Foot fusion surgery
An operation that permanently joins together one or more worn or deformed joints in the foot or ankle to relieve pain, trading movement at that joint for a more stable, comfortable foot.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Fusion permanently joins worn or deformed foot or ankle joints to relieve pain, trading movement at that joint for a more stable, comfortable foot.
- The bones need time to knit together — roughly three months — and sometimes they fail to fuse (nonunion), which can mean further surgery.
- Recovery is long: weeks in plaster and non-weight-bearing, then a boot, with full recovery six months and beyond.
- Smoking, diabetes and some other conditions raise the risk of problems and poor healing; for the ankle, joint replacement may be an alternative to discuss.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Can relieve the pain of a worn or deformed foot or ankle joint
Symptoms are mild or manageable with activity changes, footwear, insoles, braces, painkillers or injections.
The foot is in a plaster cast and kept elevated above hip level to control swelling. You are non-weight-bearing on crutches and may need blood-thinning...
A clear weight-bearing and cast/boot plan, with X-rays to confirm the fusion is solid.
The foot is in a plaster cast and kept elevated above hip level to control swelling. You are non-weight-bearing on...
Stitches are removed and the cast is changed. Keep the foot elevated; lowering it will make it throb and swell...
The cast is changed to another cast or a walking boot, with an X-ray to check the bones are healing. You may be...
An X-ray checks the fusion is solid. The cast or boot usually comes off and you move to supportive shoes, building...
What is foot fusion surgery?
Foot fusion (arthrodesis) is an operation that permanently joins two or more bones across a worn or deformed joint, so they grow together into one solid piece. It is most often done for painful arthritis of the ankle, the joints just below the ankle (the hindfoot — for example the subtalar, talonavicular and calcaneocuboid joints) or the middle of the foot (the midfoot), and sometimes to correct a deformity or after a bad fracture.
The surgeon removes the damaged joint surfaces and holds the bones together with screws, plates or staples while they fuse, much as a broken bone heals. The metalwork is usually left in place permanently but can be removed later if it becomes prominent or sore.
The central trade-off to understand is movement for pain relief. Fusing a joint stops the movement at that joint, but because a painful joint is what hurts, removing that movement usually removes the pain. For the ankle in particular, the joints in the rest of the foot keep moving and partly make up for the loss, so after a solid ankle fusion many people can walk without a limp, wear normal shoes and stay active.
Fusion is not the same as joint replacement, which keeps movement using metal and plastic parts. For some joints, particularly the ankle, replacement is an alternative in selected people. The right choice depends on which joint, your age, activity, deformity and the state of the nearby joints.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
Ankle fusion vs ankle replacement
| Point | Ankle fusion | Ankle replacement |
|---|---|---|
| Ankle movement | Lost (joint solid) | Kept |
| Wears out? | No parts to wear | Parts can wear or loosen |
| Often favoured if | Younger, deformity, heavy use | Older, stiff nearby foot joints |
| Long-term concern | Arthritis in nearby joints | Implant survival over time |
This comparison applies mainly to the ankle. The best choice is individual and decided with your surgeon; research comparing the two is ongoing.
Preparing for your surgery
- See the operating surgeon and be clear which joint or joints are to be fused and why, and discuss whether replacement (for the ankle) is an option for you.
- Ask whether non-surgical measures — activity changes, insoles or braces, painkillers, and injections — have been fully tried.
- If you smoke, stop well beforehand, as smoking significantly increases the risk of the bones failing to fuse and of wound problems.
- Tell the team about diabetes, inflammatory arthritis, steroid use and all medicines, especially blood thinners, as these affect healing and risk.
- Plan for a long recovery: weeks non-weight-bearing in plaster, then a boot, and arrange crutches, help at home and time off work.
- Set up your home for limited mobility — sleeping downstairs, keeping the foot elevated, and getting around safely.
- Arrange a lift home and ask about blood-clot prevention while your leg is in plaster.
