Years ago I was told I have a bridge of bone between two of my ankle bones (I forget which two). I didn’t do anything about it back then but it’s really starting to bother me now. Is it too late for surgery? If they did surgery, what would they do? And how long would I be laid up?

A bony bridge connecting two bones together as you described is referred to as a coalition. The two most common bony coalitions in the ankle are formed by the talus and calcaneus bones (talocalcaneal coalition) and the calcaneus and navicular bones (calcaneonavicular coalition). The condition has been treated in the past with conservative (nonoperative) care (e.g., leg cast) or with surgery to fuse the ankle.

Cast immobilization for this condition is no longer recommended as the first-line of treatment in children. And once the condition has been discovered (or revisited as in your case) in adults, conservative care is no longer appropriate. Two surgical approaches are now available. The first is an arthrodesis or fusion procedure. The bones around the two bridged bones would be fused to the coalition to create a more stable ankle.

A second alternate surgery can be done to remove the bridge of bone between the talus and the calcaneus. Then a piece of fat (taken from the patient’s buttocks or abdomen) was placed in the space left by the resected bone. Fat implantation of this type is referred to as a fat graft interposition. With this approach, patients with talocalcaneal coalitions may be spared early arthritic changes in the ankle.

After either the surgical procedure, patients are put into a short leg cast for three weeks. They are usually allowed to walk on the foot right away as much as they can tolerate. When the cast comes off, a supportive athletic shoe is advised. Following the bone resection and fat implantation procedure, physical therapy may be prescribed to help you regain motion, strength, and alignment.

Studies suggest that additional surgery may be needed after to coalition removal in order to further correct ankle alignment. It has been suggested by experts in this area that two separate conditions are often present: the talocalcaneal coalition discussed and a hindfoot deformity referred to as hindfoot valgus.

Additional surgeries to further correct the ankle alignment by correcting the valgus deformity may be recommeded. Length of time completing the treatment and rehab process with the first surgery and then subsequent procedures can take months to years. The information provided here is just a general overview and may not apply to you. Your surgeon is the best one to advise you based on your own individual situation.