ADVANCED FOOT AND ANKLE SPECIALISTS, PA
Jay S. Weingarten, DPM, FACFAS, FACFAOM
Podiatric Physician and Surgeon
Board Certified Physician – Treating Pediatrics to Geriatrics
Surgical Management of Chronic Ankle Sprains
Chronic or repeated ankle sprains result from incompetence of the lateral
collateral ankle ligaments. These ligaments function to support and control
motion within the ankle joint. When these ligaments have been damaged from
previous ankle sprains, they lose their ability to restrain the ankle joint within
its normal range of motion. Typical symptoms include chronic ankle pain,
difficulty walking on uneven surfaces or a feeling of the ankle "giving way".
Initial treatment should consist of muscle strengthening and what is referred to
as "proprioceptive rehabilitation". This can be accomplished through a physical
therapist that is knowledgeable with rehabilitation of lateral collateral ligament
instability. An ankle brace may also provide some external support to prevent
recurrent injuries and also control swelling.
Surgical Stabilization of the Ankle
Surgery may be indicated for those cases of chronic ankle sprains failing to
respond to conservative treatment. There are various surgical options
available. These surgical procedures can be divided into two types. The first
type involves the use of local tissue to reconstruct the lateral collateral
ligament complex. The second type of surgery involves the use of a tendon
graft or some other type of graft material to reconstruct the lateral collateral
ligament complex.
The use of regional tissue is typically referred to as Brostrom-Gould procedure.
This procedure is usually performed as an outpatient. This can be performed
utilizing local anesthesia with IV sedation or a general inhalation anesthesia.
The type of anesthesia depends on the surgeon and patient preference.
Postoperative convalescence for this procedure includes approximately 4 to 6
weeks in a non-weight-bearing short leg cast. This is then followed by 2-3
weeks of protective weight-bearing in a camwalker or brace. The patient will
then progress to standard footgear. This procedure has several advantages
including the use of local tissue without sacrificing normal anatomic structures,
very little restriction of normal range of motion and good cosmesis with the
incision placement.
The second type of surgical procedure is referred to as a tenodesis procedure.
This procedure involves a tendon or fascia latta graft that is routed through
drill holes within the ankle and foot bones. This is usually performed as an
outpatient and requires a general inhalation or spinal anesthesia. Postoperative
convalescence includes 6 weeks of non-weight-bearing in a short leg cast. This
is then followed by protected wirht-bearing in a camwalker or brace for 3 to 6
weeks. The patient will then return to standard footgear or rocker bottom
brace depending on the extent of swelling. Some patients may require physical
therapy but this will depend on the patient's specific situation. This procedure
has the advantage of providing excellent stability. However, the stability can
be at the expense of decreased joint motion and the sacrifice of normal
anatomic structures to reconstruct the lateral collateral ligament
complex.There are new allogenic grafts that have been developed. This allows
the surgical procedure without utilizing normal anotomical structures. Ask your
surgeon about this option.
Possible Complications
The major complications following lateral ankle stabilization procedure include
decrease in subtalar joint motion. This joint is primarily responsible for the
foot's ability to swivel side to side. The other complication not uncommonly
seen includes sural neuritis. This is secondary to excessive traction of the sural
nerve during the surgical procedure. Sural neuritis is usually transient and will
resolve within one year.
Summary
Lateral ankle instability that fails to respond to non-operative care may require
surgical management. The type of surgical procedure depends on the patient's
activity level, occupation, weight and whether or not previous surgery has
failed. The patient should discuss the various options with their surgeon to
determine which procedure is best for their situation. The ultimate goal is to
have a patient function at their pre-injury level and perform activities of a daily
living without continued ankle sprains.
1233 SE Indian St., Suite 102, Stuart, FL 34997
tel. 772-223-8313, fax 772-223-8675
1106 W Indiantown Rd, Suite 4, Jupiter, FL 33458 tel. 561-744-6683, fax 561-744-7033