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Have a patient who sustained a complete disruption of anterior talofibular ligament last year which was misdiagnosed by A&E and not immobilised until 10 weeks after injury. Forefoot and rearfoot valgus wedge helps in footwear, but she still requires eversion strapping when playing sports. Can you recommend an ankle brace to replace/augment strapping?

Many thanks

MR

 

Hi Mark,

ATFL complete rupture is often times accompanied with TCL tear. if thee is no pain during activity, ur valgus straping is the appropriate modality. howevr, ankle brace during activity wud be tricky and can interfere with performance. did u try FAA (keeps the foot dorsiflexed and everted). clinics in podiatric medicine and surgery, ankle and soft tissue injuries, 2007.discusses functional treatment for ATFL and TCL injuries. consider strengthing tib ant and peroneals.

Hope i answerd ur q. if not apologies.

Regards

David

 

Mark

If it is a complete disruption, why not consider having it 'fixed'?

Delayed primary repair of the ATFL (Brostrom procedure etc) is a very effective means of providing a lasting solution to lateral instability.

You can *try* and strengthen extrinsic muscles etc, but none of these anatomical structures comes close to the requirements for providing resistance against antero-lateral talar movement. Im opinion, it is a waste of time, and totally analagous to ACL ligament dyfunction in the knee - which is routinely addressed surgically in active people.

Why physio's and podiatrists don't look to 'fixing' the actual problem more frequently with lateral ankle ligament attenuation/disruption is a source of frustration to me. Yes, there is a role for orthotics and bracing, but if the ligament is 'gone' , it needs to be fixed.

Something to consider anyway...

LL

 

gday mark, only going on personal experience and really depending on the type of activity, I have found the "swede-o" ankle brace (not sure if this is the brand or model im sorry) really to be quite good for this sort of problem. I have used the inner lok 8 model which seemed to be really good in stabilising the ankle without sacrificing too much available movement of the joint. Must stress again mate, this is just my personal experience involving my sport, soccer, not any scientific evidence. Hope this helps a bit.
Paul

 

I like using the EpX V-lock brace.

 

Agree.

Swedo-O "Ankle lok"; white with plastic inserts.

 

Thanks for the input - have used the ankle stirrup with silicon support but found it wears badly. Will try the lace swedo style support instead. As far as surgical repair is concerned, personal experience suggests variable results - poorer the longer the condition is left untreated, although this may be practitioner specific.

Thanks again

MR