FAQ Category: Ankle

You are correct. One technique that doctors can use to repair cartilage in the knee is called microfractures. To do this procedure, the surgeon makes a small incision in your knee and inserts an awl to drill tiny holes into the bone, as close as possible to the tear or hole in the cartilage.

When the holes have been drilled, some bone marrow will seep out of the holes and then begin to clot. This allows cartilage-building cells to form and the hole or tear will be repaired.

Ankle pain, decreased joint motion, and loss of function can be very disabling. Conservative care can help some individuals regain more normal joint action. If you have not had a rehab program of some kind, then that may be your first step to recovery.

But if painful and disabling symptoms persist after six months of rehab, then surgery may be advised. Ankle fusion is the most common operation for this type of problem. Joint motion is already limited by the pain and arthritic changes in the joint. By completely fusing the joint, the pain can be decreased or eliminated.

But if you want to preserve joint motion, then a total ankle replacement (TAR) may be right for you. TAR is a fairly new operation. Implant designs are still being changed and improved.

Patients receiving TARs tend to be young in general (younger than 65 years old). But this group of patients are still older than patients who have ankle fusions.

An orthopedic surgeon is the best one to advise you. A careful exam and assessment will guide the physician in planning the best plan of treatment for you.

Loosening or sinking of the implant are the two most common reasons for total ankle replacement (TAR) failure. Subsidence is the medical term to describe sinking of the implant deeper into the bone.

Studies done on the intermediate to long-term results of TAR have been done. Researchers who have reviewed the data say it looks like as many as 28 per cent of TARs require revision for these two problems. Revision surgery may mean the current implant is removed and a new one put in its place.

Removing and replacing the implant is the most likely plan of action for a prosthesis that has come loose. Subsidence may require fusion to stabilize the joint. Changes in bone density from osteoporosis or changes in bone quality from osteopenia may mean the bone can’t support an implant of this type.

Seeing a specialist is the right step in finding out the best treatment plan for you. After taking a history and review of your records, X-rays and other imaging studies may be ordered. You may have several options to consider depending on all the various factors. The orthopedic surgeon will be able to advise you and answer any further questions you may have.

It sounds like you might have had realignment surgery to correct an asymmetrical (uneven) deformity. Sometimes realignment surgery works very well to restore the normal ankle position. Decreased pain and increased motion often result in improved function.

But when the procedure fails, then a second operation may be needed. The surgeon may be able to revise the original surgery. Two treatment options include total ankle replacement and ankle fusion.

The treatment decision is based on the position of the ankle bones. The surgeon will also look at the width of the joint space across the joint. It may be possible to measure the load placed on each side of the joint. A minor revision may be all that’s needed to unload the diseased (worn) joint area.

See your surgeon again before assuming a fusion is the next step. It’s possible that you might benefit from a rehab program. If not, a second revision operation may be possible.

The surgeon will do whatever is possible to postpone or avoid an ankle fusion or TAR. With reconstruction revision, fusion or TAR are still possible if needed later.

Osteoarthritis that occurs as a result of a poorly aligned ankle is not uncommon. In most cases (70 to 80 per cent), trauma to the ankle is the original cause of the problem.

If conservative care doesn’t help, then surgery is often advised. The two most commonly used operations include ankle joint fusion or total ankle replacement (TAR). But there are some patients who could benefit from surgery to realign the joint instead.

The surgeon may be able to balance the uneven joint space. The operation is called realignment surgery. Too much tension on the tendons can be lessened. Angles between bones in the ankle can be changed. And the bone can be lengthened or shortened.

Shear forces can be reduced and shifted to be equal across the joint. Any deformity in the midfoot, forefoot, or hindfoot may be reduced. If realignment surgery is not successful, then a fusion or TAR can still be done.

The realignment approach has made it possible for some patients to continue participating in sports activities. Running long distances, including marathons, has been done by patients who have had this operation.

A broken ankle is exactly that – a bone in the ankle is broken or fractured. The bone will need to heal and this is done by immobilizing it with a cast or brace. In some cases, surgery may be needed to fix or stabilize the break.

