Each ankle supports a force about five times a person's body weight during walking. Normally, cartilage in the ankle joint cushions the bones, so walking is painless. When the cartilage is destroyed or seriously damaged by arthritis or an injury, however, the pain can be debilitating. Patients may need ankle surgery to treat their injury or condition. Surgical options include ankle fusion surgery, ankle replacement surgery or debridement.

Many types of ankle surgery and treatment options are available at Mayo Clinic, depending on the age and activity level of the patient and the cause and severity of the condition. A foot and ankle specialist conducts a comprehensive evaluation to determine which type of ankle surgery is most appropriate for the patient. Treatment options include, but are not limited to, debridement, ankle fusion or ankle replacement.

To relieve the pain of mild osteoarthritis, Mayo surgeons may recommend debridement, a minimally invasive surgical procedure that involves cleaning up the cartilage around the ankle joint. Surgeons use an arthroscope, an instrument that permits small incisions, and insert a small camera to see the joint. Special surgical tools are used to remove damaged parts of the joint, loose pieces of cartilage and bone around the joint.

Ankle fusion is often recommended for people with severe ankle misalignment, osteoarthritis, an inability to move the foot due to a neurological lesion or a history of infection or dead bone. Ankle fusion generally is suitable for patients who are younger than 30 and wish to participate in high-impact physical activities. It also may be an option for larger patients. Ankle fusion usually allows patients to walk without a limp and without pain.

Ankle replacement surgery is often appropriate for patients who avoid high-impact activities, such as skiing, basketball and football. Ankle replacement may be better suited for people with near-normal alignment of the ankle, no history of infection in the ankle joint, and no dead bone (avascular necrosis). Most patients who have ankle replacement surgery have osteoarthritis, rheumatoid arthritis or arthritis caused by a prior trauma, such as a broken ankle.

Mayo Clinic foot and ankle specialists have expertise and experience in performing ankle fusion surgery and may perform minimally-invasive surgery when possible. Foot and ankle specialists use the newest surgical techniques and the most current technology available to effectively treat ankle conditions. Candidates for ankle fusion surgery may include patients with severe ankle misalignment, osteoarthritis or other ankle conditions.

To relieve ankle pain when cartilage has been damaged or destroyed, the bones of the ankle can be fused. Ankle fusion surgery involves the implantation of external or internal fixation devices. An orthopedic surgeon determines which type of fixation is most appropriate for each patient. In external fixation, surgical pins are fixed inside the leg and ankle bones to keep the bones in place, and an outer metal rod and pins hold the bones in place until they heal. More commonly, in an internal fixation approach using internal fixation, the cartilage at the ankle joint is removed, and the ankle and leg bones are compressed with plates and screws so that the bones fuse. The fusion may be promoted by first inserting bone-graft material, often obtained from elsewhere in the body.

Ankle fusion at Mayo Clinic may also be performed using minimally invasive arthroscopic surgery. With that method, surgeons use an arthroscope, a small camera inserted through an incision that allows the surgeon to view, diagnose and treat the joint.

After ankle fusion surgery, the screws and plates usually remain in the ankle after healing. After ankle fusion surgery, the ankle joint may have a smaller range of motion than before surgery. Other joints, if healthy, may be able to compensate for the loss of range of motion. Some patients walk so well after healing is complete that observers may not be able to tell which ankle was fused. The greater load on the other joints may eventually result in arthritis. Ankle fusion may allow for more stability and less pain than other ankle surgeries.

Mayo Clinic orthopedic foot and ankle specialists conduct a comprehensive orthopedic evaluation to determine if ankle replacement is the most appropriate treatment for the patient. Because significant risks and possible complications may occur, specialists recommend ankle replacement only after a comprehensive evaluation. Patients who may benefit most from ankle replacement are those who also have another bad ankle or an injury or arthritis elsewhere in the foot or knee on the affected side. Patients who have reduced range of motion because of previous fusions below the ankle may be good candidates.

