Based in the heart of NY, Advance Foot and Ankle Solutions offers the best facility for performing ankle instability surgery, while catering to all other various foot and ankle problems. Look no further when you can have direct access to the globally acclaimed specialist team of foot and ankle surgeons, supervising & managing your ankle instability surgery with diligence and dedication.
Advance Foot and Ankle Solutions support team is absolutely attentive to your requirements related to ankle instability surgery. Call & book an appointment right away for professionally diagnosed, treated and empathetically cured foot and ankle issues, to lead a wholesome, enviable lifestyle.
Overview Of Ankle Instability By Your Podiatrist
On an average, an estimated 1 out of every 10,000 people sprain their ankle on daily basis. Sprain is an injury in which one of the two major ligaments on the outer portion of the ankle is stretched and/or torn. These are the anterior talofibular ligament and the calcaneofibular ligament.
In majority of cases, individuals who visit a physician for their injury are instructed on how to reduce pain and inflammation via healing. They may be advised to wear an air cast or participate in physical therapy in order to strengthen the ankle muscles, following a full recovery.
The remaining 10% population of people develop ankle instability, a condition in which the ligament has healed in an erratic lengthened position. As a result, the person is prone to a feeling of the ankle “giving out” and to additional sprains in the region. Athletes such as ballet dancers, who already have extra loose ligaments, are particularly likely to develop this condition.
Ankle instability is a debilitating condition incorporating persistent pain, recurrent sprains, and repeated instances of giving way. The condition is multifactorial, deriving its features from static alignment, muscle weakness, poor proprioception, and ligamentous injury. When left untreated, this condition decreases one’s level of function and quality of life with the tendency to lead to arthritis and chronic pain.
The Anatomy & Biomechanics Of The Ankle Joint
The Basic Anatomy Of The Ankle Joint
The ankle joint comprises of 3 bones and several ligaments that attach to these bones and interconnect them, making the joint functionally stable. The 3 bones are:
The ankle is made up of 2 joints. Any one or both may be involved in bringing about an ankle fracture.
- The main ankle joint where the 3 bones — tibia, fibula and the talus — meet at a junction
- The Syndesmosis joint occurring between the tibia and fibula, held together in position by ligaments
The Biomechanics Of The Ankle Joint
Ankle stability relies on its osseous, ligamentous and tendinous structures. Static stabilizers are the osseous and ligamentous structures while the tendons provide dynamic stabilization, namely the peroneal tendons as they relate to lateral instability. The congruency of the ankle joint imparts a high degree of stability to it.
The Causative Factors Of Ankle Instability
Ankle sprains are usually caused by the foot being twisted suddenly, often with the sole pointing inwards, called an “inversion injury”.
- The deltoid ligament, on the medial side of the ankle, can sometimes be torn during severe ankle fractures.
- The front band, also called the anterior talofibular ligament, is most commonly injured.
- Ligaments that hold the tibia and fibula together may also be injured during severe sprains or fractures.
- An ankle sprain that has not adequately healed or rehabilitated completely gives rise to ankle instability, affecting the ability to balance.
- Repeated ankle sprains often cause chronic ankle instability, with each subsequent sprain leading to further weakening or stretching of the ligaments that results in greater instability.
The Signs & Symptoms Of Ankle Instability
The signs and symptoms indicated by a person faced with instability in the ankle can be outlined as under:
- Persistent Pain, Swelling & Bruising in the stretched ligament fibers
- Walking With A Limp with limited weightbearing
- Torn Or Ruptured Ligament with significantly serious sprains
- A Minor Bone Fragment breaking off the point of ligament attachment
- Bones Around The Ankle may be broken or dislocated
- The Talus Surface & Tendons around the ankle joint may be damaged
- A Repeated Turning Of The Ankle, especially on uneven surfaces or when participating in sports
- Tenderness Or Discomfort in the injured region
- Wobbly Or Unstable feeling in the ankle
The Diagnostic Procedure Of Ankle Instability
- A Thorough Medical History for careful decision-making
- A Detailed Physical Examination for general assessment and confirming the existence of multiple sprains and fracture
- Imaging Techniques developed to serve the very purpose of acquiring precision, accuracy and reliability that include:
- MRI Scans
The Treatment Regimen Of Ankle Instability
As presented with a majority of foot and ankle problems, either congenital or acquired, both noninvasive and surgical means of cure are available to be best selected for the suffering patient. By all means, your orthopedic specialist happens to be the best source of deciding on the most appropriate procedure(s) that suits you best in the healthiest way out. Thus, it is imperative that your podiatrist and you work together in conjunction and make up the final mind over carefully selecting the easiest way out.
