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I am trying to decide between two surgical procedures offered to me. Both are to correct a deformity I was evidently born with but didn't know about until now. There are two bones in the ankle that are connected by a piece of bone. They never were separate so all this time my ankle pain and funny way of walking were caused by this problem. The two choices are an ankle fusion or to cut out that extra piece of bone. The pros and cons of both procedures have been explained to me. How do I decide?
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When two bones in the ankle are formed without the normal separation between them but are held together by a bridge of bone, the condition is referred to as a coalition. The child is born this way but may not know it until later in life when the foot looks flat and ankle pain and deformity interfere with standing and walking.
The two most common bony coalitions in the ankle are formed by the talus and calcaneus bones (talocalcaneal coalition) and the calcaneus and navicular bones (calcaneonavicular coalition). The condition has been treated in the past with conservative (nonoperative) care (e.g., leg cast) or with surgery to fuse the ankle.
But more modern surgical approaches are now available. A recent article written by experts in this area, may help you. Six surgeons offer their insights, expertise, and results performing one of the newer techniques. The specific approach they took was to treat a talocalcaneal coalition by removing the bridge of bone between the two bones. Then a piece of fat (taken from the patient's buttocks or abdomen) was placed in the space left by the resected bone. Fat implantation of this type is referred to as a fat graft interposition.
Overall results were measured using a test called the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score (AOFAS). The AOFAS provides a way to measure three areas: pain, function, and alignment. Each child was followed for at least one full year. Before and after X-rays and CT scans were also compared.
Only one of the 49 feet was rated "poor" on the AOFAS. The majority (85 per cent) had good-to-excellent results. Ankle range-of-motion and mobility were much better for 92 per cent of the group. One fourth of the group did require additional surgery to further correct ankle alignment. In a small number of cases (two patients), the first surgery was considered a failure and a second (revision) surgery was needed to repeat the procedure.
Comparing these results to other studies where patients' ankles were fused, the authors point out that this bone resection and fat graft implantation is just as successful (if not more so) than the fusion. The hope is that long-term studies will show less arthritis from this condition (a typical response to the ankle fusion). These patients will continue to be followed to see if results hold or if there is a gradual but steady decline in function and alignment over time.
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