The ankle is a hinge joint between the leg and the foot, and allows up/down and side/side movement. Stability is provided by strong ligaments either side of the ankle.
The ligament on the outside of the ankle is called the lateral ligament. It is made up of three bands connecting the fibula (the prominent bone on the outside of the ankle) and the talus (ankle bone) and calcaneus (heel bone). If the ankle is twisted, the ligaments can become stretched or torn. This is known as a sprained ankle.
Brostrom-Gould: This operation is usually performed under a general anaesthetic. An incision (cut) is made over the outside of the ankle. The stretched ligament is cut and then overlapped and sewn together again under tension. A thick band of tissue called the extensor retinaculum is sewn over the top, further re-enforcing it. The skin is then carefully sewn up and a plaster of paris cast is applied from below the knee to the ball of the foot. You will remain in plaster for four weeks and in an ankle brace for up to eight weeks after this.
Tendon reconstruction: This operation is usually done under a general anaesthetic. An incision is made over the outside of the ankle. There are two tendons called the ‘peroneal tendons’ that run along the outside of the ankle. A small portion (usually 1/3 ) of one of these tendons is used as a tendon graft. It is taken from the tendon along its length and passed through small drill holes in the ankle bone (fibula), tightened and fixed to the heel bone (calcaneus), which will reform the ankle ligaments. The skin is carefully sewn up and a plaster of paris cast is applied from below the knee to the ball of the foot. You will remain in plaster for four weeks and in an ankle brace for up to eight weeks after this.
When you arrive back on the ward from theatre, your leg will be in a plaster cast back slab (half plaster) from toe to knee. You need to make sure that you do not get the plaster wet. You will also have stitches or staples with a dressing covering the wounds.
It is important to keep your leg elevated to above groin level for 55 minutes in every hour for the first two weeks following the operation.
This helps to reduce swelling. It is then important that you continue to elevate your leg regularly over the next few weeks/months.
A physiotherapist will see you on the ward and show you how to walk using a walking aid. You are normally allowed to put weight through your operated ankle while it is in the plaster cast. If you have to use stairs at home, you will be taught the safest way to do this.
Depending on your surgery, there may be some restrictions, but these will be explained to you in detail. You will usually remain in hospital for approximately one to two days after your operation.
What can I expect after a Lateral Ligament Reconstruction of the Ankle?
- Improved function/mobility
- Improved pain relief, and less need to take painkillers
- Improved ankle stability
- Less need for orthotics/ankle braces
- Return to full sporting activity
- Full recovery may take up to twelve months
Are there any major risks with a Lateral Ligament Reconstruction of the Ankle?
- Swelling You should expect some swelling after your operation. If swelling persists or worsens and you are concerned, seek advice from a member of the foot and ankle team or your GP.
- Infection Any operation is at risk of infection. Fortunately it is not common in this type of surgery but a small number of patients do get a wound infection and these normally settle after a short course of antibiotics. In rare circumstances the infection may be more severe and require further surgery to remove infected tissue and administer a longer course of antibiotics.
- Blood clots Deep Vein Thrombosis (DVT) or Pulmonary Embolus (PE) are rare but can occur. Please inform the team if you have had a DVT or PE in the past or if you have a family history of clotting disorders. You will be given an anti-embolic stocking to wear on your other leg and daily blood thinning injections while your leg is in plaster.
- Numbness or tingling This can occur at the surgical site(s) if fine, hair-like nerves are cut or more major nerves are stretched. This is normally temporary, however, patchy numbness or sensitised areas may be permanent. In rare circumstances the nerves can become hypersensitive, in a condition called Complex Regional Pain Syndrome. This can lead to severe pain as well as colour and temperature changes in the foot. If this happens, your consultant will discuss treatment with you.
- Wound healing If blood supply to the area is not good, wounds may be slow to heal. If this is the case, more frequent wound dressings may be required to ensure that the wound does not become infected.
- Scarring Any type of surgery will leave a scar. Occasionally this can cause pain and irritation. If this happens, please speak with your consultant.
REPORT SEVERE PAIN, MASSIVE SWELLING, CHEST PAIN, EXCESSIVE NUMBNESS OR PINS AND NEEDLES.
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