An ankle fusion (arthrodesis) joins the tibia, fibula and talus into a single solid block of bone. Once the bones have grown together — usually around 10 to 12 weeks — the joint can no longer move, and so it can no longer hurt at that joint. You lose the up-and-down motion of the ankle itself, but most patients regain a surprising amount of compensatory motion from the joints below (the subtalar joint and midfoot). For active patients with end-stage arthritis where joint preservation is no longer possible, fusion can be exactly the right call — it is reliable, well-evidenced, and durable. Professor Heidari performs fusion using either an open or an arthroscopic-assisted technique depending on alignment, prior surgery and bone quality. Both deliver the same end result: a stable, pain-free ankle joined securely with screws or a small plate. The decision between fusion and total ankle replacement is one of the most important conversations in this part of foot & ankle surgery, and it is talked through at length before any commitment is made.