Ankle injury (orthopaedics)
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Causes and symptoms
The ankle is a complex joint that has to endure a relatively high load. The ankle joint consists of three bone parts: the fibula, the shin (tibia) and the talus (talus).
The bone parts are covered on the joint side with cartilage. Surrounding it is the joint capsule and a number of ligaments that ensure stability to the ankle. There are several tendons running along the ankle that are important for the stability and movement of the ankle and foot.
Complaints of the ankle joint are common. These complaints are related to different aspects: position, strain, occupation, sports or age.
Ankle injuries usually occur after a sprain or sprain of the ankle, damaging the ankle ligaments and/or cartilage. In many cases, there is recovery without surgical treatment.
Ankle problems
Orthopaedic surgeons specialised in ankle injuries
Examinations
The diagnosis is made in several ways:
- Exhaustive questioning about the problems and how they might or might not have arisen.
- Clinical examination in which the shape of the foot (flat foot / hollow foot / spread foot / sagging foot) may be at the base of the problem.
- Ordinary radiography of the foot is almost always requested "standing" and already gives a lot of information. It is therefore often interesting to request this examination in advance (through your doctor or our secretariat) before your first consultation.
After extensive questioning and clinical examination, sometimes an additional examination (usually a specific scan) is necessary to determine the treatment.
Treatments
Operative treatment ankle instability
A stabilizing ankle ligament operation is chosen when there are permanent instability complaints despite adequate non-surgical treatment. Various surgical methods can be used for surgical treatment. The choice of the correct surgical method depends, among other things, on the quality of the stretched ankle ligament.
Standard procedure
In case of an ankle instability with good tissue, the standard procedure is performed. This involves making an incision across the outer ankle forward. The ankle ligament is exposed, passed through and sutured back onto the outer ankle with an anchor (small screw from which solid sutures come out) to make it shorter and firmer again. Next, the firm capsule that runs across the entire ankle (the retinaculum) is exposed and sutured over the ankle ligament for added stability. The wound is closed with dissolvable sutures.
Additional procedures
During surgery, the orthopedic surgeon can really see whether the tissue of the ankle ligament is strong enough to suture. Sometimes there is insufficient strong tissue and the choice is made to use an internal brace. This is a type of lace strap that the doctor can attach like a new ankle brace with two anchors in the places where the ankle brace normally attaches. The follow-up treatment does not change if one of these additional procedures is performed.
Sometimes, keyhole surgery of the ankle is also performed in the same operation if, for example, there is also cartilage damage that needs to be treated.
Post-treatment
The ankle is immobilized with a cast and walker for some time to allow the ankle ligaments to heal. This must remain on for six weeks, both day and night. For the first two weeks you may not put any weight on it and must walk with crutches. After that, you may walk without crutches. After six weeks, you must wear an ankle brace all day for another six weeks. For the first year after surgery, you should not play sports without a brace. For more intense sports such as soccer/basketball/volleyball/hockey, among others, you are advised to play sports with the brace even longer.
Conservative treatment ankle instability
To treat ankle instability, different treatment methods can be chosen. Initially, non-operative treatment is usually chosen to increase ankle stability. This involves an intensive exercise regimen with a physiotherapist to train ankle stability and, in particular, to improve the control of the muscles around the ankle. This is also known as improving propriocepsis. This intensive exercise therapy is usually done in combination with wearing a brace.
Arthroscopy of the ankle
For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.
A keyhole surgery of the ankle takes about 30 minutes to 1 hour and is performed under general anesthesia (deep sleep) or with an epidural. The surgery involves making two small incisions in the skin on the front or back of the ankle. Through the first, a (camera) arthroscope is inserted into the ankle joint. This provides an image of the ankle joint on a monitor in the operating room. The joint is continuously flushed with a saline solution. This causes the ankle to expand slightly and a clearer image can be obtained. For an even clearer image, the ankle joint is "blood drained" with an inflated blood pressure band around the thigh. Various instruments can be inserted through the second skin opening for the procedure.
Benefits of keyhole surgery
The procedure is safe; the risk of complications is much lower than with "open" surgery.
With keyhole surgery, a better view of the entire ankle joint can be achieved than with 'open' surgery. This also makes it possible to directly treat an injury that was not predicted.
Keyhole surgery is much less stressful than "open" surgery. The muscles around the ankle do not have to be loosened and sutured back together. Surrounding tissues are also less damaged. As a result, recovery is smoother than with an "open" procedure.
Post-treatment
Most keyhole surgery does not involve staying overnight in the hospital. Thus, one can go home the same day. Because keyhole surgery is less stressful on the ankle than "open" surgery, recovery can be smooth and functional to quickly recover enough to resume daily activities.
When fixing the ankle joint (arthrodesis) in connection with osteoarthritis, the follow-up treatment does differ from other keyhole surgery on the ankle. After the ankle is fixed, the ankle is treated with a cast and/or a walker boot for 3 months to allow the bones to grow together. However, each surgery remains unique, so recovery also varies from patient to patient.