Surgery for Chronic Ankle Instability

with Rehab

ExitCare ImageSurgical treatment for chronic ankle instability is typically only for individuals with recurrent ankle sprains or giving way due to looseness of the ankle ligaments. These patients have undergone at least 3 months of conservative treatment with no resolution of symptoms. The purpose of surgery for chronic ankle instability is to tighten the ligaments of the ankle or using other structures to replace and/or give additional support to the ligaments of the ankle.

CONTRAINDICATIONS

  • Infection.

  • Inability or unwillingness to comply with a postoperative rehabilitation program.

TECHNIQUE

There are many different techniques for fixing an unstable ankle. One of the most common techniques requires the surgeon to cut loose ligament, and then reattach them closer together with sutures. This will stabilize the ankle better. Other surgeons may choose to replace (reconstruct) the damaged ligament(s).

RELATED COMPLICATIONS

  • Infection.

  • Recurrence of giving way (instability).

  • Continued pain.

  • Stiffness of ankle.

  • Bleeding.

  • Stretching out of the repair.

  • Weakness of the muscles of the ankle.

  • Injury to nerves (numbness, weakness, paralysis) of the foot and ankle.

HOME CARE INSTRUCTIONS

Management after surgery varies.

  • Keep the wound clean and dry for the first 10 to 14 days after surgery.

  • In order to reduce inflammation, keep the foot and ankle elevated above heart level as much as possible for the first 1 to 2 weeks after surgery.

  • Pain medications will be provided by your caregiver.

  • Casting is often used, varying from 4 to 8 weeks.

  • You may not be allowed to bear weight on the foot for 2 to 6 weeks. This is followed by a short walking cast or brace for 3 to 6 weeks.

  • Postoperative rehabilitation and exercises are very important to regain motion and strength.

RETURN TO SPORTS

  • The length of recovery before a return to sports depends on the type of sport and position played, as well as the quality of ligaments at the time of repair.

  • A minimum of 3 months is necessary after surgery before returning to sports.

  • Full ankle motion and strength are necessary before returning to sports.

SEEK MEDICAL CARE IF:

  • You experience pain, numbness, or coldness in the foot and ankle.

  • Blue, gray, or dusky color appears in the toenails.

  • Any of the following occur after surgery:

  • Increased pain, swelling, redness, drainage, or bleeding in the surgical area.

  • Signs of infection (headache, muscle aches, dizziness, or a general ill feeling with fever.)

  • New, unexplained symptoms develop (drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Surgery for Chronic Ankle Instability

These exercises will help you rehabilitate your ankle the first 2-3 weeks after your cast is removed. Your physician, physical therapist or athletic trainer will progress your exercise once you have demonstrated the sufficient gains in flexibility and strength. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Dorsi/Plantar Flexion

  • While sitting with your right / left knee straight, draw the top of your foot upwards by flexing your ankle. Then reverse the motion, pointing your toes downward.

  • Hold each position for __________ seconds.

  • After completing your first set of exercises, repeat this exercise with your knee bent.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Alphabet

  • Imagine your right / left big toe is a pen.

  • Keeping your hip and knee still, write out the entire alphabet with your "pen." Make the letters as large as you can without increasing any discomfort.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Gastrocsoleus

  • Sit with your right / left leg extended. Holding onto both ends of a belt or towel, loop it around the ball of your foot.

  • Keeping your right / left ankle and foot relaxed and your knee straight, pull your foot and ankle toward you using the belt/towel.

  • You should feel a gentle stretch behind your calf or knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove shoes and sit on a chair that is preferably not on a carpeted surface.

  • Place right / left foot under knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair, while still keeping your heel down.

Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Surgery for Chronic Ankle Instability

These exercises will help you begin to restore your ankle flexibility the first 2-3 weeks after your cast is removed. Your physician, physical therapist or athletic trainer will progress your exercise once you have demonstrated the sufficient gains in flexibility and strength While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH – Dorsiflexors

  • Secure a rubber exercise band/tubing to a fixed object (table, pole) and loop the other end around your right / left foot.

  • Sit on the floor facing the fixed object. The band/tubing should be slightly tense when your foot is relaxed.

  • Slowly draw your foot back toward you using your ankle and toes.

  • Hold this position for __________ seconds. Slowly release the tension in the band and return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Plantar-flexors

  • Sit with your right / left leg extended. Holding onto both ends of a rubber exercise band/tubing, loop it around the ball of your foot. Keep a slight tension in the band.

  • Slowly push your toes away from you, pointing them downward.

  • Hold this position for __________ seconds. Return slowly, controlling the tension in the band/tubing.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Eversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Drawing the band/tubing across your opposite foot, slowly, pull your little toe out and up. Make sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercises __________ times per day.

ExitCare Image STRENGTH - Towel Curls

  • Sit in a chair positioned on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel by only curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add weight to the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.