What happens
The operation is usually done under a general anaesthetic, often with a nerve block to numb the foot and ease pain afterwards; sometimes a regional anaesthetic is used. It is performed through one or more cuts on the foot or ankle, or occasionally by keyhole.
The surgeon removes the worn or damaged joint surfaces and positions the bones correctly, sometimes correcting a deformity at the same time. The bones are then held firmly together with screws, plates or staples while they fuse. Bone graft is sometimes used to encourage healing. The metalwork is usually left in permanently.
Most people stay in hospital for the day or overnight, occasionally longer for pain control or to practise getting about without putting weight through the foot. You go home with the leg in a plaster cast and on crutches.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Symptoms are mild or manageable with activity changes, footwear, insoles, braces, painkillers or injections.
- Your pain does not clearly come from the joint being considered, so fusing it may not help.
- There is active infection, or poorly controlled diabetes or vascular disease that makes healing and surgery high-risk until optimised.
- For the ankle, you may be better suited to a joint replacement to keep movement, depending on your age, activity and nearby joints.
- You are unable to keep off the foot or commit to the long recovery the operation needs.
Delay surgery if…
- You have an active infection in the foot or elsewhere.
- You are still smoking, which markedly raises the risk of the bones failing to fuse.
- Your diabetes or other medical conditions need optimising first.
- You are taking blood thinners that need a managed plan.
- You cannot yet arrange the help at home and time off needed for a long, non-weight-bearing recovery.
Alternatives to discuss
- Activity modification, supportive footwear, insoles, braces or a walking stick.
- Anti-inflammatory or other painkillers.
- Steroid or other injections into the joint, sometimes under X-ray or ultrasound guidance.
- Joint-preserving surgery such as keyhole debridement or a realignment osteotomy in selected early arthritis.
- For the ankle, joint replacement instead of fusion in suitable people.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- Can relieve the pain of a worn or deformed foot or ankle joint
- Gives a stable foot or ankle to stand and walk on
- Can correct a deformity at the same time
- After a solid ankle fusion, many people walk without a limp and wear normal shoes
- Can allow a return to activities such as walking, cycling and low-impact sport
- Provides a durable result with no implant parts to wear out
Risks & complications
- Pain, swelling and bruising of the foot for several weeks to months
- A long period in plaster and on crutches, with reduced independence
- Stiffness, and a permanent loss of movement at the fused joint
- Swelling that can take many months to fully settle
- The bones failing to join (nonunion), which may need further surgery
- The bones joining in a poor position (malunion)
- Wound infection or slow wound healing needing antibiotics or further treatment
- Prominent or painful metalwork that may need removing later
- Blood clots in the leg or lung (DVT or PE)
- A sensitive or painful scar
- Deep infection that can be serious and may need further surgery
- Nerve damage causing numbness or chronic pain, which can be worse than before surgery
- Complex regional pain syndrome (persistent pain, swelling and stiffness)
- A bone crack during surgery that needs fixing
- Arthritis developing in nearby joints over the years because of the changed mechanics
The two biggest issues to understand are that fusion permanently removes movement at the joint, and that the bones do not always join — nonunion is the most important specific complication and can mean further surgery. Smoking, diabetes, inflammatory arthritis and steroid use all increase the risk of poor healing. Over the years, fusing one joint puts extra strain on neighbouring joints, which can become arthritic. Ask your surgeon about their own fusion (union) rates and your individual risk.
