Tibiotalocalcaneal Fusion (with Intramedullary Rod)


This surgical procedure fuses your ankle joint with a rod commonly called a "nail." It passes through the bones of your foot and lower leg. This type of fusion can be helpful if you have severe arthritis or other serious problems with your ankle. It may also be needed if you have had a total ankle replacement that has failed.


In preparation for the procedure, you are anesthetized. The surgeon creates one or two incisions in the skin to access the ankle. The end of the fibula (the thin bone of your lower leg) may be removed. The surgeon reshapes the tibia, talus and calcaneus, removing cartilage from the ends of these bones. This will help these bones fuse together. If the bones in your ankle have deteriorated, the surgeon may use a specially-prepared bone graft to fill in the spaces between the bones to help ensure proper fusion.

Inserting the Rod

A guide wire is inserted through the bottom of the calcaneus. The surgeon drills a tunnel up through this bone, through the talus and into the tibia. The rod is placed through this tunnel, locking these bones together. The rod is secured with a series of screws placed through additional tunnels.

End of Procedure and Aftercare

When the procedure is complete, the openings are closed and your foot is bandaged. Your foot may be placed in a splint, cast or boot. Initially, you will not be allowed to bear weight on the ankle. After several weeks, you may begin physical therapy. A modified shoe can help you walk more comfortably as you return to normal activity.

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