Ankle Injuries & Surgery
When the ankle fracture is unstable or in bad position, surgery is needed to repair the ankle. In some cases, the bones of the ankle may poke through the skin. These are called open ankle fractures and require surgery.
Ankle fracture surgery is not needed if the ankle is in position and stable despite the fracture. Surgery may be too risky when patients have a severe medical condition
We see them in a lot of sports, such as volleyball, basketball, soccer, tennis, many of the racquet sports and field sports. You can also get an ankle sprain in an activity of daily living.
Because they’re so common, though, people underplay the significance of an ankle sprain. So if you get an ankle sprain and you go to the hospital, and they will often tell you to, they’ll X-ray, say you don’t have a fracture. They’ll tell you to use RICE.
The RICE, which stands for rest, ice, compression, and elevation. But you may not have a really good idea as to whether you should be weight bearing or non weight bearing and what sort of rehab should you do or when should you do it.
Once you’ve determined that you don’t have a fracture, you should seek treatment very, very soon from a physiotherapist. The physio will assess you to determine what ligaments that you’ve torn and what grade of tear that you have.
This is really important because there’s three grades of tear. Grade one, which you just have a bit of pain with. A grade two, which is that, that long continuum of you have a few fibers torn and most of them are intact.
Or you may have a number of fibers, 90 percent of your fibers torn and only 10 percent intact. So that’s a really big continuum of how much instability you might have in your ankle. And you can have a grade three sprain, where it’s completely torn.
This is really important to determine because it’ll give us an idea of how we should treat you and what we should do. And it’s very specific, and it isn’t good enough to just go along and say, “This is what you do for all ankle sprains.” We need to be specific, we need to assess you, and we need to help you with your ankle sprain.
So we would usually start off with exercises that will look at range of motion and strengthening your ankle. But we may do some trunk exercises as well. Because while you can’t weight bear, we can still keep you strong through your trunk.
As you’re able to weight bear a bit more, we’ll include weight-bearing exercises, do a lot of balance and proprioceptive exercising. And then progress you to plyometric, more jumping, quick movement types of things.
From there we’d be looking at sport-specific exercise if you have a sport you’re returning to, or if you’re returning to an activity of daily living or work, we’ll try to set up a situation where you’re going to exercise appropriately for that activity.
If you sustain an ankle injury and you’re unable to weight bear immediately afterwards, you need to seek a physician’s help or go to an emergency department to have an X-ray taken.
If you’re able to weight bear, seek help from a physiotherapist. The physio will then likely send you to a sports medicine specialist or to a sports medicine shop to look at braces and other supports you may need if you have any instability in your ankle.
Local Practitioners: Physiotherapist
Arthroscopic Foot and Ankle Surgery
The arthroscope has been around for a long time, and it’s been used successfully in the shoulder and the knee for many years.
And it’s an instrument that allows surgeons to see inside the joint and project an image onto a TV screen so they can see what they’re doing, and they get a much better view of the joint on the TV screen than they’d ever get trying to look in the joint after making a large incision and looking through retractors holding the skin and soft tissue apart.
The arthroscope gives good detail, but has the added benefit that during the surgery the dissection is kept to a minimum so that the swelling and pain that occurs after the operation is much less. The arthroscope, therefore, has a lot of benefits in the foot because the foot is the part of you that is lowest down and therefore gets the most amount of blood pressure if you’re standing up.
And so keeping the cuts or incisions during the surgery down to the very minimum is very helpful in reducing wound complications as well as swelling and pain after a foot and ankle operation.So the arthroscope has been introduced into a number of joints in the foot, and in particular it’s used now for the ankle joint to allow us to see within the joint and treat conditions within the joint.
But there are other joints around the ankle now that are fairly routinely scoped, such as the subtalar joint or the big toe or the metatarsophalangeal joint. The big toe joint can be approached through two small cuts on the top side, and injuries to the cartilage surface or arthritis or boney protuberances on the top of the joint or splitting of the little bones underneath the joint can be seen and treated through the scope with less swelling and less pain.
There are other joints that might be beneficial to scope but they’re hard to get to, such as these very tight joints in the middle of the foot that are hard to see at the current time. So there are many exciting developments in foot and ankle in the use of the arthroscope that’s getting miniaturized in time, and you might want to consider talking to your family doctor to see if you need to see an orthopaedic surgeon to see if this type of technology might be beneficial for you and the foot and ankle pain that you suffer. Local Physiotherapist.
Audrey Spielmann, MD FRCP(C), discusses ankle MRI scans.
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MRI Scans for Ankles and How They Can Help Reveal Injuries
The most common type of injury is an inversion-type injury or twisting over on your ankle. That’s frequently seen with running, with any soccer, football, rugby, tennis and racquet sports as well when people twist over on their ankle.
MRI is the best modality to look at the ligaments and the tendons around the ankle and also to look for bone marrow edema, which can’t be identified with CT or ultrasound.
And so here is an example of an ankle MRI on somebody who has had an injury to the ligament, and this structure right here is the anterior tibiofibular ligament, which normally should be attached onto the bone right here. And we can see that it’s completely detached, and there is fluid within the joint, this bright material here highlighting the detached ligament.
MRI visualizes the ligaments, the tendons and also the bone for bone marrow edema and the bone to assess for bone marrow edema. All of these structures and features are best seen with MRI, and if you have any questions about MRI, contact your family doctor, your sports medicine specialist or an imaging center.
Local Practitioners: Radiologist