Ankle Arthrodesis with Nail: Indications, Procedure & Outcomes
Living with severe ankle pain can make even simple activities—walking short distances, climbing stairs, or standing for a while—extremely difficult. When conservative treatments like physiotherapy, braces, or medications no longer provide relief, surgery becomes the next option. For patients where ankle replacement does not seem appropriate, surgeons often recommend ankle arthrodesis with nail or fusion of the ankle joint.
Over the years, the way this surgery is performed has changed. Earlier, surgeons used plates and screws, but now, intramedullary nails are preferred. This method offers stronger internal fixation and has shown reliable results, especially for patients with more complex cases.
When is Nail-Assisted Fusion Considered?
Not every patient with arthritis or ankle pain will need an intramedullary nail. Surgeons usually consider it in situations where strong and lasting stability is essential:
- People with advanced post-traumatic arthritis, often after poorly healed fractures.
- Patients with rheumatoid arthritis or similar inflammatory conditions, that have destroyed the joint.
- Those with a severe deformity—where the ankle has shifted inward or outward to the extent that normal walking isn’t possible.
- As a salvage approach when earlier ankle replacement or fusion attempts have failed.
- Patients suffering from Charcot arthropathy, often seen in long-standing diabetes, where the ankle has become unstable due to nerve and bone damage.
In short, if the joint is badly damaged and traditional plates or screws are unlikely to hold, an intramedullary nail becomes a practical and often preferred choice.
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How is the Surgery Performed?
Ankle arthrodesis with a nail is performed under anesthesia, and though techniques may vary slightly by surgeon, the major steps remain consistent.
- Preparation: The damaged cartilage between the tibia and talus is carefully removed to create contact surfaces that can fuse.
- Correction: The ankle is aligned in a position that will allow patients to walk more naturally, usually with the foot pointing straight ahead and slightly flexed upward.
- Nail placement: Through a small incision, the surgeon places the nail inside the bone. Depending on the system, this can be done from below the foot (retrograde) or through the shin.
- Fixation: Locking screws secure the nail in place. Sometimes, bone grafts—either from the patient or donor—are used around the joint to encourage fusion.
After surgery, patients are generally placed in a cast or boot. Weight-bearing is restricted initially but gradually allowed as healing progresses. The exact timeline can differ; some patients start partial loading earlier, while others are kept non-weight bearing for longer if bone quality is poor.
What Outcomes Can Patients Expect?
For most patients, the biggest outcome is relief of pain. Because the ankle joint no longer moves, the grinding bone-on-bone sensation disappears. Union rates reported in medical literature often range above 90% with nail fixation, which is higher compared to several older methods.
Other advantages include:
- Greater stability even in bones weakened by arthritis or osteoporosis
- Better alignment, which makes walking less awkward
- Lower rates of wound complications compared with external fixators
- A quicker return to mobility for many patients
Still, as with any major operation, complications can arise—non-union, malunion, infection, or hardware irritation are possible. Close follow-up with the surgeon and careful adherence to rehabilitation advice are crucial in ensuring success.
Final Thoughts
Ankle arthrodesis with an orthopedic implant, like an intramedullary nail has become a dependable solution for patients whose ankle conditions can no longer be managed conservatively. By combining strong internal fixation with the ability to restore alignment, this technique has consistently shown high rates of pain relief and functional improvement. While the ankle sacrifices movement, the stability and comfort it provides often help patients regain independence in their daily lives.
