■ ■ ■ 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.

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■ ■ ■ 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.

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■ ■ ■ 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

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■ ■ ■ 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.

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■ ■ ■ 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.

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■ ■ ■ 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.

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■ ■ ■ 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.

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■ ■ ■ 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.