ANKLE INJURY TREATMENT MELBOURNE

Mr Troy Keith

Ankle sprains, fractures and surgery – A Patient’s Guide:

Mr Troy Keith MBBS (Hons), FRACS (Orth), FAOrthA
Orthopaedic Foot and Ankle Surgeon

PATIENT CARE PROCESS – MR. TROY KEITH
Learn more about Mr Keith’s approach to your care:

FIRST APPOINTMENT

GP/Specialist referral

Patient consultation & assessment

Additional testing if required

TREATMENT PLAN
(Non-operative)

Pain management

Moon boot, bracing

Physiotherapy

Exercise / Nutrition

OPERATIVE  TREATMENT
(If necessary)

Surgical process

Hospital administration

Surgery preparation – What do you need

POST OPERATIVE CARE

Early weight bearing

Pain management

Rehabilitation

Follow up appointments

ANKLE ANATOMY

What are the ligaments in your ankle?

On either side of your ankle there are strong bands of tissue called ligaments that connect the bones. These ligaments help stabilise the ankle joint and prevent it from twisting or rolling.

If you “sprain your ankle” it usually involves the ligaments on the outside of your ankle (lateral side). Injury to this side of the ankle most commonly involves:

  1. Anterior talofibular ligament (ATFL)  and/or
  2. Calcaneofibular ligament (CFL)
  3. Posterior talofibular ligament (PFL) – Rarely involved in ankle sprains

It is usually the front and sometimes middle bands that are injured when you sprain your ankle
(refer to Figure 1 below).

Ankle Anatomy Image

Figure 1

ANKLE INJURIES

How do you injure your ankle ligaments?

An ankle ligament injury (or ankle sprain) may occur when the ankle rolls inwards or outwards with the weight of your body behind it.

When your ankle moves too far in the wrong direction it may cause:

  • Injury to the ligaments on the side of your ankle with tear or rupture
  • Injury to the cartilage lining your ankle joint
  • Tendon injury with splitting of the tendon (peroneal tendons).
Ankle sprains

Occasionally a small fragment of bone maybe torn off with the ligament.

Ankle sprains are very common and occur when playing sports and when simply walking.

ANKLE INJURY ASSESSMENT

Assessing your ankle injury

Commonly ankle sprains on ultrasound or MRI reports are classified into three grades:

Grade 1 – A grade 1 injury (minor sprain) where the ligament/s are stretched.

Grade 2 – A grade 2 ankle sprain is a partial tear of the ligament/s.

Grade 3 – A grade 3 injury is a complete tear of an ankle ligament/s.

Ankle Sprain - Torn Ligaments
Mr Troy Keith

ANKLE INJURY TREATMENT MELBOURNE
DIAGNOSIS

Mr Troy Keith MBBS (Hons), FRACS (Orth), FAOrthA
Orthopaedic Foot and Ankle Surgeon.

Most Grade 1 & 2 Ankle Sprains recover within 4-6 weeks and often do not require surgery.

Grade 3 Ankle Sprains usually involves injury to multiple ligaments and may require surgery.

“It is essential to determine whether your ankle is stable or unstable after the injury as this can’t be determined using imaging alone.”

ANKLE INJURY TREATMENT

What should you do if you sprain your ankle?

To help your ankle settle sooner after injury, follow the “R-I-C-E” technique:

Ankle Injury Treatment Melbourne - RICE
  • Rest – Limit your activity to allow you to elevate your ankle.
  • Ice – Apply an ice pack (not directly to your skin)  for 15 mins every 2 – 3 hours.
  • Compression – A tubigrip or flight sock will help reduce the swelling.
  • Elevation – Keeping your ankle elevated at or above the level of your bottom (eg resting on the couch) will allow swelling and pain to settle.

Minor ankle sprains are a common injury and most will usually get better on their own.

CONTINUING ANKLE PROBLEMS

Mr Troy Keith MBBS (Hons), FRACS (Orth), FAOrthA
Orthopaedic Foot and Ankle Surgeon

If your ankle pain isn’t improving

The majority of ankle ligament injuries do not need surgery. Most will respond to physiotherapy to regain movement and to restore your balance and a stable ankle.

However if your ankle pain and movement are not improving you may have done further   injury to your ankle that may include:

  • Damage to the ankle cartilage
  • Damage to the tendons outside your ankle.

In these cases your ankle may continue to give you pain and swelling.

DIAGNOSING CONTINUING ANKLE PROBLEMS AND INSTABILITY

Mr Keith will undertake a thorough history and perform an examination of your ankle including:

  • Assessment of your ligaments
  • Previous injury/s
  • Rehabilitation performed to date
  • Medications

Mr Keith may request further imaging to better assess  the extent of ligament, cartilage and or bone damage to your ankle.

Foot Ultrasound

WHAT CAN BE DONE ABOUT ANKLE INSTABILITY?

Appropriate ankle rehabilitation with your physiotherapist can often successfully treat ankle instability. Ankle rehabilitation usually concentrates on two main areas:

  1. Restoring range of motion with strengthening of the muscles around the outside of the ankle.
  2. 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 a few weeks of a physiotherapy rehabilitation program.

If your problems continue Mr Keith will be able to provide advice in relation to your next step of treatment.

DO YOU NEED ANKLE SURGERY?

There are many other options Mr Keith and your physiotherapist will exhaust before opting for surgery.

Ankle surgery is usually a final option after non-operative treatments are exhausted.

