Ankle instability and ligament injuries, including Achilles tendon problems, are common issues that can significantly impact mobility and quality of life. Here’s an overview of these conditions and how your surgeon will address them:
Ankle Instability and Ligament Injuries
Causes: Ankle instability often results from repeated ankle sprains, which can stretch or tear the ligaments that stabilize the ankle. Chronic instability can develop if these ligaments do not heal properly.
Symptoms: Frequent “giving way” of the ankle, especially during physical activities; pain, swelling, and tenderness around the ankle; and a feeling of instability.
Diagnosis
Physical Examination: A thorough assessment by an orthopedic specialist, including specific tests to evaluate ligament stability.
Imaging: X-rays, MRI, or ultrasound to visualize ligament damage and rule out other issues.
Treatment
Conservative: Physical therapy, bracing, and anti-inflammatory medications.
Surgical: If conservative treatments fail, surgery may be necessary.
Surgical Procedures
Broström Procedure
Procedure: The surgeon repairs and tightens the damaged ligaments. This may involve stitching the torn ligaments back together and reinforcing them with nearby tissues.
Recovery: Involves immobilization in a cast or boot, followed by physical therapy to regain strength and stability.
Ligament Reconstruction
Procedure: In cases of severe damage, a graft (either autograft from the patient or allograft from a donor) is used to reconstruct the ligaments.
Recovery: Similar to the Broström procedure, but may take longer due to the complexity of the surgery.
Achilles Tendon Problems
Causes: Achilles tendonitis (inflammation), tendonosis (degeneration), or tendon rupture (complete tear). These can be caused by overuse, sudden increases in activity, or trauma.
Symptoms: Pain, swelling, and stiffness along the back of the ankle and heel. A rupture may cause a sudden, sharp pain and an inability to push off the foot.
Diagnosis
Physical Examination: The Thompson test, where the calf is squeezed to see if the foot moves (lack of movement indicates a rupture), and other assessments.
Imaging: Ultrasound or MRI to confirm the extent of tendon damage.
Treatment
Conservative: Rest, ice, physical therapy, heel lifts, and anti-inflammatory medications.
Surgical: Necessary for complete ruptures or chronic cases unresponsive to conservative treatments.
Surgical Procedures:
Achilles Tendon Repair
Procedure: For acute ruptures, the surgeon stitches the torn ends of the tendon back together. Minimally invasive techniques may be used to reduce recovery time.
Recovery: Involves immobilization, followed by a gradual return to weight-bearing and physical therapy.
Tendon Debridement and Reconstruction
Procedure: For chronic tendonitis or tendonosis, the surgeon removes degenerated tissue and may reinforce the tendon with grafts.
Recovery: Similar to tendon repair but may include additional steps to address underlying degenerative changes.
Postoperative Care and Recovery
Immobilization: Using a cast, boot, or brace to protect the surgical site and ensure proper healing.
Pain Management: Medications to manage pain and reduce inflammation.
Physical Therapy: Rehabilitation exercises to restore strength, flexibility, and function. This is crucial for both ligament and tendon surgeries to prevent recurrence and ensure optimal recovery.
Follow-Up: Regular appointments with the surgeon to monitor healing and progress, and to adjust the treatment plan as needed.
Potential Complications
- Risk of infection at the surgical site as with any surgery.
- Risk of re-injury or persistent instability.
- Possible nerve injury during surgery, leading to numbness or weakness.
By addressing ankle instability and Achilles tendon problems surgically when necessary, patients can achieve significant improvements in pain relief, stability, and overall function, allowing them to return to their normal activities.