ANKLE SPRAINS
What is it?
The ankle joint is stabilised by the soft tissues around it, and when the ankle rolls over these tissues can become stretched, disrupted or completely torn. Around the ankle the ligaments on the outer or lateral side (anterior talofibular ligament and calcaneo-fibular ligament) are most commonly affected. Less frequently, the deltoid ligaments on the inner or medial side of the ankle can be affected.
Trauma is often the cause however some patients may have hypermobility as well.
Symptoms
Typically, patients have pain around the injured area with swelling, which may be associated with instability when walking or running.
Management
Initial management for all ankle sprains without a fracture should be protection of the joint (ankle brace or walking boot), rest (crutches), compression (sometimes a compression bandage is of help) and elevation. Analgesics and non-steroidal anti-inflammatory medication may also be used. Early functional physiotherapy will be instigated to help with the recovery.
The majority of ankle sprains settle with time following the above management, however if it does not then further investiagion with magnetic resonance imaging (MRI) is considered.
With persistent pain and symptoms of instability surgical intervention can be considered. In this operation the lax ligaments are first taken off the bone. They are then secured with a special stitch and advanced and reattached by drill holes into a bony channel made on the bone (fibula for lateral structures and medial malleoli for deltoid). This tightening procedure is reinforced with repair of the overlying tissue (retinaculum) as well.
Recovery
Your leg will be placed in a below-knee cast for 2 weeks, at which stage a wound check will be performed and a complete below-knee cast applied for a further 4 weeks. For this initial 6 weeks no weight-bearing will be permitted, and crutches will be supplied for support. Elevation, above the heart level, as much as possible, is important. After 6 weeks, a walking boot will be applied, and weight-bearing will be permitted in the boot and physiotherapy instigated.
Return to work can be expected at 6-8 weeks for jobs that are sedentary and 12-16 weeks for more manual and labour-intensive type jobs.
Return to driving will not be before 6 weeks and you must be able to perform an emergency stop. It is important to inform your insurance company of the type of procedure that has been undertaken to ensure the cover is valid.
Return to sports that are non-impact can be initiated at 6 weeks (training is allowed), however impact sporting activities are not permitted before 12 weeks
Risks of Surgery
As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, recurrence of instability, and clots.