How Total Ankle Replacement Surgery Got Paul Back on His Feet

Paul Larkin, 69, sprained his ankles many times playing football in high school and college. Each time, he had the injured ankle taped up and got back onto the field. His toughness came back to bite him decades later.

When he was in his 50s, Paul learned he had severe arthritis in his left ankle. An orthopedic doctor told him that all those sprains had loosened the tendons and ligaments in his foot and ankle, leaving bone rubbing against bone.

Already familiar with total joint replacements for the hip and knee, Paul asked if total ankle replacement might be an option. As his doctor explained, the technology wasn't yet advanced enough. The best she could offer was pain medication and the hope that his symptoms might ease with time.

Years later, with surgical techniques improved, Paul had a total ankle replacement done by orthopedic surgeon Christopher Miller, MD, of Brigham and Women's Hospital.

"Before I met Dr. Miller, I was probably a year or two from being in a wheelchair," he said. "My arthritis was that painful and debilitating."

Struggling to meet the physical demands of work

Paul, a resident of East Bridgewater, Massachusetts, owns a business installing storage racks in home improvement stores. Before surgery, his ankle was making him miserable and his work nearly impossible. Some mornings, he couldn't even walk.

Over the course of each day, the ankle would swell to what Paul described as "grotesque proportions." Besides causing extreme pain, his ankle became increasingly unstable. He always had to be alert when walking, for fear of stumbling or falling.

"On my best days, I could walk around for maybe an hour or so," he said. "It got to the point where if I had to pick up something at the store, I'd walk in there with my wife, point out what I wanted, and immediately walk back to the car. I couldn't stand on a concrete floor for any amount of time."

Eventually, Paul asked a local orthopedic doctor about total ankle replacement. The doctor looked at the joint, which was by then severely deformed, and expressed amazement that Paul could still walk. "He said, 'Look, I can't help you. You've got to go into Boston and see the big boys,'" Paul recalled. "And that's how I ended up meeting Dr. Miller."

Exploring arthritis treatment options

Right away, Dr. Miller knew this would be a challenging case. The deformity in Paul's ankle caused his foot to twist inward, requiring him to walk on the outside of the foot. This, in turn, made the arthritis even worse.

Dr. Miller explained that Paul had two options. The first was ankle fusion, which involves removing damaged tissue and joining the bones of the ankle together with metal screws and plates. The second option was total ankle replacement.

"Fusion is an excellent surgery for certain patients. But for someone like Paul, who was very active and had some other issues with his foot related to past football injuries, it would have significantly limited his range of motion," Dr. Miller said. "Total ankle replacement would correct his ankle alignment, improve the ankle's range of motion and function, and get his foot flat on the ground."

Dr. Miller cautioned that the surgery was complicated and would have a recovery time of several months. However, it would also give Paul a better chance of playing with his grandkids and returning to other activities he loved without pain.

Paul chose total ankle replacement.

Undergoing minimally invasive ankle surgery

Over the next month, Paul had a series of imaging scans to gather detailed information about the shape and structure of his foot and ankle. That data was then used to create a custom 3D-printed surgical guide called a jig. This tool was designed to fit perfectly with Paul's anatomy, helping Dr. Miller make precise cuts and place the implants exactly where they needed to go.