A Guide To Addressing Lateral Ankle Instability

Start Page: 48
Peter Walimire, DPM, Joshua Daly, DPM, MBA, and Joseph A. Conte, DPM

   Single ligament reconstruction procedures include the Watson-Jones, Lee and Evans procedures. There have been mixed results in the literature with these repairs. Peters performed a retrospective review of 250 Watson-Jones stabilizations in 250 ankles and demonstrated that 95 percent of patients regained stability and 80 to 85 percent had good to excellent outcomes.12 A long-term retrospective study of nine patients with an average of 22 years follow-up who underwent the Watson-Jones procedure demonstrated loss of stability in six patients.28 Other authors have also noted loss of stability following single ligament tenodesis procedures.29-31

   The most common double ligament reconstruction procedure is the Chrisman-Snook procedure, which is a split peroneus brevis graft. Snook reported on 48 patients with an average follow-up of 10 years and observed 93 percent good to excellent results from their procedure.32

   Researchers have also described triple ligament reconstruction in cases of severe ankle sprains. However, surgeons typically perform this infrequently in the acute setting.12

   As for postoperative care, patients typically undergo a period of immobilization and non-weightbearing for four to eight weeks. This may be shorter if the physician can trust the patient to remain in protected weightbearing. One should follow all procedures with a course of physical therapy as previously described to rehabilitate ankle and subtalar joint range of motion and restore stability.12

In Summary

   Lateral ankle instability is a common problem we see in our practices. The instability can be mechanical or functional, and many patients with functional instability do not have
evidence of mechanical instability as well. Ligamentous structures remain intact with functional instability. Therefore, one should only treat this condition conservatively.

   Treatment of the lateral ankle sprain should always begin with physical therapy modalities to avoid chronic instability. Should instability persist, numerous surgical options are available to the podiatric surgeon. These procedures include primary ligamentous repair, arthroscopic procedures and tenodesing procedures. Post-operative results demonstrate excellent outcomes yet one should still treat patients with physical therapy modalities to restore range of motion, proprioception, balance and posture.

Dr. Walimire is the Chief Resident of the Florida Hospital Podiatric Medicine and Surgery Residency Program in Orlando, Fla.

Dr. Daly is a second-year resident at the Florida Hospital Podiatric Medicine and Surgery Residency Program in Orlando, Fla.

Dr. Conte is an Attending Physician with the Florida Hospital Podiatric Medicine and Surgery Residency Program in Orlando, Fla. He is an Associate of the American College of Foot and Ankle Surgeons.

For further reading, see “How To Diagnose Lateral Ankle Injuries” in the August 2005 issue of Podiatry Today, “Chronic Ankle Instability: Can Orthotics Help?” in the October 2006 issue, or “Practical Keys To Improving Fluency In Foot And Ankle Surgery” in the September 2008 issue.

To access the archives or get reprint information, visit www.podiatrytoday.com.


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