More than 30 years ago, 56-year-old Everett resident Michael Diorio fell from a palm tree while trimming fronds at a San Diego apartment. The three-story fall crushed his left heel and fractured his right ankle. Over the last 20 years, he had seven surgeries on his feet and suffered pain on a regular basis.

After his new health insurance provided him access to a Virginia Mason primary care physician, he was referred to a board certified podiatrist in the Orthopedics and Sports Medicine department. Following a thorough evaluation, Diorio was told he was a candidate for a relatively new procedure – total ankle arthroplasty, also known as total ankle replacement. Diorio subsequently had the three-hour outpatient surgery on his right ankle at Virginia Mason Hospital and Seattle Medical Center on Dec. 15 of last year and returned to work full time in late March.

“I used to limp and regularly experience pain. Now I walk almost as well as I did before my injury and without any discomfort. I’m glad I was a candidate for total ankle replacement and have been very satisfied with the experience and outcome,” he said.

The procedure and its benefits

Total ankle replacement is similar to hip and knee replacements – patients receive a new ankle joint made of precisely engineered metal and plastic parts that replace the old ankle joint.

Expected benefits from the surgery include improved ankle function and reduction or elimination of ankle pain

The surgery is typically performed without the need for an overnight hospital stay and patients usually go home the same day to begin recovery. Patients should expect a period of limited weight-bearing initially, followed by a gradual return to daily activity as their ankle heals. Most patients will have physical therapy after the procedure to help regain mobility.

People who are not candidates for total ankle replacement may be offered other procedures to relieve ankle pain.

As Diorio has experienced, total ankle replacement can provide pain relief and make it easier for people to get around. But candidates need to weigh risks and benefits before making a final decision.

How total ankle replacement can help

Total ankle replacement relieves discomfort in the joint that older adults sometimes experience during weight-bearing activities. It might also ease occasional ankle pain when not moving the joint.

However, like every surgery, there are risks such as infection and wound healing problems, although this risk is low, occurring in less than 2 to 3 percent of cases.

The American Orthopaedic Foot & Ankle Society recommends people try non-surgical options for pain relief before speaking with their primary care physician about having total ankle replacement. Before deciding on surgery, people should try treatments such as bracing, cortisone or steroid injections and changing to non-weight bearing or low-impact activities.

If non-surgical approaches do not provide relief, total ankle replacement might be appropriate.

Getting the green light

Your physician will consider a few things before recommending surgery, such as age, activity level, severity of arthritis in your ankle and the potential for arthritis in other foot joints.

In general, surgeons recommend total ankle replacement for people 55 or older. The thinking is that older adults will likely not stress the ankle as much as a younger patient, so we anticipate that the implant will last longer. Runners, or people who do other high-impact activities, are not good candidates for the surgery.

A person’s overall wellness before total ankle replacement is important. People should see their primary care physician before surgery to help ensure they are in optimal health.

If someone is thinking about total ankle replacement and they don’t think they may be a candidate, they should get a referral from their primary care provider to see and speak with a foot surgeon. This is important because even if someone isn’t a candidate for total ankle replacement, the specialist can discuss other treatment options that might help.

If you have health issues

Certain things can make total ankle replacement risky, such as no ankle movement, poor ankle-bone quality and unstable ankle ligaments.

If you have diabetes, your doctor will want to make sure you have good circulation and healthy blood-sugar levels before surgery. If your condition is not well-controlled, it increases the chance of complications, including infection.

Outcomes

According to the American Orthopaedic Foot & Ankle Society, there is a 90 to 95 percent chance that total ankle replacement will be successful and without complications.

Based on our experience at Virginia Mason, most people are doing well within about three months after surgery, and full recovery usually takes six months to a year.

Eric Heit, DPM, is a board certified podiatrist with Virginia Mason Orthopedics and Sports Medicine. His specialties include podiatry, foot and ankle surgery, podiatric surgery and sports medicine. He practices at Virginia Mason Hospital and Seattle Medical Center.