There are two main types of operation:

  1. Ankle ligament reconstruction – The damaged ligaments are tightened up and reattached to the bone.
  2. Tenodesis – One of the nearby tendons is used to replace the damaged ligaments.

Ankle Injury Treatment

ANKLE SURGERY RECOVERY TIMELINE

A typical recovery timeline for ankle surgery is as follows:

Timeline – After surgery Description
0 to 2 weeks Your foot will be in a splint to help protect it and allow your surgical wound to heal.
2 to 6 weeks You will start physiotherapy to help regain ankle mobility and strength.
You will wear a moon boot during the day and ankle brace at night.
3 months Most patients return to straight line running.
4 months Most patients  commence agility training.
5 to 6 months Most patients return to contact sports.

POTENTIAL COMPLICATIONS

The ankle surgery complications which may occur after a ligament reconstruction operation may include:

  • Ankle pain
  • Ankle swelling
  • Ankle stiffness and restricted movement
  • Infection
  • Numbness or tingling down the side of your foot
  • In 5% – 10% of cases the surgery may not work.

Mr Keith will discuss with you in detail the potential complications and risks in relation to ankle surgery.

Mr Troy Keith

Mr Troy Keith MBBS (Hons), FRACS (Orth), FAOrthA
Orthopaedic Foot and Ankle Surgeon.

If you have any questions please contact my team:

VISIT CONTACT INFORMATION

ANKLE INJURY TREATMENT MELBOURNE

Helpful information and frequently asked questions (FAQ’s)

Ankle sprains are classified into three grades:

Grade Sprain Severity Healing Time
Grade 1 A grade 1 injury to an ankle ligament is a minor sprain:

  • It means a ligament is overstretched
  • There is usually mild swelling.
 1 -3 Weeks
Grade 2 Grade 2 – A grade 2 ankle sprain is a partial tear of the ligament:

  • There is moderate swelling.
 4-6 Weeks
Grade 3 Grade 3 – A grade 3 injury is a complete tear of an ankle ligament:

  •  There is severe swelling
  • Usually involves 2 or more ligaments.
 8-12 Weeks

More severe ankle injuries

More severe ankle sprains/injuries are characterised by:

  • Significant swelling around both sides of the injured ankle
  • High energy mechanism, such as a fall from height or impact collision.

NOTE – The ability to bear weight on the injured ankle is NOT an indication of how severe your ankle injury is.

If you are concerned by your ankle injury please contact Mr Keith.

Initial treatment for ankle injuries

The R-I-C-E method outlined below is a starting treatment point for most ankle injuries. Please seek expert medical advice as soon as possible after your injury.

Treatment Explanation
Rest Limit your activity to allow you to elevate your ankle.
Ice Apply an ice pack (not directly to your skin)  for 15 mins every 2 – 3 hours.
Compression A tubigrip or flight sock will help reduce the swelling.
Elevation Keeping your ankle elevated at or above the level of your bottom (eg resting on the couch) will allow swelling and pain to settle.

Your ankle maybe too uncomfortable to walk on immediately after injury.

Using a CAM boot or ankle brace with crutches will help you to put weight early after your injury.

Early protected weight bearing  in a boot or brace with crutches is encouraged and forms part of FUNCTIONAL REHABILITATION approach to treating a sprained ankle.

Ankle recovery times

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 2 months, it would be advisable seeing Mr Keith to assess your ankle.

Mr Keith may advise a steroid injection under ultrasound to help settle your pain and inflammation. This can performed by Mr Keith at your consultation if required. He may also refer you for MRI, or weight bearing imaging to better determine your ankle problem.

Ankle injury prevention

You can’t prevent re-injuring your ankle again, but there are some things you can do to reduce the chance of it happening including:

  • MOST IMPORTANTLY  – Proprioception or Balance exercises and Peroneal muscle strengthening exercises
  • Wearing an ankle support brace
  • Taping/strapping your ankle

OTHER CAUSES OF RECURRENT ANKLE SPRAINS

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 “ (see figure A) which does not flatten on standing. This alone causes few symptoms and rarely requires treatment.

high foot arch

Figure A

Varus Heel (turned in heel)

When a high foot arch is combined with a turned in heel (varus heel- see Fiqure B) overload or the lateral (outside) structures or the foot and ankle occurs. This may predispose you to ankle and foot injuries

If you do have a high arch and frequently suffer from ankle sprains, initial treatment may include:

  • Physiotherapy focusing on  exercises to help you to regain your ankle balance and strength together with calf stretching program
  • Orthotic insoles to restore your balance.

If your ankle problems do not improve Mr Keith may discuss further options to restore stability to your foot and ankle.

Varus Heel

Figure B

Cavovarus foot correction

A cavus foot has a high arch which causes people to walk on the outside of the foot. Treatment depends on the amount of deformity and related problems.

The main goals of cavus foot surgery are to reduce pain, improve function, and prevent further damage or injuries.

The surgical procedures involved with the correction of the cavus foot are varied and depend on the patient’s foot and ankle alignment and related problems. Typically, the foot is realigned by cutting and repositioning the bones (known as osteotomies), tightening ligaments and transferring tendons also may be necessary.

Read more about ankle injuries at Better Health Channel.

 Ankle Injury Treatment Melbourne:
Mr Troy Keith – Foot & Ankle Surgeon

If you have any questions or would like to make an appointment, please feel free to contact my team:

VISIT CONTACT INFORMATION

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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.