Foot and Ankle Injuries
Foot and ankle injuries are among the most common orthopaedic injuries. Most people sprain their ankles at some stage in their lives. Patients usually report spraining their ankles going down hill or on uneven ground.
Most commonly they attend a hospital where ankle x-rays are reported as normal Ankle x-rays may sometimes show a small chip of bone off one of either the tibia, the fibula, the talus, the calcaneus or the cuboid. The small avulsion fractures are still treated as an ankle sprain.
Initial management of an ankle sprain is rest, sometimes in a removable plaster. Non-weight bearing on crutches is important initially. Swelling reduction with either ice or compression bandaging is very helpful. Physiotherapists employ a sequential compression device called a masman pump to reduce the swelling. Ankle sprains can be very painful if a large haematoma (blood clot) is present under the skin and very occasionally one has to drain a blood clot to give relief of pain.
Most ankle sprains improve without ligament repair surgery. Some ankle sprains however remain painful, swollen, stiff or unstable. Ankle physiotherapy will help many patients regain their range of motion and strength. Wobble board exercises will help the patient regain their sense of balance and joint position (proprioception).
Ankle sprains that do not improve in a reasonable time frame….3 – 4 weeks have one of the following pathologies: synovitis (inflammation of the lining of the joint), cartilage injury (talar dome injury), nerve injury, tendon injury, associated fracture not seen on plain x-rays. These patients are best imaged with MRI (magnetic reasonance imaging) scanning of the ankle.
Some of these patients will require injections, some more physiotherapy, some medications and some ankle surgery.
Arthroscopic surgery of the ankle is where a 2.9mm telescope is inserted in the ankle to visualize the structures. Using a device that works something like a pool cleaner, one can remove the inflamed lining of the joint (synovectomy), remove loose pieces of bone or cartilage and grind down bone spurs within the ankle.
Arthroscopic surgery of the ankle is popular among sports people because smaller incisions often means shorter convalescence and therefore less time off sport.
Patients with unstable ankles that fail a good physiotherapy rehabilitation program should consider ankle ligament reconstruction surgery. The surgery is performed as a day only procedure and is successful approximately 90% of the time. As long as the patient’s joint surfaces are in good condition most patients report a general feeling of improved stability after an ankle ligament reconstruction.
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