Published figures to discuss
Reported rates vary with which and how many joints are fused, the technique, and patient factors — especially smoking, diabetes and inflammatory arthritis, which substantially increase complications. How fusion is confirmed also matters: scans (CT) detect more incomplete fusions than ordinary X-rays. The figures below are cautious ranges; ask your surgeon for their own results.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Failure of the bones to join (nonunion) | Commonly reported around 1–16% depending on joint, technique and patient factors | The most important specific complication; markedly higher in smokers and people with diabetes, and may need further surgery. | Ankle arthrodesis: indications, outcomes and patient satisfaction (PMC)ncbi.nlm.nih.govPublished figure |
| Fusion confirmed solid on CT scanning | Around 79% across joints in one systematic review of CT-verified fusion | Lower than figures based on ordinary X-rays, as scans pick up more incomplete fusions; not all incomplete fusions cause symptoms. | Ankle arthrodesis: indications, outcomes and patient satisfaction (PMC)ncbi.nlm.nih.govPublished figure |
| Overall complications (wound, infection, healing) | Reported broadly around 10–20% across series, varying widely | Much higher in smokers, people with a high BMI, and those with diabetes; many complications are minor and treatable. | Ankle arthrodesis: indications, outcomes and patient satisfaction (PMC)ncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
Recovery from foot fusion is long and staged. You will be off your feet or limited for weeks, the bones take around three months to fuse, and full recovery takes six months and beyond, with swelling lingering for many months.
- A foot that throbs and swells when lowered, easing with elevation
- Weeks of limited mobility in plaster and on crutches
- Swelling that lingers for many months before fully settling
- Gradually improving strength and walking over several months
- Permanent stiffness at the fused joint, which most people adapt to well
Aftercare
- Keep the foot elevated above hip level as much as possible in the early weeks to control swelling.
- Stay non-weight-bearing or follow your exact weight-bearing instructions — putting weight through too early risks the fusion failing.
- Keep the cast dry and intact, and use crutches safely as shown.
- Take any prescribed blood-thinning medication while in plaster to reduce the risk of clots.
- Take pain relief as prescribed and watch for warning signs of infection or a clot.
- Attend all cast changes and X-ray appointments so healing can be checked.
- Do not drive until you are out of plaster, can walk comfortably in your own shoes and can do an emergency stop, and your team agrees.
- Follow advice on gradually returning to walking, work and exercise as the fusion becomes solid.
- Crutches and help with getting about arranged
- Home set up for elevation and limited mobility (sleeping downstairs if needed)
- Help at home for shopping, cooking and washing
- Long enough time off work booked for your type of job
- Blood-clot prevention understood while in plaster
- Cast kept dry — waterproof cover for washing
- Clinic contact number saved for concerns
Scars and how they heal
There are one or more scars on the foot or ankle over the joints that were fused, or several small scars with a keyhole technique. Scars are firm and pink at first and usually fade over months, though some people get a sensitive or slightly tender scar. Protecting healing skin from strong sun helps it settle.
⚠ Get urgent help if…
- Increasing redness, swelling, heat or discharge around the wound, or fluid leaking from it (signs of infection)
- Fever or feeling generally unwell
- Calf pain or swelling, or sudden breathlessness or chest pain (possible clot)
- Severe or escalating foot pain not controlled by your usual pain relief
- A cast that becomes too tight, or new numbness, tingling, or cold or discoloured toes
- Spreading, burning pain with marked swelling (possible complex regional pain syndrome)
- A sudden crack, pop or change in the position of the foot
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the joint fuses solidly, the pain from that worn or deformed joint is relieved, and you have a stable foot to walk on. After a successful ankle fusion in particular, many people walk without a limp, wear normal shoes and return to low-impact activity, because the remaining foot joints compensate for the lost ankle movement.
It is realistic to expect pain relief and stability rather than a normal, fully mobile joint — movement at the fused joint is permanently gone. Some people have ongoing swelling, occasional aching, or stiffness, and the changed mechanics can lead to arthritis in nearby joints over the years. Your surgeon should explain what your particular fusion can achieve.
A solid fusion is durable and has no implant parts to wear out, so the result usually lasts. The main long-term issue is that fusing one joint places extra load on neighbouring joints, which can become arthritic over the following years and occasionally need their own treatment. Keeping active and a healthy weight, and using supportive footwear, can help protect the foot.
Combining with other procedures
Several joints are sometimes fused at the same operation (for example a triple fusion of the hindfoot), and a deformity may be corrected during the fusion. Where arthritis affects both the ankle and nearby joints, your surgeon will discuss which joints to include and whether fusion or, for the ankle, replacement is the better overall plan.
