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ANKLE FUSION
Ross Hauser, M.D.
It
is common for
Prolotherapy doctor to see people with continued pain
complaints after surgery. This is a very common occurrence in our office
in Oak Park, Illinois. Often overlooked causes of this post-surgery pain
are that the surgery itself may cause
ligament
injury or the surgery may
not repair the ligament injury. When performing surgery, the ligaments
are stretched and pulled in order to gain access to the joint. In 1992,
Dr. J. Albert and associates looked at what actually occurred in the
ankle when the joint was opened or distracted for ankle surgery. What
they found was that when the joint was opened in the clinically
recommended range "complications of pin bending, excessive ligament
strain, and bony destruction did occur." Anyone with post-surgery pain
should be checked for ligament injury.
Prolotherapy to the injured
ligaments will eliminate the pain in such a case.
Ankle fusion may provide some temporary pain relief, at
least for a while. Imagine how much motion your ankle normally has. What
is going to happen when all of that motion is lost? Other joints around
that fused joint must move more in order to compensate for the fused
joint. This will cause excessive strain to these joints or the joints
around them. The long-term outlook for
ankle fusion patients, no matter which
joint, is long-term pain and disability. The reason why people succumb
to these operations is that they feel they have no other options. There
is an alternative to ankle fusion—Prolotherapy. For that matter, there
is an alternative to almost any orthopedic surgery for pain. That option
is
Prolotherapy.
 Ankle fusions typically have high rates of nonunion. This means that up
to 30 percent of fusions fail, meaning that the bones do not hold
together. In one study of 42 patients, the overall complication rate was
55 percent, including nonunion,
fracture, pin-site infections, and
hardware problems. Yet surprisingly, 85 percent of the people were
satisfied with the results. People, we are setting our standards way too
low! An operation has a 55 percent complication rate, yet we are
satisfied? The most common long-term consequence of ankle fusion is
arthritis
in the joint below the ankle, called the subtalar joint. Guess
how long it takes to become arthritic? It does not take long. The
average time is about four to five years. Most studies show that after
arthrodesis (ankle fusion) the subtalar joint is significantly arthritic
in 50 percent of the cases. All that an ankle fusion does is cause
arthritis to travel from one joint to the other. On top of that, the
fused joint can no longer be moved at all.
The
orthopedist's solution to the ankle fusion failure is "let's come up
with another operation" so the sequence of events will continue:
ligament sprain,
RICE treatment, mild
NSAIDS, then stronger and stronger
non-steroidal anti-inflammatory
drugs (research paper at
prolotherapy.org), leading to
cortisone shots,
then
Arthroscopy, ankle fusion, and, finally, ankle replacement. We
think not! How about just doing Prolotherapy after the initial injury?
It is much simpler. Anyone starting out with the RICE treatment
 is most
likely going to end up later in life with several masked people around
them with sharp blades. If this is what you want, follow the standard
sports medicine protocols. If not, run to a Prolotherapy doctor, if you are
still able. Your joints depend on it.
The above scenario does not even take into account the dramatic gait
abnormalities that occur with ankle fusion. Remember, fusion of the
knee, back, or ankle means that the joint can never be moved normally
again. At minimum, most of the motion in the subtalar joint will be
lost. In regards to ankle fusion, the velocity of the gait will be much
slower and the length of the stride will decrease. Other joints around
the fused area, as already noted, will have to contract a lot more. This
causes the energy expenditure of walking to increase dramatically.
You may also want to read:
Twisted Ankle
Chronic Ankle Pain in a Female Athlete
Golf, Prolotherapy and Weak Ankles
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