What is lateral Ankle Instability?
Chronic ankle instability is the result of repeated mild to moderate ankle sprains or may be the result of one severe ankle sprain. The ankle may feel weak, may repeatedly sprain or “give way”. The lateral (outside) ankle ligaments are more prone to injury that then medial (inside) ligaments, which are much stronger. Approximately 10-20 percent of people that have an ankle sprain will develop chronic lateral ankle instability.
Can it be corrected surgically?
In many cases yes. The aim of this surgery is to restore normal stability to the ankle. Consequently, this will resolve the pain that is associated with an unstable ankle and the feeling of the ankle “giving way”.
When should you consider lateral ankle ligament surgery?
Surgery may be advised if non-surgical treatment options do not relieve the instability, discomfort and problems in the ankle. Generally, six months of non-surgical treatment is recommended before proceeding with surgery.
There are several different techniques that can be performed. The most commonly performed technique involves making an incision over the outside of the ankle. The ankle ligaments are identified and then tightened, using stitches or anchors that are placed into one of the bones of the ankle. Other tissue is then stitched over the repaired ligaments to further strengthen the repair.
Can it be done as a day case operation?
Surgery is usually performed as a day case, provided that you are medically fit, and have someone who can collect you and look after you after the operation.
If you have medical problems, for example diabetes, asthma or high blood pressure, you may have to stay overnight after surgery. If you cannot be collected and looked after, you must stay overnight to avoid complications.
Usually the surgery is performed under a general anaesthetic. Alternatively, an injection into the back, leg or around the ankle can be performed to make the foot numb while you remain awake. Local anaesthetic is injected into the foot while you are asleep to reduce post operative pain. You will also be provided with pain relieving medication after the surgery. The anaesthetist will consult with you at the hospital prior to surgery and will discuss the anaesthetic process in full.
Post operative recovery
You will be in a cast or splint for a minimum of two weeks following surgery. Weight bearing is gradually increased using a removable walking boot. It may be up to six weeks before complete weight bearing can take place.
How soon can I...
Go back to work?
This depends on what you do and how you get to work. If you have an office job that allows you to elevate your foot for the majority of the day, you could perhaps return to work after one week. On the other hand, if you have a heavy manual job you may be off work for up to three months. If you need to drive to work, this can also affect when you can go back. It also depends on which ankle is being operated on. Your podiatric surgeon will advise you further.
Once you are back into comfortable shoes, you may be able to start driving again. You must be comfortable and not too stiff before trying to drive. It is best to start by driving short distances. Remember, if you cannot safely make an emergency stop, your insurance will not cover you in the event of an accident. As a guide, an automatic car can be driven approximately 3 weeks after surgery and a manual car approximately 6 weeks after surgery.
Once you are wearing normal footwear you can start gently exercising your foot and walking further each day. When you are comfortable doing this you can start gentle running and stretching. Impact sports can follow as comfort dictates. Every patient is different in how quickly they can resume exercise again: be guided by your own body's reactions and the advice of your surgeon. The majority of people can resume most of their previous activities within 2-3 months of surgery.
Can there be complications?
Ankle ligament repair surgery is very effective in the vast majority of patients. Although it is unlikely, there are complications that can arise following surgery. These can include:
- Infection: Antibiotics are given before and after surgery to reduce the chances of infection however it can still occur.
- Nerve injury: Minor damage to the nerves can occur as a result of small sensory nerves being caught in scar tissue. It may cause an area of numbness or sensitivity around the incision that extends to the top of the foot. This occurs in up to 20 percent of cases and can range from increased sensitivity to complete loss of sensation.
- Wound healing difficulties: Problems with wound healing are rare and tend to occur primarily with patients with diabetes and smokers. If you do smoke, it is recommended that you stop smoking at least four weeks prior to surgery.