Ankle Instability Surgery

Considering Ankle Instability Surgery?                                              

Ankle instability surgery is a possible treatment for a condition known as chronic ankle instability. This condition is one in which the ligaments in the outer portion of the ankle “give out.” This can occur while a person is active or while they are stood still. Ankle instability is caused by repetitive strains of the lateral tendons in the ankle. Ankle sprains are very common, but those who sprain their ankle often are more likely to damage the ankle’s tendons to the point where they are unable to heal correctly. The end result is a ligament which has healed in a looser-than-normal position, thus it fails to remain tight and stable. An unstable ankle makes it difficult to walk in high-heeled shoes and uneven ground which can prove dangerous for some individuals. As a person with ankle instability puts the sufferer at a greater risk of having future strains, ankle instability surgery could save them a great deal of pain.

Who is a good candidate for this surgery?

Laxity in the ligaments can be detected by a physical examination of the ankle as well as by x-ray. If attempts at physical therapy have failed to strengthen the ankle and restore the patient’s range of motion, then surgery is likely to be a good treatment for them. Some people have to use a brace in order to support their ankle and prevent strain during movement. Someone who relies heavily upon a brace may choose to elect surgery so that they no longer have to use the brace. Individuals who have strong surrounding muscles in the ankle, such as athletes and dancers, are far less likely to respond to muscle retraining exercises and therefore would also make good candidates for the surgery.

How is ankle instability surgery performed?

There are two main types of surgery that can be performed to treat ankle instability. The first type is known as a ligament tightening procedure. This surgery is begun with an incision in the skin on the lateral (outer) portion of the ankle. Holes are drilled into the lower portion of the fibula. The ligaments that have been overstretched to become loose are cut and each end is placed on top of each other until the proper tightness is reached. The ends are then sewn together and the holes in the fibula are used to secure the stitches to the bone. The surgeon may also decide to reinforce the area by pulling the edge of the ankle’s retinaculum upwards and sewing it to the bone. The retinaculum is a band of tissue that runs across the front of the ankle and offers extra stability to the nearby ligaments.

The other surgery is called a tendon graft procedure. This form of surgery is usually recommended for individuals whose existing ligament is so damaged and weak that a tightening procedure probably would not have much of an effect on the ankle’s strength. For this procedure, the surgeon will need to remove a piece of tendon from a nearby area (usually on the outside of the foot, and use it to replace the damaged ankle tendon. To do this, the surgeon starts by drilling two holes into nearby bone—one near the tendon that will be “harvested” and the other near the tendon that will be replaced. The surgeon then makes an incision and removes the healthy tendon. Finally, this tendon is woven between the two holes until it is taught and secure.

What is the recovery time like for this surgery?

A cast or brace is usually worn for the first month or so and patients are instructed to put little or no weight at all on the ankle for up to 12 weeks after surgery, although normal activity is usually achievable after six weeks. After the ankle is seen to be healing properly, the patient will have to attend physical therapy for a few months. This time can seem to pass by slowly but it is imperative that the patient takes it one step at a time and does not push themselves too hard.  Full recovery can take up to six months even with the support of a brace.