Ankle Instability, Chronic, Surgery For

■ ■ ■ Indications (Who Needs Surgery, When, Why, and Goals)

Surgery for chronic ankle instability is reserved for people who have recurrent ankle sprains or giving way due to looseness of the ankle ligaments and have tried an appropriate rehabilitation program for at least 3 months without relief of symptoms. The goal is to stabilize the ankle to prevent further giving way. This is done either by tightening the ligaments or using other structures to replace or give additional support to the ligaments of the ankle.

■ ■ ■ Contraindications (Reasons Not To Operate)
  • Infection of the ankle or an inability or unwillingness to complete the postoperative program of keeping off the foot or to perform the rehabilitation necessary may preclude surgery.

  • Surgery is not always as effective if the ankle has been unstable for more than 10 years and the patient has generalized looseness of joints.

■ ■ ■ Risks and Complications of Surgery
  • Infection

  • Bleeding

  • Injury to nerves (numbness, weakness, paralysis) of the foot and ankle

  • Recurrence of instability (giving way)

  • Stretching out of the repair

  • Continued pain

  • Weakness of the muscles of the ankle

  • Stiffness of ankle

■ ■ ■ Technique (What Is Done)

Several techniques are in use at this time. Currently, one of the most popular techniques involves cutting the torn or stretched ligaments, then tightening the ankle by removing the slack in the ligaments by oversewing them. Other techniques involve taking all or part of one or more tendons on the outer part of the ankle and rerouting them, often through bone, to replace (reconstruct) the ankle ligaments.

■ ■ ■ Postoperative Course
  • Management after surgery varies.

  • Keep the wound clean and dry for the first 10 to 14 days after surgery.

  • Keep the foot and ankle elevated above heart level as much as possible for the first 1 to 2 weeks after surgery.

  • You will be given pain medications by your physician.

  • Casting is often used, varying from 4 to 8 weeks.

  • You might not be allowed to bear weight on the foot for 2 to 6 weeks; this is followed by a short walking cast or brace for 3 to 6 weeks.

  • Postoperative rehabilitation and exercises are very important to regain motion and then strength.

■ ■ ■ Return To Sports
  • A return to sports depends on the type of sport and position played, as well as the quality of ligaments at the time of repair.

  • A minimum of 3 months is necessary after surgery before return to sports.

  • Full ankle motion and strength are necessary before returning to sports.

■ ■ ■ Possible Complications
  • Frequent recurrence of symptoms is possible. Appropriately addressing the problem with rehabilitation decreases the frequency of recurrence and optimizes healing time.

  • Injury to other structures (bone, cartilage, or tendon) and a chronically unstable or arthritic ankle joint are possible with repeated sprains.

  • Complications of surgery including infection, bleeding, injury to nerves, continued giving way, ankle stiffness, and ankle weakness.

■ ■ ■ Notify Our Office If

  • You experience pain, numbness, or coldness in the foot and ankle

  • Blue, gray, or dusky color appears in the toenails

  • Any of the following occur after surgery:

    • Increased pain, swelling, redness, drainage, or bleeding in the surgical area

    • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever)

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects)

Do not eat or drink anything before surgery. Solid food makes general anesthesia more hazardous.

➢RANGE OF MOTION AND STRETCHING EXERCISES • Ankle Instability, Chronic, Surgery For

These are some of the initial exercises you may start your rehabilitation program with after surgery, once your cast has been removed, until you see your physician, physical therapist, or athletic trainer again. These exercises are usually done for the first 2 to 3 weeks after motion is allowed. Your exercise program will be progressed when appropriate. Please remember:

  • Flexible tissue is more tolerant of the stresses placed on it during activities.

  • Each stretch should be held for 20 to 30 seconds.

  • A gentle stretching sensation should be felt.

RANGE OF MOTION • Active Dorsi/Plantar Flexion

  1. Pull your toes and foot toward your body as far as possible, then point the foot and toes away from body as far as possible.

