ANKLE INSTABILITY

True ankle instability doesn't often occur with one sprain but is more a chronic problem. An ankle sprain (whether the first, fourth or tenth time) is initially treated with bracing, physiotherapy and pain medications. If this fails, your instability persists and this issue is affecting your quality of life, then a stabilization procedure may be right for you. If your issue isn't instability after sprains but rather ongoing pain, then read more about ankle arthroscopy as this may be a consideration for you.

Learn more at FootcareMD.org

Surgery

Image from OrthoInfo, AAOS

LATERAL LIGAMENT RECONSTRUCTION

An unstable ankle can be reconstructed to re-stabilize the ankle. Often an ankle arthroscopy is performed at the same time to clean up scar tissue within the ankle and look for (and treat) any cartilage injury. The lateral ligaments (ATFL and CF ligaments) are then reconstructed with what is called a Brostrom lateral ligament reconstruction. During this procedure, your exisiting ligament tissue which is too loose, is tightened and reattached to the bone (fibula) with suture anchors. If severe instability is found, your tissue is inadequate or you are at risk for re-tearing, an additional stabilization device (Internal Brace) may be required. Dr. Roberts will assess your ankle and balance the risks and benefit of this added procedure with you.

Learn more about Ankle Arthroscopy

ANKLE STABILIZATION POST OP INSTRUCTIONS

FOLLOW UP:

First appointment: approximately 2 weeks from surgery, usually at the Burnaby Hospital Fracture Clinic.
Prior to your surgery, you should have received dates for your 6 week and 3 months follow up visits.
You will typically arrange a follow up one year from surgery as well for final xrays.

EXPECTED RECOVERY TIMELINE:

Swelling and pain is normal and expected in the first two weeks. Rest, elevation and pain medication are important to help manage this.
If your pain is severe and you aren't managing with the instructions and pain medication provided, call or go to the Burnaby Emergency Department.
Ideally by 3 months following surgery, you are walking not necessarily far, or fast but able to get back to your normal day to day in a more normal shoe.
Swelling is normal and not a concern and can last for up to 6-12 months. Some swelling doesn't always resolve fully.
If all is healing well, you can progress your walking and other physical activity as your symptoms allow.
You will not know full recovery (pain, swelling, strength) until 9-12 months following surgery.

DRESSING:

You will go home from surgery with a splint on your foot and ankle. This can remain as is until your first 2 week appointment. After this appointment, once your wound has healed adequately, you will be placed in a post operative boot.

WOUND:

Your wound(s) are closed with sutures or staples, some of which will need to be removed.
Do not get the dressing or wound wet for the first 2 weeks. To ensure this, a bag should be placed over the let to avoid anything getting wet.
The dressing/splint should remain on until your first appointment. Do not remove this. It will be changed at the first 2 week appointment
Sutures are removed typically at the 2 week mark.
After your sutures are removed, you can shower 2-3 days later and allow clean water to run over the wounds. Pat this dry and reapply a dressing if it is your preference. It is not required. The steristrip tapes on your wound can get wet. Just pat them dry.
Steristrips should stay on for about 10-14 days usually. If they fall off prior to this, they do not need to be reapplied. If they are still on after 14 days, ensure you please remove them yourself.
Do not immerse the wound in a bath, hot tub or pool until the scar is fully healed with no scabs. This is often 4 weeks.
No lotions or creams should be used until the wound is fully healed, often 4-6 weeks.

WEIGHTBEARING

You may not put any weight on your foot until 2 weeks from surgery.
Unless you've had additional work done, at 2 weeks from surgery, you can begin walking in your boot. In and out (inversion, eversion) of the ankle needs to be avoided until 6 weeks post op.
At 6 weeks from surgery you can transition to a shoe as able. Keep in mind some people still have too much swelling at this point to be able to get into the shoes they want just yet.

PHYSIOTHERAPY:

At the 2-3 week mark, if you feel able, you may begin physiotherapy. Prior to this due to swelling, wounds and dressings, possibly therapy will be limited.
Dr. Roberts will provide you a custom physiotherapy prescription to help guide your therapist in your recovery.

DRIVING:

You are not able to drive if you are still taking Opioid (Narcotic) pain medication
Left foot surgery: beginning at least 2 weeks post op, once you are able to comfortably remove the sandal/boot while driving. Contact your insurance for further recommendations.
Right foot surgery: You can drive once you are walking fully in a shoe.
Try practicing in a parking lot first to ensure your reaction/strength/motion is adequate

FLYING:

If possible, you should consider avoiding long haul flights for the first 4-6 weeks from surgery.
If you must fly before this there is an increased risk of blood clot. Try to keep moving on the flight, stay hydrated, avoid alcohol, consider compression socks. Discuss with Dr. Roberts if you require a blood thinner to keep your risk as low as possible.

WORK:

You should arrange to be off of work for the first 2 weeks after surgery to allow for rest and recovery.
If you are working from home or can get to work safely and work in a flexible seated job, you could return to work after the first week if you so choose, provided you are off opiod (narcotic) pain medication. You will need to elevate the foot and allow for more breaks. More commonly, most patients take 6 weeks off work.
Any work should be sedentary for the first 8-12 weeks.
Typically a return to more physical duties can begin gradually at the 12 week mark from surgery.
You may discuss your return to work plan with Dr. Roberts if you still have questions.