Sprain > Treatments
Surgery to reconstruct ligaments after an ankle
sprain is usually performed after you have tried conservative
treatment, have gone to physical therapy and have good
ankle strength, but continue to have signs of instability
in your ankle. Repeated ankle sprains is an important
sign of ankle instability that may need surgical treatment.
Competitive athletes and other people who need to be
on their feet may become candidates for surgery immediately
after suffering a severe, Grade III sprain that hinders
their ability to walk. Though surgery is commonly prescribed
to treat torn ligaments, partially torn or elongated
ankle ligaments can cause a chronically unstable ankle
that may benefit from surgery.
Preparing for Surgery
The actions you take before surgery can be every bit
as important as the procedure itself in ensuring a healthy
to your return home from the hospital, make sure that
you have received any equipment you will need when you
get home. This may include crutches or household items
to make movement around the house easier. You should
receive prescriptions for any of these from your doctor
before you go home from the hospital.
physical problems or changes in your overall health,
such as a fever or infection, should be reported to
your surgeon, and you should notify your surgeon of
any new medications you are taking.
possible, discontinue the use of any anti¡Vinflammatory
medicine, especially aspirin, a week prior to surgery,
to prevent excessive bleeding during the procedure.
reduce the risk of infection, improve healing, and decrease
complications, try to quit smoking or decrease the amount
you smoke. In general, smokers have a higher infection
and complication rate overall.
learn about the potential risks and benefits of the
surgery, ask your surgeon any questions that will help
you better understand the procedure. It can also help
to talk to someone else who has undergone the same surgery.
a second opinion from another qualified surgeon is often
advisable, particularly in rare or unique cases.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
Day of Surgery
At most medical centers, you will go to "patient
admissions" to check in for your operation. There
may be separate check-in areas for ambulatory outpatient
(patients go home the same day after surgery) and for
overnight inpatient surgery, so be sure to ask your
doctor or an assistant about this. After you have checked
in to the hospital, you will go to a holding area where
the final preparations are made. The mandatory paperwork
is completed, and your ankle may be shaved, though this
is not always necessary. You will be asked to change
into a hospital gown and, if applicable, remove your
watch, glasses, dentures, and jewelry. You will have
the opportunity to speak with your orthopedic surgeon
or an assistant and meet the anesthesiologist or nurse
anesthetist (a nurse who has done graduate training
to provide anesthesia under the supervision of an anesthesiologist).
An IV (intravenous) line may be inserted into your arm
at this time. Then, you will walk or ride on a stretcher
to the operating room. Most patients are not sedated
until they go into the operating room. Here are some
important steps to remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
you will most likely be able to go home within a few
hours of surgery, arrange for someone to drive you home
when you are released.
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your short leg cast or
splint when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
to take to the hospital
Open ligament reconstruction of your ankle sprain can
take about an hour to perform, depending on the extent
of ligament damage. Spinal anesthesia typically is given
to numb you from the waist down, and you usually are
sedated so you sleep through the procedure.
small, four- to five-centimeter incision is made along
the outside of your ankle so your surgeon can expose
your fibula and heel bone.
two ligaments most commonly in need of repair after
a sprain, called the anterior talofibular and calcanealfibular
ligaments, may need to be sewn back onto your smaller
lower leg bone.
in your skin are closed with stitches and your ankle
is put into a splint to immobilize it. You are then
taken to the recovery room.
After surgical ligament reconstruction in your ankle,
you will be transported to the recovery room where you
will be closely observed for one to two hours while
the immediate effects of anesthesia wear off. Your ankle
will be elevated and immobilized in a splint or cast
when you wake up. After surgery, you typically experience
some pain, and adequate pain medications will be prescribed
for you. You will be given intravenous (IV), oral, or
intramuscular pain medications as needed. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse who, with the help of your physician, will determine
when you can prepare to go home. You will normally be
able to leave the hospital or clinic the same day after
surgery. Some patients may be admitted for an overnight
hospital stay, depending on how much pain management
you need. Your surgeon will prescribe crutches and you
are usually instructed to keep weight off your ankle
for the first three weeks. Make sure to have someone
available to drive you home, as you will be unable to
drive a car.
