As with other joint replacements, the most frequent source of ankle pain and joint destruction is arthritis—osteoarthritis, traumatic arthritis, and rheumatoid arthritis. Patients suffering from severe, incapacitating chronic ankle pain presently face limited options. For many, ankle fusion is the answer. Fusion alleviates pain, is durable, and remains the gold standard among orthopaedic surgeons. But fusion, which completely restricts ankle motion, can over time place stress on the knee and other foot joints.
More recently, researchers, clinicians, and patients are discovering encouraging results from total ankle replacement.
"I was having severe problems with the loss of cartilage in both ankles," Carl Fuerst, 76, told the Post. "The problem probably resulted from high-school and college sports. But as I grew older, I began to experience severe pain in both ankles."
Fuerst consulted with specialists, who suggested ankle fusion.
"I knew someone who had a fused ankle, but the thought of fusing both ankles didn't appeal to me at the time," says Fuerst, who continued to endure pain. During a business trip to South Dakota, Fuerst—a water park designer—met with a doctor named Frank Alvine, M.D., who owned a water park with his family and who ironically also helped develop the ankle replacement joint currently in use.
After several consultations, Fuerst opted for replacement surgery, undergoing ankle replacement surgeries one year apart.
"Today, I can walk hours without pain," Fuerst reports. "I mow lawns, hike, walk on uneven surfaces, go to beaches and walk on the sand. Before the surgery, not only was I getting to the point that I needed a wheelchair, [but] I was [also] experiencing tremendous pain in bed at night. The surgery changed my life. It has just been wonderful."
Fuerst in many ways represents the ideal candidate for the new procedure.
"An ideal candidate might include an older individual who has severe arthritis and is at a moderate activity level," Dr. James W. Brodsky, clinical professor of orthopaedic surgery at the University of Texas Southwestern Medical School, told the Post. "There's no question that the procedure is offering significant hope: excellent pain relief with the advantage over fusion of preservation of motion in the ankle joint."
The decision of fusion versus replacement, however, remains the subject of intense scientific investigation, and the decision depends on the proper selection of patients.
"Clearly, some patients are far better off with fusion than with ankle replacement," says Dr. Brodsky. "Fusions are strong, stable, permanent, and provide excellent reliable and predictable relief of pain, which is the most important factor in treating arthritis. But one of the drawbacks of the procedure is the possibility that fusion may increase the mechanical load on the adjacent joints over many years."
If you are interested in exploring the options, Brodsky recommends utilizing the online resources available at the American Orthopaedic Foot & Ankle Society (www.aofas.org) or calling 800-235-4855 to learn more about the procedures and to help locate an experienced surgeon in your area.
For Carl Fuerst, ankle replacement was simply the best choice. Four years later, he enjoys an active, pain-free life.
"From my perspective, the surgery has worked out wonderfully," reports Fuerst. "I don't know if everyone has the same results. I do know that when I began to look into it, I talked to various people who underwent the surgery, who offered insights into the benefits that they received. Subsequently, many people have been in touch with me over the last few years, and I can only tell them that it has worked very well for me. I would hope that it worked as well for them."
Readers interested in learning more about the procedure and Carl's experiences may contact him via email at Cjfuerst@aol.com.
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