, guide, and support you every step of the way. Relief is possible, and often, it begins with asking the right questions and finding a team that truly understands your needs. Wherever you are in your journey, Orthopedic ONE is here to help you take that stronger step forward.