Ankle Fusion - Would You Suggest It?

[PASTGood]

Has anyone had an ankle fusion since being diagnosed with PD? I work with a man who has severe and constant ankle pain. His specialist has recommended a fusion. He and his wife are understandably hesitant and are wondering if anyone with PD has had the surgery and how they faired afterward. Any advice/suggestions will be greatly appreciated! Thank you!

[Hikoi]

I find this very concerning as I have never heard this done for Parkinsons. But is it for PD or something else? To reply properly I would need more information like What is wrong with his ankle, how long has he had this problem, how long has he had Parkinsons and what treatment is he on. How old is he?

Certainly they should not do anything in a hurry, so many people have unnecessary surgery. I would be wanting to know what the success rate is for this op in curing pain.

[Bailey_Texas in reply to Hikoi]

i think i their question has any one had ankle fusion that also has PD.

[Hikoi in reply to Bailey_Texas]

Yes it may be, trouble I think if they are writing from the US is that treatment gets so compartmentalised and each sees the problem from there particular speciality when it may actually be best treated by treating the Parkinsons rather than surgery.

[beauxreflets]

I well imagine, with the Laws of Nature, that any fusion joining two seperate bones into, a fixed solidified whole, will cause further and or new problems to arise in adjacent areas.

As a porter, I recall chatting with a lady who could no longer walk without physicaly snapping more bones in her feet after the fusion of tarsal, metatarsal bone tissue!

The loss of flexability simply increased the loads passed on laterally through mechanical leverage, hence her having to be wheeled around in a wheelchair!

Is Physiotherapy an option that has failed?

With my PD there have been times when I have used a wrist support and a back support; to enable comfort and muscles to revitalise.

[honeycombe3]

I'm with Hikoi here - we simply do not have sufficient information to be able to offer constructive advice. I am a PwP, dxd 12 yrs & I have had foot surgery during that time. I should be happy to share my experiences with PASTgood openly on this site but only if I feel that I have sufficient information to enable the reader(s) to benefit.

[etterus]

Fusions are usually indicated for unstable segments in the biomechanical chain of movement. It is usually considered a last choice option for severe problems because it is irreversible and will add to the probability of increased stress on the adjacent joints. If the pain is controlled and the function is improved the procedure is considered successful. It is considered a salvage operation so don't expect to be able to run a marathon.

[HeartSong]

Here's a possible alternative - depending on the source of your friend's pain. About 12 years ago, I had had severe pain for about a year in my right heel and the outer side of my right ankle. I went to a big time orthopedic specialist who prescribed physical therapy for me. I worked with the physical therapist for about 3 months. Through his exercise prescriptions, the heel pain went away. However, the pain on the outer side of my right ankle did not subside, and it was so intense that I couldn't walk more than a half a block. Neither the orthopedic specialist nor the P.T. had any idea what was causing the problem or how to treat it. About two weeks after they released me, I was searching desperately on the internet for some answers, and I came upon a book called "The Trigger Point Therapy Workbook", by Clair Davies. As I learned, trigger points are chronic knots in our muscles that won't release, and most of the time the pain that they cause is referred pain, meaning that the pain is a bit of a distance from the actual knot. And the treatment is to press on the knot for a few seconds over a period of time to get it to release. Done over time, this can bring about a permanent release. I bought the book and started studying it for a solution. I found one muscle in which a knot close to the knee could refer pain to the outer side of the ankle. I wasn't aware of any discomfort around the knee, but when I pressed on the spot where the book instructed me, I screamed it was so painful. So, I pressed on it for a few minutes everyday, morning and evening. After a week of this pressing, the pain in my outer ankle, which had been there for a year, went away and has never come back.

I urge your friend to get a copy of this book and try it before doing anything as drastic as fusion. It covers possible muscle knots over the whole body and has excellent diagrams. It's on Amazon for $16.00.

This book is based upon the work of two medical doctors several decades ago. One of these doctors was the personal physician to President John F. Kennedy when he was in office. President Kennedy had a lot of pain in his back, and he credited this doctor with enabling him to continue his work.

[PASTGood]

Everyone, thank you so much for your thoughtful and helpful responses! I have shared all of them with the couple I am working with.

The 30-degree twist in my client's ankle is due to a pre-PD diagnosis injury. The specialists have tried all sorts of other treatments and therapies to no avail. His specialists believe the fusion is the last resort that will reduce the amount of constant intense pain he experiences thereby improving his quality of life.

Like most of you, I had many questions for this gentleman as well. MY concerns/questions for him were about his freezing and falling. For example, does he fall often, does he tend to fall in a certain direction, how will the fusion affect his gait/balance, is an ankle replacement not an option?

As I have learned, my client has been dealing with this a VERY long time. He and his wife have done a ton of research about his injury and the treatments. They've pretty much tried and explored every possible solution but sadly have come to the end of the rope with no success.

Because I work with a couple hundred people in my city who have PD and have contact with many more throughout our province, they were hoping I could connect them with another person with PD who has had an ankle fusion.

My client's situation is so unique though (ankle fusion) that I have yet to find anyone who matches them exactly. I have always found the members in the Parkinson's Movement to be so very helpful, I thought I would reach out and ask here in hopes of widening my "net".

You have not disappointed either. I really appreciate your suggestions and assistance - as do the people I am working with. My clients have asked me to send you a HUGE, warm "thank you"!!

If you ever cross paths with someone with PD who has had an ankle fusion (this seems like looking for a needle in a haystack!), please ask them to say hello to me as I know someone who could benefit from their expertise : )

[Sedona in reply to PASTGood]

My hubby had an ankle fusion last year, though I am the one with PD and I walk much better than he does. It was a last resort & he waited 6 years after being told by the doctor that he needed to have it done, so he was pretty bad. He was in extreme pain & very unsteady, the cartilage in his ankle had deteriorated so that he was practically walking on the side of his foot. At first, he thought it a success, though still a bit unsteady and stairs & inclines being somewhat difficult, he did not have the pain. However, the pain has returned in other areas of the foot and ankle, he freezes when first standing up and he literally hobbles around. He and the doctor are debating another surgery, either removing the pins & replacing with a plate or an ankle replacement, which he was not a candidate for before. However chances for a successful outcome are less than before. Also, I had to assist him and drive him around for months and I'm not sure how much longer I'll have the ability to do that. Best of luck to your client.

[PASTGood]

Hello Sedona .

Thank you for your reply! Ankle fusions seem like such extreme measures, reserved obviously for last resorts. I am so sorry to hear of your husband's ongoing pain and lack of success with treatment. It must be so disheartening.

I will most definitely share your husband's experience with the people I am working with. Maybe what you have written will give them pause...or at the very least arm them with more questions for his PD specialist and his surgeon.

Again, thank you and all the best to you and your husband.