Ankle Surgery

Fractures:

If you have fractured your ankle, the doctor may recommend surgical or non-surgical treatment, depending on the nature and severity of the break.

There are three bones in your ankle – the tibia and fibula of your lower leg and the talus of your foot. If you fracture a bone, it will need to be reset. Depending on the level of damage, it may be necessary to fasten the bone in place with screws and/or plates.

If only one bone is broken and the ankle is stable, the doctor may use a cast to immobilise the facture and stop the ankle from moving. If the ankle is unstable you may need to have a metal plate or screws to hold it in place. You will have a splint to protect that ankle until the swelling goes down, followed by a cast.

Recovery from a fracture usually takes around six weeks. However, ligaments and tendons can take longer to heal – up to two years in some cases. When the doctor gives you the all-clear to start moving your ankle, you may be referred for physiotherapy to build up your strength and mobility again.

Sprains:

Sprains are categorised as mild, moderate or severe. Surgery is not normally recommended unless there is extensive damage, or other treatments fail. Mild sprains are normally treated using the RICE method (Rest, Ice, Compression and Elevate). Once you can put weight on the ankle again, your doctor can suggest some stretching and strengthening exercises.

Moderate sprains will also benefit from the RICE approach but may also need a boot or cast to immobilise the ankle. Physiotherapy will be needed to regain full use of the ankle.
A severe sprain is one where the ligament has torn or ruptured. This type of sprain can take a long time to heal. Treatment includes immobilisation of the ankle followed by a longer period of physical therapy to build strength and flexibility.

Occasionally, if it does not heal, the sprain may require surgery to repair the torn ligaments.

Tendon or ligament damage:

The options for treating tendon injuries are similar to the treatment for sprains. They include:

• anti-inflammatory drugs to control the pain
• immobilisation using a cast or splint
• a brace to provide full support during movement
• physiotherapy
• possible surgery to repair the tendon/s or the supporting structures of the foot

Injured ligaments and cartilage can normally be repaired using arthroscopy (keyhole surgery), which is less invasive and faster to recover from than conventional open surgery. Your ligaments are strong elastic bands of connective tissue that keep the bones in place. Tendons attach the bones of the foot to the muscles. Ligaments and tendons can be sprained or ruptured if they are overextended or made to move in a way that is abnormal.

Arthritis of the ankle:

Osteoarthritis can cause the cartilage covering the ends of the bones to roughen and thin, so the bone underneath becomes exposed. The result is pain, swelling and restricted movement of the joint. If the condition becomes severe, surgery may be necessary.

Most ankle surgery achieves either complete alleviation of pain or a significant reduction. Sometimes there can be an extended recovery period, particularly in the case of ligament surgery, however you should regain a good level of mobility and be able to resume your normal activities after surgery.

Ankle arthroscopy: Arthroscopy (keyhole surgery) is used for both diagnosis and treatment of ankle conditions. It involves making a small cut through which a thin tube (the arthroscope) is inserted. A tiny camera inside the arthroscope enables the surgeon to examine ankle in detail and small surgical instruments can be inserted alongside or opposite the arthroscope to repair damage to bones, ligaments, tendons and cartilage. Because only small cuts are needed, recovery is faster and mobility can usually be regained more quickly.

Ankle replacement: this is used when the ankle joint is severely damaged and needs to be replaced. It entails removing the damaged ends of the tibia and talus bones and replacing them with an artificial implant. Ankle replacement surgery is less well-established than hip or knee replacement, and ankle implants last for less time (around 10-15 years). Stiffness after surgery is another common problem. As with other types of artificial joint replacement surgery, there is a possibility that the implant will wear and may need to be removed in the future after which bone fusion will be the only option.

Ankle fusion: this entails removing the damaged ankle joint and fusing the talus bone to the tibia to form a stiff but pain-free ankle. The foot is fused at almost right angles to the leg, as it would be if you were standing up. The procedure can be carried out using keyhole surgery. Recovery takes between 12 and 14 weeks. You will need to wear a cast for 6-12 weeks. It should be easier to walk normally after surgery although running routinely is not recommended.

Triple hindfoot fusion: this is where three joints – the talonavicular, subtalar and calcaneocuboid – are fused together. It is used either to correct foot deformity or as a treatment for arthritis. Fusion is carried out with metal plates or staples and has a recovery time of 12-14 weeks.

Achilles tendon repair: The Achilles tendon is the largest tendon in the body and, as we age, it can start to wear, leading to pain and swelling. On rare occasions, surgery can be used to repair damage to the Achilles tendon.

Each year, ankle treatments enable thousands of patients to enjoy an active life, free of chronic ankle pain.

Our patient-care process

• Once all of your diagnostic procedures are completed, we will be able to explain whether surgery is recommended.
• We will go through the procedures with you, covering the operation itself, the recovery process and the future prospects.
• Your orthopaedic surgeon will also explain the risks: these are small, but it is important for you to understand them.
• You can feel reassured that you will receive expert care from the start of the process, including your after-care.