Chronic Ankle Sprains (Lateral Ankle Instability): Treatment Options

Chronic Ankle Sprains (Lateral Ankle Instability): Treatment Options

Once a patient has had one ankle sprain, the risk for getting more goes up. After several ankle sprains, some type of treatment is recommended to prevent further injury. Here, you can see the x-rays of someone who has had many sprains. You can see that their joint is loose, and the bones shift around more than they should.

If someone with chronic or long-term ankle instability does not try any type of treatment, their joint cartilage can wear down and they can develop arthritis in their ankle, their pain will get worse, and simple activities will probably be more difficult.

When it comes to nonsurgical treatment, rest, ice, compression, and elevation of the injured ankle along with a brace is what most health care providers will recommend. Along with doing ankle exercises for strength, wearing a brace can help the patient return to their desired level of activity with routine balance exercises to help keep the ankle stable.

If the brace and exercises just are not doing the job and the ankle keeps rolling in, surgery might be the best way to treat the problem. There are several different procedures that can be done to stabilize the ankle. When a single standard incision is made to do the surgery, it is referred to as an open repair.

The traditional Brostrom repair is when the surgeon takes the stretched ligament, cuts it in half, and then folds it over itself in what is called a pants-over-vest configuration. The tissue is then simply sewn together, shortening it back to its original length.

The next open repair option is the Brostrom-Gould. This is a traditional Brostrom repair that was just shown, but it adds another piece of tissue in the ankle to try and help strengthen the repair.

One of the more recent variations of the Brostrom repair is the ATFL repair augmented with a piece of suture. Here, the ligament is repaired directly to the bone with suture anchors and then a large flat suture is implanted over top of it, helping to support the repair during the early phases of healing.

There are other repair types that are considered more minimally invasive. The ArthroBrostrom repair is an arthroscopic procedure to repair the ligament using a few small incisions rather than one large one. The mini-open Brostrom ligament repair uses a single incision, but it is smaller than the standard open surgery. Because of the smaller incision, there are some extra steps to the procedure, but the ligament is repaired in the same fashion.

Regardless of the type of repair that was done, recovery from this surgery looks pretty similar across the board. Patients are put in a big, bulky splint in the operating room and keep it on for around 2 weeks. After that, they may be placed in a walking boot, but still not allowed to put any weight on it until 4 to 6 weeks after surgery.

Most patients can walk on their own at around 3 months and after formal physical therapy, can return to full activity anywhere from 6 to 12 months after the surgery. The most important thing to do is to listen to the doctor and the physical therapist regarding rehab instructions. Their goal is to guide you down the road to a full recovery.