The Non-operative Course Of Treatment
After a precise diagnosis of ankle instability has been established, non-operative treatment is the first line of therapy, avoiding surgery at its most.
- The Home-Based, Most Fundamental course of managing an instable ankle goes as follows:
- Protection of the injured area from further injury
- Resting the bruised ankle to avert its additional damage by weight-bearing
- Ice application to ease off the pain and reduce swelling in the joint
- Compression of the ankle via softly wound crepe bandage for immobility
- Elevation of the ankle up to the chest level to reduce pain and swelling
- Bracing via wearing an ankle brace to gain support for the ankle and keep the ankle from turning is usually advised. Bracing also helps prevent additional ankle sprains from occurring.
- Physical Therapy is an essential line of treatment that involves various treatments and exercises to strengthen the ankle, improve balance and range of motion and retrain your muscles in gaining back their former level of function. As you progress through the rehabilitation phase, you may also receive training that relates specifically to your activities or sport.
- Medications in the form of NSAIDs may be prescribed to reduce pain and inflammation.
The Operative Course Of Treatment
If the injured ankle does not resume its normal appearance and function within a few months of the noninvasive treatment, or is still painful 6 months after an injury, further investigation/treatment using ankle arthroscopy would be required and you may be offered ankle ligament repair or reconstruction surgery by your foot and ankle surgeon to repair the damage, based on the degree of instability or lack of response to nonsurgical approaches.
The surgeon would select the surgical procedure best suited for your case based on the severity of the instability and your activity level. The length of the recovery period will vary, depending on the procedure(s) performed.
Prior to plying on the conventional surgical intervention procedures, certain key considerations in surgical planning need to be addressed. It should be understandable that ankle instability is a compound problem with ligamentous pathology, potential dysfunction or failure of the dynamic support of the ankle, and structural abnormalities. These are listed as below:
- Peroneal Tendon Dysfunction
- Syndesmotic Instability
- Subtalar Instability
- Cavus Foot Type
- Intra-Articular Pathology
- Suprapedal Deformity
The surgical intervention falls into two main categories, explained as under:
- Anatomic Reconstruction (Broström Procedure) is the preferred method in which the stretched or torn ligaments are repaired and allowed to heal in a shortened position. This reconstruction can be accomplished by using the patient’s own tissue or utilize a cadaver tendon (an allograft), if the patient’s own tissue is too stretched out or different. For added stability and to help prevent re-injury, the surgeon may also tighten the retinaculum (a band of fibrous tissue that helps hold the ankle in proper alignment). This procedure offers the superb advantages of maintaining full mobility of the joint, a smaller incision, and a more speedy recovery. The primary shortcoming of this procedure is that ligaments may rarely become loose a second time and require additional repairs.
- Peroneal Substitution Ligament Reconstruction is a procedure in which the ligament is replaced entirely with another piece of tendon from the patient’s ankle. This procedure is less preferred as the main dynamic ankle stabilizer, the peroneal tendon, is utilized. When the torn ligament is too badly damaged and insufficient to repair, a tendon allograft is employed that requires a larger incision, a longer recovery period, and carries a risk of nerve irritation which can lead to chronic pain and stiffness.
The Postoperative Care & Recovery Phase
- Following surgery, the ankle is placed in a plaster splint.
- The patient should use crutches or a knee scooter to avoid weightbearing on the affected foot.
- At 2 weeks, the plaster splint is replaced with a cast or removable boot to be worn for an additional 2 to 4 weeks.
- Formal physiotherapy is initiated at 6 weeks.
- An ankle support is worn for walking until 12 weeks after surgery.
- By the end of 3 months, most people can go unbraced and return to all their normal activities, including participation in sports.