Ankle Replacement

By Mark T. Gould MD

What is an Ankle Replacement?

An ankle replacement is the total replacement of the joints within the ankle that are no longer functioning properly. Usually, an ankle replacement is needed due to arthritis or trauma.  This would involve the fitting of the talus bone within the ankle to the tibia in the lower leg.  Through the use of metal components that include pure titanium where the components make physical contact with the bone. A smooth piece of medical-grade plastic lies between the metal components allowing the ankle bones to slide with no more resistance than a natural ankle.

If you have ankle pain related to arthritis or trauma, there is no need to live with this pain.  Our goal at JOI is to get you back to enjoying the things that you love to do.

Total Ankle Replacement components from Stryker. JOI Rehab

Stryker Total Ankle

Why would you need a Total Ankle Replacement?

The most common reason for an individual to need a total ankle replacement is arthritis. Arthritis will eventually break down the smooth cartilage within the ankle. This will result in the ankle becoming inflamed, irritated, and hard to mobilize.  The pain associated with this will increase as the arthritis progressing with the ankle joint.  Here are the top 3 reasons you may need a total ankle replacement:

What to Expect from a Total Ankle Replacement

You can expect to be non-weight bearing for 4-6 weeks. Around that time post surgery you can begin walking around and placing partial weight on the ankle usually with the assistance of a boot. You will be partially immobilized in a boot for up to 10 weeks. During this period you can perform functional exercises with a physical therapist to restore normal ankle function. Full recovery can take up to 6 months but everyone heals differently.

Should My Ankle Hurt after Total Ankle Replacement?

A patient can plan to experience pain immediately following their surgery and it will continue for up to 2 weeks. The pain is managed through the use of medication and physical therapy. The majority of patients are off the medication after two weeks.  Physical therapy can certainly help you to return to your normal activities.

 Longevity of a Total Ankle Replacement

Dr. Gould of the Jacksonville Orthopaedic Institute Beaches utilizes the Prophecy® Surgical Planning as well as acquiring their components from Stryker.  Dr. Gould is board certified by the American Board of Orthopaedic Surgery.  He specializes in the treatment of the foot & ankle, lower leg, and general orthopedic surgery.

The longevity of a total ankle replacement using this technology has been shown in many studies from Stryker to have good results still at the 9-12 year follow-ups.

Total Ankle Reconstruction

Ankle Replacement by JOI

What is Prophecy® Surgical Planning?

Prophecy® Surgical Planning is a software created by Stryker for their physicians to improve total ankle replacement outcomes for patients. Additionally, this software allows the surgeon to create a visualization of the surgery from the patient’s CT Scan. Prophecy® will then be able to give the accurate sizes and alignments for the 3-D Printed guides that will allow the surgeon to perform the surgery with less risk. This risk reduction allows for better quality and more satisfaction among patients.

The new technology presented in this article certainly has improved the outcomes from this procedure.  If you have persistent ankle pain, please give us a call!

Aging Adventurously a Testimonial by Jill Firth

A woman is active again after double ankle replacement surgery by Dr. Gould

Jill Firth and her husband. JOI Rehab

Jill Firth and Husband in the Andes

One of Jill Firth’s greatest joys is being active. Exercising, bike riding, snow skiing, hiking and other outdoor activities have been life-long hobbies, keeping her in top physical condition. When she had the opportunity to go backpacking through the Andes Mountains in Patagonia she was ready for the challenge.

On the last day of the trip, Firth and her husband went boating through iceberg-filled water, hiking 4.5 miles up a mountain, and hiking a glacier. Firth was 62 at the time. When she was at the top of a 50-foot hill on the glacier, a 60-mile-per-hour wind gust knocked her over. She slid to the bottom of the hill then fell an additional 30 feet into a deep crack in the glacier. “I landed in a V-shaped crevice that stopped my fall. By some miracle, I didn’t fall further,”

Firth said. “I blacked out for a minute when I hit the rock-hard ice. When I woke, I saw my left foot and knee by my left shoulder. I knew there was no way my body should be in that position. Both ankle bones were broken off my feet.”

