Ankle Instability

Ankle Instability:

Ankle instability is typically caused by recurrent ankle sprains, which can damage the lateral ligaments of the ankle, causing increased laxity of the joint. Patients who are hyper-flexible generally, are predisposed to ankle instability events. Recurrent ankle instability events increase the risk of the development of arthritis in the joint. Common symptoms of chronic ankle instability include pain, swelling, weakness, stiffness, and a sense that the ankle may give out without any precipitating event.

Treatment:

Non-operative treatment includes:

A dedicated course of physical therapy for a minimum of 6 weeks.
Bracing the ankle to prevent instability events.
Orthotics with a lateral heel wedge to correct the supination of the foot.

Surgical treatment:

If instability persists despite conservative management, surgery may be indicated. Surgery typically consists of arthroscopic debridement of the ankle joint followed by an open-modified Brostrom procedure, also known as anatomic repair. This procedure results in anchoring the anterior talofibular ligament and calcaneofibular ligaments to the bone. An alternative surgical procedure is known as nonanatomic repair. This technique uses a donor tendon graft to replace the damaged ligament.

With either surgical procedure, Dr. Moon recommends a thorough post-operative course of physical therapy and bracing, to reduce the risk of surgical failure with a significant ankle roll post-operatively.

Post-Operative Care:

After surgery, patients are placed in a splint and are non-weight bearing on the operative extremity until their first post-op appointment about 2-3 weeks after surgery. During the initial postoperative period, it is important that the patient elevate the extremity above the heart as much as possible, to decrease the risk of delayed wound healing and/or infection. At the first post-operative appointment, sutures will be removed if indicated. The patient is then transitioned into a cast if the soft tissues are amenable. Between 4-6 weeks postoperatively, the patient is transitioned to a boot and starts physical therapy. Patients can usually expect to be back in a regular shoe approximately 3 months postoperatively.