Sunday Lifestyle • Health&Family • Medical Technology • Sunday, March 28, 1999

Little pieces of plastic used to

rebuild ankles

They look like mutant Legos. Two flat pieces fit together and a third in half-moon shape pivots against them. Less than 2 inches wide in all.
And there, in three little pieces of plastic coated with space-age metal, is the newest and most successful artificial ankle so far.
"I was back walking in five or six weeks," says John Fogleman, 57, a tennis coach at St. Andrew's School in Boca Raton who in December became the first South Floridian to get a new and improved version called the Agility.
"I could hardly walk, I was limping so badly," Fogleman says. "I have a little limp yet because there's still some tenderness. I still have some swelling because I have some pins and wires in there that won't be out for a couple months. [But now] I'm out on the courts for four or five hours. The swelling isn't like it was before and the pain isn't like it was before."
Joint replacements are nothing new. Artificial hips have been around since 1969, not to mention knees, shoulders and elbows. Replacement ankles have been less successful, but a new generation is now performing much better.
Patients report fewer complications, less pain and the return of a nearly normal range of motion, says Dr. Peter Merkle, a Pompano Beach orthopedic surgeon who implanted Fogleman's ankle. It is expected to last 15-20 years.
Artificial ankles have had trouble because the ankle is so complex. What laymen call the ankle is really three joints where four small bones meet. The ankle joint itself controls only the up and down motion of the foot. The other joints control other motions.
Total ankle replacement is best for people with arthritis and those who, like Boca's Fogleman, break their ankles. Such patients over the years lose their cartilage, the smooth material that protects joints. When it's gone, bones rub painfully and the joint deteriorates.
The replacement piece takes the place of cartilage. In the surgery, a groove is sawed into the bottom of the tibia (shin) bone. The flat pieces are attached there. The half-moon pivot piece is attached to a cut in the ankle bone (talus). Two screws hold the bones together while the joint solidifies over several months.
Merkle says that in many patients, the $20,000 procedure beats the normal treatment, ankle fusion, in which the joint is bonded into a single piece that barely flexes.
But the procedure is not for everyone. It won't help people with unhealthy bones or severe damage to ligaments, tendons or feet, he says.
And it's no miracle. Although 80 percent of 450 patients nationwide report excellent or good results, restoring three-fourths of normal motion is the best that should be expected, Merkle says.
"Any time you do an operation, you're never going to be as good as God made you," Merkle says.
The artificial ankle feels a bit funny, Fogleman says.
"In cold weather orwhen you apply heat, it's a strange sensation," Fogleman says. "It would be like you have something there you can knock on. It's hard."

Your Medicine is written by Sun-Sentinel health writers. Bob LaMendola can be reached at or at 954-4526.