Daring Rescue

The strong winds made a helicopter rescue impossible, so the only option was to carry Firth to safety. Firth was secured inside a protective cage normally used for helicopter rescues and men took turns carrying her down the treacherous trail through the mountains. Next, she was placed in a small boat, where the cage was tied to the wooden seats. Eight to ten-foot waves tossed the tiny boat while the captain dodged the icebergs. “Those guys risked their lives to help me,” she said. “I prayed for God to protect those heroes and thanked God I was alive, I had no pain medication; my body was broken. I put my life in God’s hands.”


Multiple Surgeries

Along with severe compound fractures in both ankles, Firth also had a fractured hip and several crushed vertebrae, requiring three surgeries while spending 17 days in the ICU in Punta Arenas, Chile. Firth was then medically evacuated by air ambulance to a trauma hospital in Virginia, where she was living at the time. Doctors there performed additional surgeries on her ankles, hip, and spine.

Beginning Physical Therapy

Firth began physical therapy. “When I was evaluated for physical therapy, they had me try to stand and I couldn’t. I would black out. I knew it was going to be a really long road to recovery,” said Firth. In time, she recovered. But the fall left her with no cartilage in her ankles and arthritis set in. She was in pain and unable to do many of the things that brought her joy.

Finding a Surgeon with a Solution

When Firth and her husband moved to Jacksonville, Fla., she began searching for an orthopedic surgeon. She interviewed three different surgeons before she found one who was willing to help her — Mark Gould, MD, a board-certified orthopedic surgeon at Baptist Medical Center Beaches who specializes in foot and ankle reconstructive surgery. Dr. Gould performed total ankle replacement surgery on Firth’s right ankle after a procedure to regrow bone destroyed by the arthritis. Once it healed, he did total ankle replacement surgery on her left ankle.

Dr. Gould and Total Ankle Replacement

Total ankle replacement surgery requires the surgeon to remove arthritic bone and cartilage then prepare the ends of the shinbone and the foot bone. The new artificial ankle joint is then inserted and attached. “Under the care of an experienced total ankle replacement team, this approach can reliably reduce pain from the 8-9/10 range to a 2-3/10 range, and preserve or return excellent motion and gait,” said Dr. Gould. “While not the typical total ankle patient, Jill’s indomitable spirit, attention to detail and adherence to the treatment plan made caring for her a true joy,” he said. “Recent technological advances in advanced imaging and 3D printing have improved reproducible results, and in my practice, make total ankle replacement a better option for many of my patients over ankle fusion,” Dr. Gould said. “I am truly blessed to care for these complex debilitating injuries.”

Total ankle replacement allows for more normal movement of the joint. An ankle replacement typically last 15 to 20 years, depending on the patient’s activity level and other factors. “I have the highest praise for Dr. Gould. While most doctors saw a 65-year-old woman, Dr. Gould saw me as athletic and someone who wanted to be very physically active for the rest of her life. He cared about me. If it wasn’t for him, I would have had an ankle fusion and would always walk with a limp,” Firth said.

Adventures Resumed

Jill and her Husband Current. JOI Rehab

Jill and Her Husband Post Surgery

Today, at 67, after a total of 11 surgeries, Firth is as strong as ever. She does a lot of biking and high intensity exercise classes. Although she was advised not to regularly walk long distances (to help her ankle replacements last longer), she still enjoys an occasional hike. Her adventurous spirit has not been diminished. Firth recently returned from a 17-day trip to Antarctica, where she hiked glaciers and icebergs again – though they were not nearly as tall as the ones in Patagonia. “It felt so good to be back out there,” she said. “I thank God every day that I am where I am, and that He put me in the hands of Dr. Gould. “It’s so hard to even think about the accident. I walk normally now, and nobody would know anything ever happened to me. I have Dr. Gould to thank for that.”

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Book an Appointment with The Jacksonville Orthopaedic Institute Today!

Dr. Gould is accepting new patient consults for ankle arthritis and other conditions of the ankle.  You can schedule online here. 

You can still call 904-JOI-2000 to make new patient appointments.  A new option, you can now schedule and cancel follow-up appointments with your physician at the JOI Patient Portal. 

Finally, to make appointments with JOI Rehab, please call 904-858-7045.

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