In ankle replacement surgery, a surgeon makes an incision in the front of the ankle and removes the damaged joint surfaces. The surfaces are replaced with plastic and metal devices called prostheses.

Ankle replacement may give the patient movement in the foot and a near-normal gait. After surgery, patients may walk and take part in low-impact activities such as golf. They should not, however, engage in such exercises as step aerobics or use an incline treadmill or stairstep machine. Artificial joints can wear or become loose, and may eventually need to be replaced. A replacement joint's life depends on how the joint is used.

Mayo Clinic foot and ankle specialists in the Department of Orthopedic Surgery work with an integrated team to ensure that each patient receives individualized ankle surgery and treatment. The integrated team may include specialists from rheumatology, physical medicine and rehabilitation and other departments, who collaborate to find the most appropriate treatment for each patient.

The experienced physicians at Mayo offer high-quality orthopedic care for more than 70,000 patients each year. Physicians and researchers have access to the most current technology and treatment options for ankle and other orthopedic conditions. For many years, surgeons at Mayo Clinic have performed complex ankle surgeries to treat ankle conditions, such as ankle fusions and ankle replacements.

Mayo Clinic in Rochester, Minn., is ranked among the Best Hospitals for orthopedics by U.S. News & World Report. Mayo Clinic in Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked high performing for orthopedics by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for orthopedics.

At Mayo Clinic, we assemble a team of specialists who take the time to listen and thoroughly understand your health issues and concerns. We tailor the care you receive to your personal health care needs. You can trust our specialists to collaborate and offer you the best possible outcomes, safety and service.

Mayo Clinic is a not-for-profit medical institution that reinvests all earnings into improving medical practice, research and education. We're constantly involved in innovation and medical research, finding solutions to improve your care and quality of life. Your doctor or someone on your medical team is likely involved in research related to your condition.

Our patients tell us that the quality of their interactions, our attention to detail and the efficiency of their visits mean health care — and trusted answers — like they've never experienced.

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Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

All the surgeries described in these pages are available in Arizona.

Ankle surgery is performed by specialists in Orthopedic Surgery. Specialists in Rheumatology and Physical Medicine and Rehabilitation are involved in the treatment and rehabilitation of patients who have had ankle surgery.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

All the surgeries described in these pages are available in Florida. Mayo Clinic in Florida also offers repair of cartilage defects in young patients (over age 18) without arthritis. Surgeons also perform tendon reconstruction and ligament repair.

Ankle surgery is performed by specialists in Orthopedic Surgery. Specialists in Rheumatology and Physical Medicine and Rehabilitation are involved in the treatment and rehabilitation of patients who have had ankle surgery.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

All the surgeries described in these pages are available in Minnesota.

Ankle surgery is performed by specialists in Orthopedic Surgery. Specialists in Rheumatology and Physical Medicine and Rehabilitation are involved in the treatment and rehabilitation of patients who have had ankle surgery.

The Biomechanics and Motion Analysis Laboratories in the Department of Orthopedic Surgery are consulted in some cases, such as in gait analysis and prosthesis evaluation.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

All the surgeries described in these pages are available for children in Minnesota.

Ankle surgery is performed by pediatric orthopedic specialists in Orthopedic Surgery.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

The Department of Orthopedic Surgery at Mayo Clinic has long been involved in research advances in orthopedic surgery, including how to alleviate suffering from various ankle and foot conditions. Currently, 24 funded investigators, many of them active clinicians, with nearly $7 million in annual funding, are doing research in 10 basic research laboratories. They also are conducting clinical trials and other clinical research into virtually every aspect of musculoskeletal pathology.

The Biomechanics and Motion Analysis Laboratories in the Department of Orthopedic Surgery use gait analysis, prosthesis evaluation, strength testing and other testing to evaluate a patient's ankle treatment. Foot and ankle specialists in the laboratory test patients in a motion lab to determine which treatment will be most effective for their condition.