Lateral ankle surgery

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Hi All

I have a patient with surgical questions, and would be glad of the community's input to help answer them............

40yr old male with unilateral lateral ankle instability. He has tried a dozen different orthotic prescriptions over the last decade with almost no benefit (I provided UCBLs which he finds the most beneficial).

He saw an Orthopaedic consultant two months ago (privately) who took an MRI which showed fluid in the ankle mortice, specifically around the talar head/lat mall area.

Ortho said there was indication to cut the affected/weakened ligament and shorten it to give ankle back its stability.

Pt is thinking of second opinion, but admits it may be only option as ankle is constantly painful and therefore walking is never balanced. One small thing (lifting a weight or pushing a wheelbarrow) can trigger the pain/soreness and it can take weeks or months to settle down.

Attempts to focus excercise on strengthening it from previous physio's are ineffective because any amount of movement produces pain

The case is unusual in my opinion, in that it does not ever seem to be 'turning' that triggers flare-ups. instead it just seems to be weight or gentle pressure that causes it.

Ortho surgeon seems confident that this one ligament, has been stretched and is the cause of his issues. But can we be sure of this? seems pretty fundamental to be sure before progressing to surgery.

Any other options?


With many thanks in advance!


Pete

 

Kahuna (the big one?)

We're both most likely missing some info, second-hand MRI results given by the patient are usually not very accurate.

All things being equal, considering the unilateral nature and apparent lack or Pes Cavus (you didn't mention it) it is likely an old rupture of the ATF alone or along with the CF ligament could cause instability.

What has his examination revealed?
Is his ankle unstable, increased inversion compared to the other ankle? Pos drawer sign?

I would suggest that if his ankle is "always painful" that even if he does have a chronic instability that his pain is most likely coming form secondary arthritis, synovitis and or an OsteoChrondral Defect. He may have a linear tear of the peroneal (s) as well.

If your patient has has an opinion from a surgeon and wants another surgical opinion, he should go to another surgeon and get one.

Steve

 

I had a patient who had the ligament shortened without any problems post op. The only consideration was alternatives to the exercise he liked to do IE> walking became cycling and as for pushing a wheelbarrow, or pushing anything,, there are always alternatives that many patients , particularly men, really dont want to discuss. IE: use a bobcat, get help etc etc. One of the most difficult areas to treat in lower limb injury is the attitude of the patient with respect to change...
Kind regards

Footdrcb