Besides the obvious complaint of pain and being unable to bear weight on your ankle, if you have any of these signs or symptoms, you should be checked by a doctor as soon as possible:

You may be seeing the results of some local decisions made by your school board or administrators to save money. There isn’t a lot of evidence that these screening programs are worth the high cost. Everyone is screened but only a small number of children are actually identified with a problem.

With all the budget cuts, it may be a new cost savings measure in your local area. A similar decision was made in Canada several years ago. School nurses conducted all the scoliosis screening. When the school nursing program was cut, scoliosis screening went by the wayside.

Then a study was done to compare the results of referral patterns before and after screening was ended. They found a large number of patients were sent to a specialist unnecessarily. They did not have a problem with scoliosis. And many children were sent too late to benefit maximally from early treatment.

We suggest asking your son or daughter’s pediatrician to add screening for scoliosis as past of the annual physical exam. You may want to make sure she also has her vision and hearing checked at least once between the ages of 11 and 14.

It sounds like you had a significant ankle injury. Was there bone and soft tissue damage?

Fracture with rupture of the syndesmosis usually requires this type of treatment. The syndesmosis is a group of ligaments holding the two bones of the lower leg together at the ankle.

It takes about six weeks for bone to heal in the average, healthy, adult. The use of tobacco products can delay bone healing. The presence of some health conditions such as diabetes or osteoporosis can slow down the healing process. And it takes much longer than six weeks for healing to occur around the ligaments.

Although this point is debated, many surgeons advise their patients with a syndesmotic injury to avoid putting weight on that side for up to 12 weeks. Some surgeons allow weight-bearing after six weeks but the patient is in a walking cast.

After a few weeks, the soft ankle brace will replace the cast. Once the screws are removed, full weight-bearing is allowed. The screws are taken out around 12 weeks. Patients who put weight on the leg too soon run the risk of poor healing or nonhealing of the soft tissues. Weight-bearing can put enough pressure that the screws can come loose or even break.

Failure to follow your surgeon’s instructions can lead to poor results of treatment. Ankle instability with chronic sprains and even dislocation can occur. Many studies of patients with this type of problem show that a poorly healed or nonhealed syndesmotic injury leads to decreased ankle function.

The syndesmosis refers to the ligaments and connective tissue that hold the bottom of the two lower leg bones together. These two bones are the tibia (your shin bone) and the fibula. The fibula is next to the tibia along the outside of the leg.

The syndesmosis is made up of a total of four ligaments and a band of tissue between the two bones. This band is called the interosseous membrane.

The syndesmosis can be sprained or ruptured. There may or may not be a bone fracture at the same time. Severe injuries with bone fracture and/or syndesmotic rupture requires surgery. The goal is to realign the bones and stabilize the joint. The hope is to restore normal movement and function.

There are a wide variety of braces used to treat scoliosis or curvature of the spine. Studies show that the type and location of the curve(s) dictates which kind of brace to use.

When braces were first used to treat scoliosis, the Milwaukee brace was worn 23 hours a day. This type of brace goes from neck to sacrum with metal uprights to hold the body straight.

It has a pelvic girdle, two posterior uprights, one anterior upright, and a ring around the base of the skull that also supports the lower jaw. It was originally made of leather and metal. It has been revised now and is constructed out of rigid plastic with metal uprights. Straps attached to the frame are used to apply corrective forces.

A brace that starts under the arm and does not include the neck can be used for curves lower down in the thoracic spine. This type of brace is called a thoracolumbosacral orthosis or TLSO. Both the Milwaukee and the TLSO types of braces are usually worn 22 hours each day. They are removed only for a brief period to shower, change clothes, and participate in certain (noncontact) sports.

The nighttime braces, such as the Providence or the Charleston are worn at least eight to 10 hours each night while the child is sleeping. The way in which these two braces work is different.

The Providence pushes the curve toward the midline of the spine. The curve may even be overcorrected at first. The Charleston bending brace works by bending the spine in the opposite direction of the curve. Studies show the Providence brace works best but it must be used early when the curve is 25 to 35 degrees.

