Anatomy
The ankle joint is composed of three bones – the tibia (forming the inner aspect of the ankle); the fibula (forming the outer side of the ankle); and the talus (the lowest bone in the ankle joint). A number of ligaments are attached to these bones to help with ankle stability and movement. The main ligament groups of the ankle are the lateral collateral, (including the anterior and posterior talofibular, and the calcaneofibular ligaments) and the medial collateral ligament group.
Some of the tendons that also provide ankle stability include the peroneus longus and the peroneus brevis. The peroneus brevis tendon runs from the small bone lump on the lateral side of your foot and up along the ankle to connect to the peroneus brevis muscle of the lower leg. The peroneus longus runs behind the peroneus brevis, and further under the foot until it attaches to the base of the bone of the big toe.
When you sprain your ankle, the anterior talofibular ligament is the one most commonly injured. The affected ligaments stretch and can tear. Chronic ankle instability is usually the result of repeated ankle sprains. If the ligaments and surrounding tissues have not healed completely following injury, it is likely the ankle will again give way during future activity.
Non-operative Treatment
To help prevent further sprains of your ankle, it may be recommended that you wear an ankle support when participating in sporting activities. Physiotherapy can assist in strengthening the muscles of the ankle. Anti-inflammatories may be prescribed to reduce the pain and swelling of your ankle following an injury.
If conservative measures do not help improve your ankle, surgery may be suggested to reconstruct the damaged ankle ligaments.
Operative Treatment
Lateral Stabilization of the Ankle +/- Peroneus Brevis Transfer
Ankle stabilization surgery aims to reconstruct the affected ligaments of the ankle with a peroneus brevis tendon transfer to substitute for the damaged lateral ligament. This surgery is usually performed as a day surgery case.
Post-Operative Course
A padded dressing and plaster slab is applied after surgery, to allow for healing and support of the ankle.
It is important initially to rest your ankle joint and keep your foot elevated to assist with healing. You may find ice packs help reduce swelling of your ankle.
Crutches will be necessary to help you mobilize for the first week or two. You will be fitted with a Donjoy walkabout boot that you will need to wear for about 6 weeks, until your ankle has healed and is stable. Riding on an exercise bike may be suitable about 2 weeks post surgery - Dr Mansfield will advise you on what activities you can commence and when.
Risks/Complications
Possible risks of this surgery include: