Ankle Sprains
Sprains of the ankle can be the result of direct injuries or from the shape or posture of the foot and lower leg.
These injuries can, if not correctly assessed and managed, lead to chronic problems such as arthritis to the ankle joint. This may potentially lead to more significant surgery such as ankle replacements or fusions.
Ankle sprains are classified into 3 broad groups, Grade 1 is a mild sprain which will go onto full healing, Grade 2 is a where a tear has occurred and the ankle may be loose after the injury. Grade 3 refers to a complete tear. Often grade 3 injuries usually have other structures damaged at the same time such as cartilage, tendon and secondary ligaments.
Over time, grade 2 and 3 sprains that are not managed well can progress to more chronic problems.
Ankle Ligament Reconstruction (Brostrom Operation)
Surgery for ankle instability has advanced over the years, more so in the last decade. Call to discuss your problems in more detail and possible solutions for your ankle instability.
If you have torn the ligaments on the lateral side of your ankle and the ankle keeps giving way on you, you would normally be prescribed a course of physiotherapy to settle down inflammation in your ankle, strengthen the muscles and ligaments around the ankle to help control the joint better and ‘wobble-board’ exercises to re-teach the nerve endings inside the ankle to work better. If the physiotherapy does not improve your ankle, we would then arrange an investigation (MRI scan) to confirm that your ankle is truly unstable and to check there is nothing else the matter inside the ankle joint. If you continue to have problems, you would have the choice between wearing a lightweight brace on the ankle while doing the things that cause your ankle to give way or having an operation to repair the damage.
If you have very lax or stretchy ligaments generally you would be best to have the torn ligament repaired with a special ‘rope’ placed over the ligament repair (Internal brace). If the shape of your foot is causing the ankle instability then this is usually surgically corrected at the same time as the ligament repair.
What is it?
The Brostrom operation is a repair of damaged ligaments on the outer ("lateral") side of the ankle.
Why would it be done?
If you have failed conservative care through physiotherapy and using a brace. If you have very lax or stretchy ligaments generally you would be best to have the torn ligament repaired with special type of suture. Otherwise, we would recommend a simple repair of the ligament, which can even be done many years after the original injury. This is the Brostrom operation.
What does it involve?
A cut is made over the outer side of the ankle. The remains of the ligament are found. Small grooves are made in the bone on the outer side of the ankle (the "lateral malleolus"). Small anchors are placed in the bone and stitches attached to these anchors are used to fasten the ligaments back in place. An additional “false ligament” is then used to strengthen the repair (called the internal brace). The tissues on the outer side of the ankle are then stitched to the ligament to support it. The skin is closed, usually with a dissolving stitch buried under the skin.
Will I have to go to sleep (general anaesthetic)?
The operation can be done under general anaesthetic (asleep). Alternatively, an injection in the back of the knee can be done to make the lower leg numb while the patient remains awake. You can choose to have sedation to sleep through the operation.
You will be given pain-killing tablets as required after the operation.
Will I have a plaster on afterwards?
No. You will be given a special boot (cam walker) to use, initially with crutches. Normally you will be in the boot for 4 weeks.
What will happen afterwards?
Physiotherapy will be arranged to start getting your ankle going again when you come out of the boot.
You will go through another full course of physiotherapy to make your ankle strong and flexible, to get back peroneal muscle strength and to retrain the fine nerve endings in your ankle to give the right signals to the muscles around them.
How soon can I...
Walk on the foot?
Straight away but this is restricted at the beginning to help reduce swelling and make the foot and ankle comfortable.
Go back to work?
This will depend on the job you do and whether you can work from home.
Drive?
If you have your left foot operated on and have an automatic car you can drive within a few days of the operation, when your foot is comfortable enough. Otherwise you will have to wait until the ankle is strong and flexible enough to work the pedals and you have come out of the boot.
Play sport?
Once you are into your ankle brace you can gradually increase your level of activity under the guidance of your physiotherapist. Once you can walk comfortably you can start running, swimming and cycling, increasing the distance covered gradually. Once you can run comfortably you can do some turning and jumping. As this recovers you can go back to low-impact, non-contact sports and finally to full contact sports. It is common to take 6-8 months to return to sports such as football or rugby.
What can go wrong?
The repair may be:
Too tight: the ankle feels stiff and may not recover flexibility. Over a period of some years the ankle may develop aching pain and in some cases arthritis
Too loose: the ankle still feels lax and gives way. Most people still find it to be much better than before but a few (about 5%) need to be re-operated on
With the Brostrom procedure it is commoner to be too loose than too tight.
In a few cases the wound is slow to heal or develops a minor infection. This usually settles with dressings and/or antibiotics.
The nerves to the top and outer side of the foot run close to the ankle where the operation is done. This produces a numb, sometimes tingly, occasionally painful area over the top or outer side of the foot which normally gets better over 6-8 weeks.
There is a small risk of developing a deep venous thrombosis (clots in the veins of the leg) after this type of surgery. We will assess if your individual risk is high enough for you to need blood-thinning medication.