I fractured my talus and have looked into the worst-case scenario—the death of the talus bone. My surgeon said if this happened, the best option would be an ankle fusion. I respect his surgical skills, but the more I talk to people, the more I conclude that he’s dead wrong. I haven’t heard anything good about ankle fusions and I’ve talked to two people who are happy with their ankle replacements. My PT said she would almost never recommend a fusion now that replacements are an option. Although a replacement is a new procedure, if you seek out the right specialist it sounds like you can have a good outcome. What do you think?
TLBZLAND Rock and Ice Forum

“Dead wrong” is, well, totally wrong. The two operations are not necessarily competitors for the best outcome.

Really, who would you listen to when it comes to the management of a tricky orthopedic situation? I understand you may have researched this, but your specialist has spent years upon years learning and understanding the intricacies of surgical options. Google searches, trawling forums, or asking your friends does not trump your specialist. If only it were that easy.

For starters, ankle replacement is usually contraindicated in patients with talus necrosis! Generally speaking, ankle replacement is for people over 50 with a debilitating form of joint disease such as rheumatoid arthritis, but with otherwise strong and healthy bones. You may also not realize that roughly a quarter of these replacements are failing within 10 years and over half have significant complications, considerably higher than for ankle fusion.

By the time a joint becomes a candidate for fusion (arthrodesis), the range of motion is gone or extremely reduced anyway. This operation is not a fix, but an attempt at pain reduction and improved function, and may end up being an intermediate step to ankle replacement if you are too young or don’t immediately fit the profile for a replacement.

Although most people will assume that an ankle replacement will allow greater range of motion (ROM) compared with an ankle fusion, there is only a marginal difference between the two and enhanced ROM is not considered an expected upside.

Joint replacement surgery is rarely undertaken in a young patient (i.e. under 50). The prosthetic unit has a lifespan and will eventually fail—either within the hardware or at the point where the prosthetic joins to your tissue. I am not an expert on ankle replacements, but I would bet that aggressive replacements are more prone to failure and subsequent replacements become increasingly unsustainable. Each time a prosthetic is replaced, a certain amount of tissue is resected.

Maybe you can do it once, maybe even twice—but maybe not at all. My point is that arthrodesis is not second fiddle to ankle replacement. In certain situations it may be an alternative, but in others joint fusion remains the best practice. Many factors dictate a surgical course of action. Don’t get me wrong, spend all the time you feel necessary to research your options. Knowing what possibilities are available will keep your medicos on their toes and help you understand what to expect.


I smashed my toenails while kicking my frozen feet into the ends of my boots on an ice climb. Is it better to heat up a piece of metal and drill through the nail to let the pressure out, or leave it alone?
Fungitoad Rock and Ice Forum

I am a believer in do-ityourself emergency medicine where possible. Emergency departments are overrun by the medically inept, victims of a riskaverse and “what if?” society. “I have a runny nose, what do I do?” Try a tissue.

When I was 10 or so, my mate threw a block of steel to me. I put out my hands to catch it, but thought better of it as it ponderously rolled through the air. Had I moved my foot, it would have been a perfectly executed evasion. I woke at 3:00 in the morning. My toe throbbed as if to the beat of a Zulu battle drum. I tried to sleep, but it was a Sisyphean task. I woke my friend’s mom, embarrassed but desperate. She heated a needle and my eyes widened. The smell of burning organic material was acrid and a little alarming, but when she withdrew the needle, blood spurted out like a burst water main and the relief was a euphoric rush the like I would not experience for some years to come.

I say go for it.