Physicians generally recommend that you avoid bearing
weight until your incision has healed. Crutches may
be prescribed for about three weeks after surgery. Rest
as much as possible with your ankle elevated above the
level of your heart. This helps blood drain away from
your ankle and controls swelling. You may need to use
pain medication prescribed by your physician for one
or two days after surgery. Pain usually decreases within
a few days. It can be helpful to have someone around
the house who can assist with any physical chores. Though
individual recoveries vary, a typical recovery schedule
after surgery may go as follows:
days - Return to your physician's office to have your
stitches removed and the post-surgery ankle splint replaced
by a short leg cast. Continue using crutches to keep
your body weight off your ankle while wearing the cast.
weeks - Your ankle comes out of the cast and you begin
weight bearing while wearing a brace called a cam walker.
You may be able to discontinue using crutches, depending
on how much pain you are still experiencing. You usually
can perform range of motion exercises three times a
day to begin rehabilitation.
weeks - Most patients can stop wearing a cam walker
and return to normal shoe wear. Your physician may prescribe
an ankle brace that fits inside your shoes.
months - Your ankle usually is back at full strength
and no longer in need of a brace.
to call the doctor after surgery
Physical therapy usually is prescribed to help ligaments
heal after open ligament reconstruction surgery. When
your cast comes off three weeks after surgery, your
physician may refer you to a physical therapist to begin
early motion, which helps circulate fluid out of the
ankle. Early motion consists of simple up and down flexion
and extension, and progresses to small circles or drawing
the alphabet on the floor with your toes. Therapists
also may use electrical stimulation to control swelling.
Physicians generally recommend that you avoid bearing
weight and walking in pain after surgery. Patients tend
to heal better in the long-term if they start rehab
slowly, instead of rushing to begin painful exercises
on an ankle that has not yet healed. When swelling and
pain have gone away and you feel comfortable without
supportive wrapping, you usually start an exercise program
to strengthen all the muscles around your ankle. Elastic
bands are often used to provide resistance as you move
your ankle in different directions. You may help your
ankle feel better by icing it for ten minutes both before
and after rehab exercises. It is particularly important
to strengthen the peroneal muscles, located on the outside
of your lower leg around your small lower leg bone (fibula).
The peroneals help keep your ankle from turning inward.
Arthritis is a result of repeated ankle sprains, which
can hinder your ability to return to your previous activity
level. People with arthritis may need to spend extra
time in rehab and perform a more elaborate training
program. The final steps of rehab help increase coordination,
and may include balance beam exercises and running in
a figure-eight pattern. When the injured ankle is about
90 to 100 percent as strong as the uninjured ankle,
you may be ready to begin returning to activities. Most
patients can rehabilitate their ankles with four to
six months of physical therapy and return to activities
at full strength.
sprain rehabilitation exercises
To prevent the recurrence of ankle sprains, you should
make the stretching and strengthening you learned in
physical therapy part of your regular exercise routine.
A strong and flexible ankle may be more able to withstand
any abnormal positions and strain that occur during
sports and activities. The goal of surgery is to restore
stability to your ankle. If you suffer another ankle
sprain after surgery you should visit your physician
because the ligament repair may be inadequate for your
level of activity. Depending on your age and ankle strength,
your physician may place some restrictions on your sports
and activities. Before activities, remember to warm
up your ankle muscles by stretching in all directions.
Tight ankle muscles and ligaments may be more apt to
pull or tear. Replace athletic shoes when the padding
or the tread wears out. Avoid participating in activities
in old, worn-out shoes because they do not provide good
padding or side-to-side support.
In general, you should try to provide extra support
to your ankle for at least 12 months after a severe
sprain, possibly longer. Taping is a good preventive
measure if it is done immediately before participating
in the sport and if the person doing the taping is trained
in proper techniques. Ankles are usually taped all the
way from the midfoot to the lower calf. Braces may be
useful after surgery to enhance recovery and prevent
further injury. Neoprene sleeves provide compression,
while other lace-up types of braces provide more support
using metal or plastic strips on the sides of your ankle.
DEALING WITH PAIN
A small amount of pain is normal during activities,
but if you feel so much pain in your ankle to warrant
taking a painkiller before an activity, you should visit
your physician. Do not continue to run on a sore ankle.
Pain after rehabilitation could be a sign that you have
other minor foot and ankle injuries that need proper
treatment before you can return to activities.