About
The ankle joint is inherently stable due to its bony architecture & numerous strong ligaments surrounding the joint.
The synergistic functioning of all the ligaments is very important for normal walking, running, jumping. Tears of any of these ligaments will lead to chronic pain, recurrent ankle sprains and damage to the ankle bone(avascular necrosis of talus bone).
Ankle sprains due to twisting of the ankle is a very common injury due to injury to the ligaments at the outer aspect of the knee. Ankle sprains can be of different grades and warrants treatment. Poor healing of the ligament/ non-functioning ligament leads to inability to support the ankle especially while walking on uneven surfaces, sports requiring sudden pivoting movements, jumping etc.
Neglected injuries can ultimately lead to premature arthritis of the joint because of loss of normal joint kinematics.
Symptoms
- History of recurrent twisting of ankle/ history of recurrent falls
- The sensation of giving away especially on uneven surfaces, jumping, running
- Recurrent swelling around the ankle
- Pain on the outer aspect of the ankle
- Pain within the ankle joint – associated osteochondral injury within ankle joint
Investigation
Ankle instability is a clinical diagnosis. However various modern-day radiological investigations can complement correct diagnosis.
It is very important to get special weight-bearing as well as various stress x-rays that reproduce the mechanism of injury. Stress x-rays will guide us in knowing how the bony structures behave to various stresses.
It is the investigation for visualisation of soft tissues including the ligamentous structures. It not only diagnose ligament injuries but also evaluate the extent of the injury.
Diagnosis is always based on a combination of investigations along with clinical examination.
Treatment
Ligament injuries around the ankle have a very good healing potential & heal well with conservative treatment. (PRICE PROTOCOL)
- Protection
- Rest – reduction of the inflammation
- Ice application – reduction of the inflammation
- Compression
- Elevation
- Analgesics – for control of pain
- Physiotherapy – Cryotherapy- during injury stage and at the rehabilitative stage - strengthening the muscles on the outer aspect of the ankle at the latter stage.
Advised for patients with recurrent ankle instability associated with a cartilage injury.
Depending on the severity, it is possible to repair the ligament (ATFL ligament) to the bone using special kind of screws called suture anchors. This can be done using mini-open(small incision) or through Arthroscopy(key hole) surgical techniques.
Rehabilitation
Post- surgery below knee Plaster of paris cast (POP) will be given for 6 weeks . 2nd day after the surgery patients would be enabled to walk with crutches without weight bearing on the operated limb.
After 6 weeks gradual weight bearing is allowed. Focused physiotherapy will begin after 6 weeks.
Usual time to return to sports is 7-8 months following sports specific physiotherapy protocol.