Physiotherapy is the mainstay of treatment for chronic ankle instability, especially proprioception exercises (wobble board). Surgery for a chronically unstable ankle (Brostrum procedure) is done as a day case procedure and requires a period of non-weightbearing to allow the tissues to heal and to stabilise the ankle. Rarely, implants or bone procedures are performed to improve the success of the stabilisation procedure.
Ankle arthroscopy is a minimally invasive surgical procedure (“key hole”) which enables the surgeon to operate through tiny incisions around the ankle. An arthroscope is introduced through a portal which allows the joint and its structures to be visualised and a working portal is used to insert instruments. Removal of “wear and tear debris” and scar tissue in an arthritic ankle can be helpful. Loose bone causing locking of the joint can often be cured by identifying and removing these loose bodies. Catching or impingement in the front or back of the ankle can be due to bone “spurs” and can be removed arthroscopically. Damage to the articular cartilage can be addressed arthroscopically either by curettage or drilling the defects using a microfracture technique. This procedure does not create new or heal damaged articular cartilage but attempts to generate scar tissue to take its place and reduce the symptoms.Recovery from ankle arthroscopy is patient and procedure dependant. Most patients can weight bear as tolerated and can resume general activities and return to work at between one- or two-weeks following surgery. Treatment using the microfracture technique requires a period of non-weightbearing for up to four weeks.
Achilles tendon problems
Pain arising from the Achilles tendon is common. Tendon rupture is a catastrophic failure of the tendon which, in selected people, is surgically repaired. Biological failure of the tendon in its mid-portion (non-insertional) or at its insertion (insertional) are usual examples of Achilles tendinopathy which cause pain, limp and difficulty with stairs. Physiotherapy is always attempted in tendinopathy and is often successful.
Surgery for Achilles tendinopathy is performed as a day case and may require a period of protected weightbearing on crutches and/or plaster cast immobilisation. Blood thinning medicine is usually prescribed during your rehabilitation procedure. A removable walking boot is used for four to six weeks following the immediate postoperative period and physiotherapy is a valuable additional treatment during this phase of your recovery.
Arthritis of a joint is due to the loss of articular cartilage. This material enables the ends of the bones creating that joint, to smoothly articulate. This biological failure creates a stiff, painful joint which can cause intrusive pain and progressive limitation in even simple activities of daily living. There is no cure or procedure to replace articular cartilage. The gold standard treatment for ankle arthritis is ankle fusion, although ankle replacement surgery is gaining in popularity. Ankle fusion surgery is usually performed as a “key hole procedure, but may be performed as an open procedure if there is severe deformity, large bone defects, etc. As with all fusion procedures, the basis for pain relief occurs by making the painful joint solid or fused (arthrodesis). To achieve this, the arthritic joint is removed with high speed burrs, and the resulting joint surfaces held in place with screws or plates, until they heal in the desired position. Weightbearing is limited during this period which range from six to twelve weeks.
Ankle pain is a common complaint and can be the result of an injury or slowly develop over months or years. An accurate diagnosis, often involving tests such as MRI, and appropriate treatment of any identifiable cause (e.g. Gout, inflammatory arthritis) should precede any surgical procedure. Common causes of ankle pain include arthritis, articular cartilage injury and ankle instability.
Ankle instability can sometimes be present and tolerated for years (“weak ankles”). More commonly, ankle instability can result following a severe “sprain”, which can damage the structures responsible for ankle stability.