Surgery for Ankle Sprains

Surgery is only very rarely part of the acute treatment of an ankle sprain. Rather, patients who require surgery usually have recurrent ankle sprain injuries, and persistent ankle pain. These patients have ligaments that were torn and have not healed properly, leaving the ankle joint too loose.

What surgery is performed for the treatment of chronic ankle sprains?
Patients who have chronic, recurring ankle sprains usually have loose ligaments that need to be tightened. The most commonly performed surgery to repair these ligaments is called a Brostrom repair. In this surgery, the ligaments on the outside of the ankle, are tightened, and the thick tissue around these ligaments, called the retinaculum, is advanced. This procedure tightens the loose tissue, preventing the ankle from being unstable.

How do I know if my ankle is unstable?
Instability of an ankle joint can be detected both by careful physical examination as well as special x-rays tests.

• Examination
  On physical examination, your doctor can stress the ligaments that were injured to feel how tightly they have healed. By comparing to your opposite ankle, your doctor can get an idea of how loose the injured ankle is compared to the normal ankle.

• X-ray Tests
  A x-ray test can also be performed to assess the stability of the ankle. By placing a stress on the ligaments, and taking an x-ray, your doctor can see if the bones are held together tightly enough.

What other problems could be causing these symptoms of chronic ankle pain?
There are a number of causes of chronic ankle pain, and it is important to ensure the cause of yours before embarking on a treatment plan. Causes of chronic pain following ankle sprains include:

• Incomplete rehabilitation

• Injury to other ligaments
  • Subtalar ligament injuries

  • Syndesmosis ligament injuries

• Cartilage injury (OCD)

• Nerve damage

• Reflex sympathetic dystrophy

• Peroneal tendon dysfunction

This is not a comprehensive list, just a few of the potential causes of chronic ankle pain. Therefore, if you have persistent pain after an ankle sprain, a careful examination is necessary to ensure you have the proper diagnosis. Only then can treatment focused on the problem can begin.

Last updated: 3/8/2006

References:

• Wolfe, MW, et al. "Management of Ankle Sprains" Am Fam Physician 2001;63:93-104.
• Osborne MD, Rizzo TD "Prevention and treatment of ankle sprain in athletes" Sports Med. 2003;33(15):1145-50.

The images in this article were generously provided by Medical Multimedia Group, Inc.

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