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Foot and Ankle sports injuries
Foot and ankle injuries include the injuries in the leg below the knee and they are common while playing sports such as football, hockey, skating and in athletes. Treatment for some of these conditions may be orthotics, braces, physical therapy, injections or surgery. Common sports injuries include sprains and strains, ankle fractures, and Achilles tendinitis.
Ankle sprains
Ankle sprains are a common sports injury that can cause pain and swelling of the joint. In the vast majority of patients, non-surgical treatments will alleviate pain and restore function to the joint. However, there are some situations where surgery may be necessary to stabilize the ankle joint to allow a return to full activities for the patient.
First line of treatment in Ankle sprain
Most ankle sprains are fairly minor injuries which will get better with simple self-care treatment. REMEMBER THE MNEMONIC “RICE “which forms the basic treatment of a sprained joint:
- Rest take the weight off the injured joint as much as possible for a day or two
- Ice an ice pack (a small bag of frozen peas or corn is ideal) can be applied for 10-15 minutes 3-4 times a day to reduce swelling
- Compression a firm bandage or strapping will help to get swelling down
- Elevation resting with the ankle above the height of the body will allow swelling to drain away into the bloodstream
Although a couple of days rest is useful, it is best to start taking some weight on the injured ankle reasonably soon after injury, usually within 2-3 days. Also start to exercise and stretch the injured ankle as soon as possible after the injury.
Indications for Surgery After Ankle Sprain
In general, there are two situations where surgery may be considered.
Acute Injuries
The first situation is an acute injury, one that just recently occurred. In these situations, surgery is very seldom the treatment. Only in very severe injuries, in high-performance athletes, is surgery considered. These patients have usually sustained a Grade III ankle sprain and have clinical and x-ray findings of a severely unstable ankle. Early repair in these cases may help to speed recovery of athletic activities.
Chronic Instability
More commonly, surgery is performed when an athlete has recurrent symptoms of ankle instability–the ankle often gives out and is re-injured. These patients have usually tried simpler treatments including therapy, strengthening, bracing, and still have complaints of the ankle buckling. A modified Brostrom procedure essentially tightens the lateral ankle ligaments.Here the removal of the bone attachment of these ligaments on the fibula may be done and reattach the ligament in a tighter l position. This procedure is an anatomic reconstruction because it attempts to restore normal ankle mechanics by restoring the normal anatomy.
In some situations, the ligaments have been stretched out significantly, and repairing the ligaments may lead to persistent instability if the tissue is not felt to be strong enough. In these patients, some doctors prefer a non-anatomic reconstruction. Another option is to add tissue graft to the ligaments to add strength. In these situations, some surgeons recommend using a graft from another part of your own body, or a donor graft. Ankle arthroscopy is becoming more commonly used as a component of ankle ligament surgery. Often the arthroscope is used to confirm the diagnosis and ensure that the cartilage and joint are in good condition. While ankle arthroscopy is not currently used as the procedure to repair damaged ligaments, this is becoming more commonly used in conjunction with ankle ligament surgery.
Surgical Recovery
Recovery after ankle stabilization surgery depends on the procedure performed. However in general patient feels better by 3 months and can go to physical activity by 3 months. Complications from surgery are most commonly encountered during the rehabilitation phase. Stiffness of the ankle joint or recurrent instability are both possible complications from stabilization surgery. Other risks include infection, would healing problems, and nerve injury.