  2. Perform this exercise with the knee straight and then with the knee bent.

  3. Hold this position for _____ seconds.

  4. Repeat exercise _____ times, _____ times per day.

RANGE OF MOTION • Ankle Alphabet

  1. Write all the capital letters of the alphabet with your foot and ankle. The motion should come from your foot and ankle, not your hip or knee.

  2. Move the foot and ankle slowly, writing the letters as large as possible/comfortable for you.

  3. Repeat exercise _____ times, _____ times per day.

RANGE OF MOTION • Ankle Dorsiflexion

  1. Sit on the edge of a chair as shown.

  2. Place your _____ foot closest to the chair.

  3. Keep your foot flat on the floor and move your knee forward over the foot.

  4. Hold this position for _____ seconds.

  5. Repeat exercise _____ times, _____ times per day.

STRETCH • Gastrocsoleus

  1. Sit with your leg straight out in front of you and loop a towel around the ball of your foot as shown in the diagram.

  2. Pull your foot and ankle toward you using the towel.

  3. Keep your knee straight while doing this. Do not let your knee bend.

  4. Hold this position for _____ seconds.

  5. Repeat exercise _____ times, _____ times per day.

➢ STRENGTHENING EXERCISES • Ankle Instability, Chronic, Surgery For

These are some of the initial exercises you may start your rehabilitation program with after surgery, once your cast has been removed, until you see your physician, physical therapist, or athletic trainer again. These exercises are usually done for the first 2 to 3 weeks after motion is allowed. Your exercise program will be progressed when appropriate. Please remember:

  • Strong muscles with good endurance tolerate stress better.

  • Do the exercises as initially prescribed by your physician, physical therapist, or athletic trainer. Progress slowly with each exercise, gradually increasing the number of repetitions and weight used under their guidance.

STRENGTH • Dorsiflexors

  1. Attach one end of elastic band to fixed object or leg of table/desk. Loop the opposite end around your foot as shown.

  2. Slowly pull the foot toward you. Hold this position for _____ seconds. Slowly return to starting position.

  3. Repeat exercise _____ times, _____ times per day.

STRENGTH • Plantarflexors

  1. Loop elastic band around foot as shown. Pull the band toward you with your hands.

  2. Push your toes away from you slowly. Hold this position for ____ seconds. Slowly return to starting position.

  3. Repeat exercise ____ times, ____ times per day.

STRENGTH • Towel Curls

  1. Sit in a chair and place a towel on a noncarpeted floor. Place your foot/toes on towel as shown. (You may also stand to do this exercise rather than sit.)

  2. Curl/pull towel toward you with your toes while keeping your heel on the floor. Move towel with toes only. Do not move your knee or ankle.

  3. If this is too easy, place a light weight (book, hand weight, etc.) at the far end of the towel.

  4. Repeat exercise _____ times, _____ times per day.

STRENGTH • Ankle Eversion

  1. Attach one end of elastic band to fixed object or leg of table/desk. Loop the opposite end around your foot.

  2. Turn your toes/foot outward as far as possible, attempting to pull your little toe up and outward. Hold this position for _____ seconds.

  3. Slowly return to starting position.

  4. Repeat exercise _____ times, _____ times per day.

STRENGTH • Ankle Inversion

  1. Attach one end of elastic band to fixed object or leg of table/desk. Loop the opposite end around your foot.

  2. Turn your toes/foot inward as far as possible, attempting to push your little toe down and in. Hold this position for _____ seconds.

  3. Slowly return to starting position.

  4. Repeat exercise _____ times, _____ times per day.

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CONTACTS (USA)

800 Stanton L Young Blvd, Williams Pavilion, Department of Orthopedic Surgery, Suite 3400, Oklahoma City, OK, 73117, USA

Tel: +1 405-271-BONE

amgad-haleem@ouhsc.edu

CONTACTS (EGYPT)

Kasr Al-Ainy Hospital, Cairo University, College of Medicine, EL Manial,
Cairo,Egypt

haleem@kasralainy.edu.eg

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