Ankle Instability

Blog post by Mr. Mark Blackney

Introduction

Ankle sprains are one of the most common sporting injuries. Usually the injury recovers with suitable rest and physiotherapy.

Ankle instability occurs when the ankle repeatedly gives way during sporting or even daily activities. This leads to recurrent ankle sprains, joint pain, swelling, inflammation and damage to the ligaments around the ankle. Some people experience ankle pain intermittently, others feel that their ankle ‘aches’ more often. Recurrent instability episodes can cause damage to the joint surface cartilage, the formation of bony spurs (osteophytes) and arthritis.

Non Operative Treatment

The first line of treatment for ankle sprains is rest, ice, compression and elevation with painkillers and anti–inflammatories (if tolerated). Physiotherapy is then useful to regain range of movement, strength, balance and joint position sense.

An ankle brace may be useful for people who have tried all these measures and experience ongoing problems with sporting or daily activities. Finally, a targeted corticosteroid injection may offer relief from ankle inflammation and help settle symptoms so that physiotherapy can continue.

Operative Treatment

When all these non operative measures fail and recurrent ankle instability becomes an ongoing problem surgery is indicated. The ankle ligaments are assessed clinically and an MRI scan is sometimes necessary to identify any problems within the ankle joint itself or the tendons and ligaments around the joint.

There are two components to the surgery.

An arthroscopy is performed with a camera through two small incisions at the front of the ankle. The joint surfaces are inspected, inflammatory and scar tissue is removed and any bony spurs (osteophytes) are trimmed away. An incision is made over the outside of the ankle where the ligaments have been torn away and the ligaments are reconstructed in an anatomical fashion and reinforced with overlying tissue (modified Brostrum-Gould repair). If indicated, the tendons behind the ankle are inspected and repaired.

At the end of the operation a backslab (half plaster) is applied to immobilise the ankle and protect the reconstruction.

Postoperative Recovery

As with all reconstructive surgery your rehabilitation and postoperative physiotherapy regime forms a vital part of your recovery from surgery and return to normal activities.

The first two weeks are dedicated to reducing the swelling with elevation of the foot and mobilising non–weight bearing with crutches to allow the wounds to heal. You will then be allowed to wear a lace up ankle brace and gradually increase your weight bearing status and work on range of motion. 6 weeks after surgery the brace is removed for daily activities and an intensive strengthening and balance program begins. The brace is to be worn for all sporting activities and you should be able to return to sports 3–6 months after surgery. The ankle may always be a bit stiffer than the normal side and a slight reduction in range of motion is not uncommon but this is rarely a significant problem.

Risks and complications

No surgery is risk free. The risks and complications will be assessed and discussed with you. There is always a small risk of infection, blood clots and anaesthetic problems and measures are taken to reduce these. There is approximately a 5% chance of experiencing problems with recurrent instability and this is usually due to a fresh injury or sprain. A successful outcome is achieved in more than 90% of cases.

Recovery

  • Hospital stay: 1 night
  • Elevation: 1 week
  • Plaster back slab (Non weight bearing): 2 weeks
  • Sutures removed: 2 weeks
  • Crutches: 2–4 weeks
  • Walking well: 6 months
  • Return to sports: 3–6 months
  • Final Result: 12 months

These timeframes should be used as a guide only and may vary for individual patients based on the nature or extent of the actual surgery performed and individual circumstances. Please contact Mark Blackney's rooms on (03) 9417 0762 or Terence Chin's rooms on (03) 9928 6450 if you require further information.