Some experts suspect the Providence brace works better because children are more likely to put it on and keep it on for the required number of hours. It’s likely that not wearing the Milwaukee brace or the TLSO has resulted in poor outcomes.

Taping is a common way to support a joint, especially the ankle joint. The goal is to reduce the risk of re-injury and avoid another ankle sprain. But does it work? And if it does work, what’s the mechanism behind the effect?

Right now, all we have are theories about this. The general consensus is that taping does help prevent re-injury. There are two most likely explanations for this. First, tape gives the joint mechanical support. The tape keeps the ankle joint from moving too far in any one direction.

Second, it enhances proprioception. Proprioception is the sense of where the ankle is at any given moment. Proprioception allows the ankle to feel changes in the surface or slope of a surface. That way the ankle and foot can make necessary corrections to stay steady and balanced while walking or running.

A new theory has been proposed as a result of some recent research. It may be that ankle taping may have a placebo effect. Placebo means it doesn’t really have any effect, but the person thinks it does.

Under these conditions, the athlete performs with increased confidence. The athlete expects the tape to work, so it does. Studies show that taping doesn’t negatively effect performance. It’s likely that taping does prevent reinjury. It probably doesn’t really improve function.

All things considered, it’s still a good idea to use taping to prevent spraining the ankle again. The method of taping isn’t as important as the person’s belief that the taping is helping.

Ankle sprain is one of the most common injuries among all kinds of athletes. And three-fourths of those who sprain their ankles once, do it again. Chronic ankle instability could really effect your performance as a gymnast.

You may want to wear some type of ankle support. If tape seems too restrictive, try using elastic wrap or a neoprene sleeve that fits over the foot and ankle. A recent study comparing different types of ankle taping showed taping does not impair function or performance.

It doesn’t improve performance either. But it gives the athlete a sense of stability and confidence needed during competition. And it may prevent re-injury, which is equally important.

Although only your doctor will be able to tell you for sure, it doesn’t sound like an addiction but, rather, that you’ve become dependent on the medication. The difference between the two is that if you have an addiction, you have to have the medication right now, immediately. You need it and you miss it when you don’t have it. Obtaining the drug and administering it is just as important in the high.

For people who are dependant, they have a physical need for the drug. Their pain gets worse if the medication in their system is lowered and they may develop signs like a runny nose or muscle aches. These are physical signs.

The best thing to do is to go see your doctor and discuss your concerns.

When pain and loss of motion persist beyond the expected time for normal physiologic healing, the condition is said to be chronic. It doesn’t mean that you won’t get better. Seeking out additional treatment may be a good idea.

Most doctors will advise using medications such as over-the-counter analgesics to help with pain. Getting back to normal activities as soon as possible is always advised. Many patients start to fear certain movements will cause increased pain, so they avoid moving their necks. This sets up a fear-avoidance cycle that results in worse motion.

Studies have not shown yet just what is the best exercise program for chronic whiplash. We do know that learning to move freely is helpful. Patients are encouraged to keep moving even when pain is increased by physical activity.

A physical therapist may be able to help you find the right program for you. The therapist will test your motion and strength. Coordination, fear of movement, and overall fitness level should be taken into consideration. The type of work you do and skills required will be assessed.

A progressive program of exercises designed to get you back to your preinjury level will usually take about four to six weeks. A daily home program will be part of the plan. Most likely the therapist will take measures of your pain and disability before and after to show any change or improvement.

This is important because many people gradually improve but don’t always recognize the changes. They think they haven’t made any progress, when in fact they are nearly normal again.

With the continued aging of America, the number of major joint replacements is on the rise. Although hip and knee replacements are the most common, the demand for shoulder replacement surgery is also increasing.

Studies have been done to compare the results of these three operations. Data is taken from hospital records. Length of stay, complications (even death rates), and costs are measured and reported.

Age over 65, overall health, and male gender are risk factors for increased problems after joint replacement surgery. But this doesn’t mean that if your father-in-law is in this category, he is destined to have problems. Many people have good outcomes with improved function, decreased pain, and better quality of life.

Shoulder replacement surgery tends to have fewer complications associated with it compared with hip and knee replacements. Length of stay is also shorter. These two factors translate into cost savings, too.

