Dr. Öğr. Üyesi Görkem Kıyak
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Foot & Ankle
Arthrodesis of the ankle joint
What arthrodesis of the ankle joint (ankle fusion) is, how the bones are joined with screws or a nail, who it helps when arthritis has worn the joint out, how it compares with ankle replacement, approximate costs in Turkey against the UK, US and Germany, the long non-weight-bearing recovery, risks and how to check a hospital.
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Arthrodesis of the ankle joint in Turkey: what ankle fusion is
Arthrodesis of the ankle joint, usually called ankle fusion, is an operation that joins the shin bone (tibia) to the ankle bone (talus) so that the two heal into one solid piece. The worn cartilage is removed, the bone surfaces are shaped to meet cleanly and the joint is held still with screws, a plate or a nail until the bones grow together. The aim is not to restore movement but to take away the pain that comes from bone rubbing on bone. Orthopaedic hospitals in Turkey perform ankle fusion for arthritis, old fractures and failed ankle replacements.
This guide explains how the operation works, who it suits, what it costs compared with the UK, US and Germany, how long recovery takes and what walking is like afterwards. For other joint operations see our orthopedics treatments in Turkey.
Why would someone need an ankle fusion?
The usual reason is end-stage arthritis of the ankle, most often after an old fracture or ligament injury (post-traumatic arthritis), less often from rheumatoid arthritis or a long-standing deformity. Other reasons are a failed or loose ankle replacement, bone death in the talus (avascular necrosis), severe instability, nerve conditions that leave the joint unstable and infection damage. Pain is felt on every step, the ankle swells and stiffens, and braces, insoles, walking aids and injections have stopped helping. Fusion is generally considered once these non-surgical steps have been tried.
How does the surgery work, step by step?
The operation is done under general or spinal anaesthesia, often with a nerve block that numbs the leg for several hours afterwards. It usually takes between 90 minutes and two and a half hours.
- Access. The surgeon reaches the joint through an open incision at the front or outer side of the ankle, or through small keyhole (arthroscopic) cuts when the deformity is mild.
- Preparation. Remaining cartilage and damaged bone are removed from both surfaces so that raw, bleeding bone is in contact.
- Alignment. The foot is set at about 90 degrees to the leg, slightly turned out, so you can walk with a smooth step.
- Fixation. Two or three large screws, a plate, or a rod passed through the heel (used when the neighbouring joint is also damaged) hold the bones. Bone graft from the patient, a donor or a substitute is added when there is a gap.
- Closure and splint. The wound is closed and the leg is placed in a padded splint.
Does ankle fusion work, and what does the evidence say?
Ankle fusion is a long-established operation, and the evidence is consistent that it relieves pain in most people with end-stage arthritis and gives a stable, load-bearing ankle that suits standing and walking. It is considered a durable solution, which is why it is often advised for younger or heavier patients and for people who do physical work. What it cannot do is restore up-and-down movement: the bones are joined by design. Studies also show that, over many years, the neighbouring joints in the foot (subtalar, midfoot) take on extra load and some people develop arthritis there. Not every fusion unites: non-union is a recognised complication, and smoking and diabetes increase the chance.
Arthrodesis of the ankle joint cost in Turkey and what changes the price
The figures below are approximate ranges for a single ankle, not hospital quotes. The hospital confirms its own price in a written quote after reviewing your X-rays or scans.
| Country | Approximate cost range |
|---|---|
| Turkey | €3,500 – €9,500 |
| United Kingdom | €9,000 – €20,000 |
| United States | €18,000 – €45,000 |
| Germany | €9,000 – €18,000 |
The price depends on the fixation (screws are cheaper than a plate or a nail with its instruments), open versus arthroscopic technique, whether bone graft is needed, whether a previous implant must be removed, the number of hospital nights and the type of room. A package usually covers the pre-operative tests, the operation, the anaesthetist, the implants, the hospital stay, a splint and the first dressing changes, plus airport transfers. Crutches, a knee scooter, a boot and physiotherapy back home are often extra, so ask for the inclusions in writing.
Ankle fusion or ankle replacement: which suits you?
Ankle replacement keeps some movement, which is attractive, but not everyone is a candidate. Fusion remains the more predictable choice when the bone is poor, the deformity is large, the patient is heavy or very active in manual work, the ligaments are unstable or an earlier replacement has failed. Your surgeon should explain why one is advised for your ankle and what each would mean over ten years.
| Option | Best suited to | Typical limits |
|---|---|---|
| Ankle fusion (arthrodesis) | Severe arthritis, deformity, poor bone, heavy or active patients, failed implants | No up-and-down movement; strain on neighbouring joints over time |
| Total ankle replacement | Older, lighter, less active patients with good bone and straight alignment | Implants can loosen and may need revision |
| Ankle arthroscopy and debridement | Early arthritis, bone spurs, impingement | Not a lasting answer to widespread joint wear |
Who is a good candidate, and who should wait?