Follow-up & long-term care
You will be reviewed at intervals after surgery — typically around two weeks, six to eight weeks and three to four months — with X-rays to confirm the bones are healing and the fusion is solid. Report any signs of infection, a possible clot, or a sudden change in your foot straight away rather than waiting.
- Keep up any exercises and walking programme your physiotherapist recommends.
- Wear supportive, well-fitting footwear and use any recommended insoles.
- Manage your weight and stay active to reduce strain on nearby joints.
- Report new pain in neighbouring joints, or prominent painful metalwork, for review.
Revision and secondary surgery reality
- If the bones fail to fuse, or fuse in a poor position, further surgery may be needed.
- Prominent or painful metalwork is sometimes removed in a later, smaller operation.
- Arthritis can develop in neighbouring joints over the years and occasionally needs its own treatment.
- Final healing and the true result take months to judge, as the bones fuse over about three months and swelling settles over up to a year.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- A clear weight-bearing and cast/boot plan, with X-rays to confirm the fusion is solid.
- Blood-clot prevention while the leg is in plaster, and clear warning signs to report.
- A named contact for wound concerns and pain control.
- Physiotherapy and a graded return-to-activity plan once the fusion is solid.
- An honest plan if the fusion fails or nearby joints become painful later.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Surgeon's fee and how many joints are being fused
- Anaesthetic fee and whether a nerve block is used
- Hospital or theatre facility fee and any overnight stay
- Implants and bone graft (screws, plates, staples, graft material)
- Pre-operative imaging such as X-rays and CT scans
- Casts, walking boot, crutches and physiotherapy
- Follow-up appointments, repeat X-rays and policy on further surgery if the fusion fails
- Surgeon's fee and exactly which joints are included
- Anaesthetist's fee
- Hospital or facility fee and expected length of stay
- Cost of implants, bone graft, casts and walking boot
- Pre-operative and follow-up X-rays or CT scans
- Physiotherapy sessions included or extra
- What happens, and what it costs, if the fusion fails or another complication occurs
On the NHS? Foot and ankle fusion is widely available on the NHS for disabling arthritis or deformity when non-surgical treatment has not helped; private care is sometimes chosen for a shorter wait or a particular surgeon.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not making clear that movement at the fused joint is lost permanently.
- Underplaying the risk of nonunion, or not discussing how smoking and diabetes increase it.
- Not discussing joint replacement as an alternative for ankle arthritis where appropriate.
- Glossing over the length and demands of recovery, including weeks non-weight-bearing.
- No clear emergency instructions for infection, clots or a too-tight cast.
Marketing red flags
- Promising a normal, fully mobile foot or ankle after a fusion.
- Downplaying the risk of the bones not joining.
- Presenting keyhole fusion as suitable for everyone regardless of deformity.
- Not mentioning the effect of smoking and diabetes on healing.
- Skating over the months-long recovery and the chance of nearby-joint arthritis later.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Which joint or joints are you fusing, and why is fusion the best option for me?
- For my ankle, is a joint replacement a reasonable alternative, and what are the trade-offs?
- What is your own fusion (union) rate, and what is my personal risk of nonunion?
- How will smoking, diabetes or my other conditions affect my healing and risk?
- What does the recovery and weight-bearing plan look like, and how long until I can work and drive?
- How likely am I to get arthritis in nearby joints later, and what would that mean?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Will I be able to walk normally after a foot or ankle fusion?
What if the bones do not join?
How long is the recovery?
Should I have a fusion or an ankle replacement?
Will the metalwork stay in forever?
Is it available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: BOFAS — A Patient's Guide to Hindfoot and Midfoot Fusion Surgery (PDF) BOFAS — A Patient's Guide to Ankle Arthritis (PDF) Royal Orthopaedic Hospital NHS FT — Ankle and hindfoot fusion Ankle arthrodesis: indications, outcomes and patient satisfaction (PMC) CT-verified union rate after arthrodesis of ankle, hindfoot or midfoot — systematic review (PMC)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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