As more and more joint replacement surgeries are done, further information will be gleaned and reported to help patients make decisions about whether or not to have this operation and the best timing for the best results.

Ankle injuries are one of the most common problems gymnasts and other barefoot athletes face. Studies show that ankle and foot problems are especially prone to injury in trampoline athletes.

Athletes in other sports often use ankle support inside their shoes. Semirigid and soft braces are available. Barefoot athletes are more likely to use tape because there is no shoe to hold the brace in place.

However, tape only offers the ankle stability for the first 20 minutes it’s in place. It’s also expensive when you add up daily wear and replacement for practice and events. So, it’s not recommended as the first choice.

A recent study of the best stabilizing support was reported from the Institute of Sports Medicine in Germany. They compared three different ankle support systems to being barefoot and to wearing the support inside a shoe.

An aircast semirigid ankle support was used along with a soft, canvas lace up support, and tape. All three devices were tested inside a standard Nike Cross Training XT shoe and inside the same Nike shoe that had been cut out to simulate being barefoot.

They found the soft brace worked the best for barefoot sports. There are no rigid parts on this brace to cause self-injury to the athlete during performance. And they can be worn in contact sports such as judo or karate. Unlike tape, it’s easy too get on and off and it can be adjusted. The ankle is stabilized without losing motion needed for the activity. A shoe is not required to hold it in place.

A dynamic program of ankle motion, strengthening, and improving proprioception (joint position sense) is always recommended first. In any barefoot sport that relies heavily on the foot and ankle, function, motion, strength, and stability are essential.

In trampoline and other gymnastic events, the ankle must respond to even the tiniest wobble or landing that isn’t right on. Previous ankle injuries, weak ankles, or less than normal joint motion can increase your risk of injury. Improving proprioception has been shown beneficial as well.

Once you have these key ingredients as part of your daily training program, you may not need any further support. But if you do, then experts suggest you may want to consider using a soft lace-up or velcro strap brace.

The semi-rigid aircast works well once you’ve sprained your ankle because it doesn’t allow you to plantar flex or point your toes. Any loss of plantar flexion when there’s no injury present will compromise your work on the trampoline. Should you find yourself with an ankle sprain, the Aircast is a good choice during the acute or early phase of healing.

The bridge of bone between the tibia and fibular bones of the lower leg seen on X-ray is called a synostosis. It is usually a sign of trauma causing an overgrowth of bone. Sometimes a synostosis forms in the ankle after an ankle ligament is torn from a severe sprain.

In children, a synostosis can be congenital, meaning your child was born with it. This does not mean it is genetic or inherited. Congenital synostosis occurs if there’s been trauma or infection while the child is in the mother’s womb. The synostosis forms during the healing process.

In adults, synostoses can occur after bone graft in the lower leg or if absorbable rods are used for ankle fractures. Any kind of growth delay or abnormality in child or adult can result in synostosis between the two lower leg bones.

It may not be possible to tell if your child was born with this feature, or if a former soccer injury could have led to its formation. Synostoses do grow in size as a result of repeated, tiny fractures occurring called microfractures.

Your son may need to take some time off from sports to allow the healing process to complete itself before further fracture(s) occur.

Ankle sprains are the most common ankle injury in today’s competitive athlete. Pain and swelling can keep an athlete benched at the heighth of the playing season. Restoring the joint to normal as quickly as possible becomes the goal.

It sounds like your daughter may have received a treatment called electrical stimulation (ES). An electrical current or impulse can be passed through the skin via flat electrodes applied to the muscle. The electric current applied is low-voltage with just enough energy to cause the muscle to contract. This type of ES is called neuromuscular electrical stimulation (NMES).

By contracting and relaxing the muscles through multiple cycles, a pump action is created. This muscle pump helps keep fluid from pooling thus decreasing or minimizing edema. Instead, blood and lymph fluid are moved away from the ankle into the leg and back up toward the heart.

Usually a 30-minute treatment session with five second contractions can create 360 cycles. This is far more muscle pumping than a person can do by actively contracting the muscle. As your daughter experienced, the result can be rapid recover and return to sports.