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Chronic ankle instability – Part 2 Surgical treatment

Chronic ankle instability is a condition in which the ankle “gives out” frequently. The ankle either doesn’t give the right feedback to the brain or the motor response is not firing in a way to keep the ankle from rolling or spraining while you perform anything from sports to walking, but this instability can hamper even the simplest of tasks: standing. After multiple ankle sprains the ankle just doesn’t hold up and is quite simply weak

Surgical Options

Many of the names of the procedures carry with them the surgeon who first described the procedure. This is the case for the Bröstrom-Gould and Dwyer procedures. The surgeon will choose the procedure which best addresses the underlying pathology or problem. For those with mild mechanical instability or those with functional instability which does not resolve with conservative treatment. This is primarily a direct repair of the ligaments at the ankle. Using specialized suturing techniques and materials, the surgeon is able to anatomically repair the lateral ankle ligament complex with the retinaculum or connective tissue band in the area. This procedure is not for those patients weighing greater than 225-250 pounds since this is a soft tissue correction only. Other reasons this procedure is not chosen are instability of greater than 10 years, and arthritic changes to the ankle joint itself.

Dwyer Calcaneal Osteotomy: In some patients, the biomechanics and alignment of the foot require a structural change to ensure that the soft tissue repair holds and prevent recurrence of injury. The Dwyer calcaneal osteotomy is usually performed with two separate cuts on the heel bone and secured with screws to hold the osteotomy (medical term for bone cut)

Post operative protocol

If soft tissue repair/Brostrom-Gould procedure is performed, the patient should anticipate 3 weeks in a below the knee cast putting no weight on that leg, followed by 3 weeks in a CAM boot. It is also recommended that the patient avoid all sporting activities for 6 months.

In the case of a calcaneal osteotomy, there is a longer period of nonweightbearing, up to 8 weeks. A cast is placed for the first three weeks, followed by a CAM boot.

Complications

Risks of surgery remain the same as most other foot surgeries: Infection, nerve injury, failure of materials, failure of fixation, or failure of the bone to heal.

References:
1. http://www.aofas.org/footcaremd/treatments/Pages/Calcaneal-Osteotomies—Evans,-Dwyer,-Medalizing,-Lateralizing.aspx
2. http://jbjs.org/content/92/14/2375
3. delhifootankleclinic.com

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