Ankle Injury Treatment Melbourne
Ankle sprains, fractures and surgery – A Patient’s Guide:
Mr Troy Keith MBBS (Hons), FRACS (Orth), FAOrthA
Orthopaedic Foot and Ankle Surgeon
What are the ligaments in your ankle
On either side of your ankle there are strong bands of tissue called ligaments. These can be divided into two main groups:
- Ligaments on the outside of the ankle lateral ligament complex
- Ligaments on the inside of the ankle (deltoid ligament complex)
If you ‘sprain your ankle’ it usually involves you injuring the ligaments on the outside of your ankle (lateral ligament complex). This group is made up of three separate bands:
- Anterior talo-fibular ligament – at the front
- Calcaneo-fibular ligament – in the middle
- Posterior talo-fibular ligament- at the back.
It is usually the front and sometimes middle bands that are injured when you sprain your ankle (refer to Figure 1 above).
Your ankle is a hinge joint between the leg and the foot, and allows up and down movement. The bones of the leg (tibia and fibula) form a slot, and the talus bone of the foot fits between them.
How do you injure your ankle ligaments?
Most ankle ligament injuries are caused when the foot rolls or ankle twists inwards or outwards with the weight of the body behind it leading to an ankle sprain. Occasionally a small fragment of bone maybe torn off with the ligament.
The twisting force of your ankle and body weight may cause other injuries such as:
- Damage to the cartilage lining in your ankle joint
- The tendons and/or ligaments on the side of your ankle may be sprained or torn.
Ankle Injury Treatment Melbourne
What should you do if you sprain your ankle
Minor ankle sprains are a common injury, most will usually get better on their own. To help your ankle settle sooner follow the “R-I-C-E” technique:
- Rest –Take the weight off the injured ankle as much as possible for a few days
- Ice –Apply an ice pack to the injured area for 10-15 minutes 3-4 times a day to reduce swelling (a small bag of frozen peas is ideal)
- Compression – A support bandage or flight socks will help reduce the swelling
- Elevation – Resting with the ankle elevated will allow swelling to settle.
It is best to start putting some weight on your injured ankle 2-3 days after the injury. You may require a boot and crutches to do so.
When you are able to start moving the injured ankle up and down after the injury try to avoid any side to side movements that will aggravate the injured ligaments further.
Normally a “minor “sprained ankle will recover within 2-4 weeks, more severe sprains usually take around 3 months. Your ankle maybe swollen for a few months until it completely settles.
Continuing ankle problems
The majority of ankle injuries will get better and do not lead to long-term problems.
In rare cases you may have done permanent damage to your ankle such as:
- Damage to the ankle joint itself
- Damage to the tendons in your ankle
- Ankle weakness or instability
In these cases your ankle may continue to give you pain and swelling.
Diagnosing continuing ankle problems and instability
Your doctor or physiotherapist should undertake a thorough examination of your ankle including:
- Medical history
- Injury or ailment related information and
- Physical examination.
An ultrasound or a MRI scan may need to be ordered to view your ankle joint to help diagnose the problem.
What can be done about ankle instability?
Appropriate physiotherapy can often successfully treat your ankle instability.
Your “ankle rehabiltation”concentrates on two main areas:
- Restoring range of motion with strengthening of the muscles around the outside of the ankle.
- Work on your balance with the use of specialised equipment such as a “wobble-board,” or a “mini trampoline.”
Most people will find their ankle much more stable and comfortable after physiotherapy.
If your problems continue it may be best to seek the advice of an orthopaedic foot and ankle surgeon.
Do you need ankle surgery?
There are many other options your doctor and physiotherapist should exhaust before opting for surgery. Ankle surgery is usually a final option.
There are two main types of operation:
- Ankle ligament reconstruction – The damaged ligaments are tightened up and reattached to the bone.
- Tenodesis – One of the nearby tendons is used to replace the damaged ligaments.
Ankle surgery recovery timeline
A typical recovery timeline for this surgery involves:
After surgery to 2 weeks – Your foot will be in a plaster to help protect and heal your ankle.
Weeks 2 to 6 weeks – You will start physiotherapy to help regain ankle mobility and strength. Wearing a moon boot during the day and ankle brace at night.
3 months after surgery – Most patients return to non contact sports – straight line running.
6 to 12 months after surgery – Expected full recovery.
The complications which may occur after a ligament reconstruction operation include:
- Ankle pain
- Numbness or tingling down the side of your foot
- Ankle swelling
- Ankle stiffness and restricted movement
- In 5% – 10% of cases the surgery does not work.
Ankle Injury Treatment Melbourne – Helpful information
I still have pain and swelling after spraining my ankle 3 months ago – Why?
Your ankle may just be taking longer than usual to recover. Persistent inflammation also known as ‘synovitis’ may be contributing to your pain.
There may also be some other damage to your ankle. If your ankle is still causing you trouble after 3 months, it may be worthwhile seeing an ankle specialist. They may recommend an steroid injection to help settle the pain and inflammation.
How can I prevent spraining my ankle again?
You can’t prevent re-injuring your ankle again, but there are some things you can do to reduce the chance of it happening again including:
- Taping or strapping your ankle
- Wearing an ankle support
- Ankle strengthening exercises.
Other causes of recurrent ankle sprains to be aware of:
High arches – Abnormal foot shape
If you have an abnormally shaped foot it may adversely affect the biomechanics of your ankle and may predispose you to further ankle sprains.
A high foot arch is known as “pes cavus “ (refer to Figure A ) which does not flatten on standing. This alone causes few symptoms and rarely requires treatment.
However when combined with a turned in heel or known as a varus heel (refer to Figure B ) overload of the lateral (outside) structures of the foot and ankle occurs. With time this may predispose you to injury of the lateral ankle ligaments, and tendons at the side of the ankle (peroneal tendons) as well as the fifth metatarsal.
Your surgeon may investigate further, potential causes of why you have an abnormally high arch and turned in heel. However in a large number of patients no known or identifiable cause is found.
If you do have a high arch and frequently suffer from ankle sprains, initial treatment will be physiotherapy based. Orthotic insoles may also be considered.
Physiotherapy will target a calf stretching program and exercises to help you to regain your balance and strength.
If your ankle problem does not improve Mr Keith may discuss further operative procedures to restore the biomechanics to your foot in addition to performing an ankle ligament reconstruction.
Cavovarus foot correction
A “cavovarus” foot correction usually consists of:
- An osteotomy of the heel bone to correct the turned in or “varus” heel.
- And/or an osteotomy of the first metatarsal of the big toe often performed to help lower the arch of the foot
- An achilles tendon lengthening
- And tendon surgery with either tendon repair if needed and/or a tendon release or tendon transfer as required to rebalance the foot.
The arch of the foot has been lowered with a osteotomy of the the first metatarsal and an osteotomy of the heel bone has been performed to correct the turned in “varus” heel.
Ankle Injury Treatment Melbourne
Mr Keith consults to patients from all over Melbourne in relation to ankle injury treatments. Mr Keith consults with patients at the following practice locations in Melbourne Armadale, Malvern, Richmond, Heidelberg and in Shepparton, country Victoria.