Good candidates have severe, constant ankle pain, joint damage visible on X-ray or CT and have already tried bracing, footwear changes and injections. You are less suited, or the surgeon may ask you to wait, if you smoke or use nicotine products (this sharply reduces bone healing), have poorly controlled diabetes, poor circulation in the leg, an active skin infection near the ankle or severe osteoporosis. Because you cannot put weight on the leg for weeks, the surgeon will also ask about help at home and whether you can manage crutches or a knee scooter.
Arthrodesis of the ankle joint recovery: how long in Turkey and when can you walk?
Recovery is long compared with many orthopaedic operations, and the exact schedule is set by your surgeon.
- Hospital: usually one to three nights. The leg is elevated and a splint is worn.
- Weeks 1 to 2: no weight on the leg; wound check and stitch removal around two weeks.
- Weeks 2 to 6: a cast or boot, still non-weight-bearing in most protocols.
- Weeks 6 to 12: an X-ray checks that the bones are uniting; weight-bearing in a boot usually starts gradually.
- From about 3 months: walking in a supportive shoe, physiotherapy for the calf, knee and hip and for gait.
- 6 to 12 months: swelling settles and the foot adapts; a rocker-sole shoe often makes walking feel smoother.
Most patients stay in Turkey for 5 to 10 days: long enough for the first check and splint change, with the rest of the healing done at home. Flying is generally allowed once the surgeon agrees; keep the leg raised and ask about blood-thinning medication for the flight. A video follow-up lets the team review the wound and X-rays you send.
What will walking be like after ankle fusion?
Most people walk with much less pain once the bones have united. Because the ankle no longer bends, the foot, midfoot and hip make up some of the movement; many people walk normally on flat ground but notice stiffness on slopes, stairs, uneven ground and when getting out of a low chair. Running and sports that need sudden push-off are usually limited, while walking, cycling and swimming are commonly resumed. Ask the surgeon what level of activity is realistic for you rather than relying on a general promise.
Risks and complications of ankle fusion
Every operation carries risks. Specific to ankle fusion are non-union (the bones do not join, sometimes needing further surgery), malunion (healing in a poor position), wound healing problems and infection, nerve irritation or numbness around the foot, a painful or prominent screw, and later arthritis in neighbouring joints. General risks are blood clots (deep vein thrombosis) and anaesthetic complications; the NHS and orthopaedic societies such as the American Academy of Orthopaedic Surgeons (AAOS) list these for foot and ankle surgery. Stopping smoking, controlling diabetes and following the no-weight rule reduce the risk. Ask the hospital how a complication would be handled and who would treat you at home.
How to choose a surgeon and hospital, and which questions to ask
Look for an orthopaedic surgeon who regularly performs foot and ankle surgery, an accredited hospital with an anaesthetist and a physiotherapy team, and a written plan and price before you pay a deposit. Red flags include a quote with no breakdown, no review of your scans before the offer, promises that you will have normal movement, pressure to book fast and no plan for aftercare. Read how our process works and send your scans through our free quote page for a written plan. Questions to ask the clinic:
- Is fusion definitely better for me than replacement, and why?
- What fixation will be used, and is bone graft expected?
- How many nights in hospital, and how long should I stay in Turkey?
- When may I put weight on the foot, and who checks my X-rays?
- Does the price include the boot, crutches and implants?
- What happens if the bones do not unite?
Hospitals with Orthopedics in Turkey
Frequently asked questions
It is ankle fusion: surgery that joins the shin bone and the ankle bone with screws, a plate or a nail so they heal into one piece. It removes the pain of an arthritic joint but gives up up-and-down movement.
In most people with end-stage ankle arthritis it relieves pain and gives a stable ankle for walking. Success depends on the bones uniting, which is less likely in smokers and in people with poorly controlled diabetes.
Approximate ranges are €3,500 to €9,500 in Turkey, against about €9,000 to €20,000 in the UK. The price depends on the fixation, graft, hospital stay and what the package includes; the hospital confirms it in a written quote.
Neither suits everyone. Fusion is more predictable for poor bone, large deformity, heavy or active patients and failed implants; replacement keeps some movement but can loosen. A surgeon should explain the choice for your ankle.
Expect around six weeks without weight on the leg, then gradual weight-bearing in a boot, with walking in a shoe from about three months. Swelling and stiffness keep improving for up to a year.
A nerve block and medication control pain during and after surgery. The first days are sore and swollen, and most people manage with prescribed painkillers and keeping the leg raised.
Most people walk comfortably on flat ground, though the foot is stiffer on stairs, slopes and uneven ground. A rocker-sole shoe often helps, and running is usually limited.
A united fusion is generally permanent. Over many years the neighbouring joints can take extra load, and some people develop arthritis in them.
The main risks are non-union, infection, wound problems, nerve numbness, blood clots and later arthritis in nearby joints. Stopping smoking and following the weight-bearing rules lower the risk.
Plan for about 5 to 10 days: one to three nights in hospital and a check before flying. The rest of the healing, including the no-weight period, happens at home.
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