FAQ Category: Ankle

Using videotaped presentations before surgery is a fairly new idea in the world of health care. The advantage is that the information is consistent and complete. Nothing important is left out or forgotten. Older adults can control the volume on the TV so they can hear everything. They are less likely to ask a nurse or doctor to speak up.

A recent study was done comparing patient understanding and retention of preop information. Patients were divided into two groups. One group got the standard verbal information. The second group watched a videotape with information about risks, benefits, and other treatment options.

Everyone answered some questions in a survey given right after getting the information. They also filled out the same survey again 10 weeks later.

It turns out the videotape group had better understanding and recall of the material. Patients with less education did especially well compared to patients in the verbal group. You can probably reinforce the information you thought was important just by talking with your father about the video.

Pain, swelling that comes and goes, and loss of motion are common symptoms of a “frozen ankle.” Stiffness is also a common feature.

Frozen shoulder or frozen ankle are also referred to as adhesive capsulitis. Literally this means the joint capsule is stuck or glued down. In other words, it’s not gliding and sliding as it should. The result is a stuck or “frozen” joint.

The shoulder is the joint most commonly affected by adhesive capsulitis. Frozen shoulder is a diagnosis used for many people with this problem. Frozen ankle is not as common. Most of the time the patient has had a traumatic injury to the ankle leading up to the condition.

The entire capsule is usually involved so that motion is limited in all directions. Walking can be difficult, especially on uneven or sloped surfaces like ramps, curbs, and stairs. Surgery to release the tight capsule can help restore motion and function.

You may be experiencing the start of post-traumatic adhesive capsulitis. This is like having a frozen ankle (similar to a frozen shoulder). Scar tissue forms in and around the ankle. Fibrous bands try to replace any torn ligaments and stabilize the joint.

Unfortunately the body sometimes overdoes it and too much scar tissue and too many adhesions form. Loss of motion from the restrictive tissue sets up a pain cycle early on.

It’s best to make an appointment with your surgeon for some follow-up. You may need to resume some of your rehab exercises. The therapist can also mobilize the joint. This may break up some of the adhesions, restore the joint fluid, and ankle motion. If a short course of therapy doesn’t change the picture, then surgery may be needed.

The doctor may have to cut the joint capsule and possibly remove some of the fibrous scar tissue. This type of surgery can sometimes be done arthroscopically. This saves you from having large, painful incisions and more scar tissue later.

Your surgeon is the best one to advise you on this. Often the decision isn’t made until the surgeon is able to see what’s going on inside. Pressure on the ulnar nerve along the outside of the elbow is the main cause of cubital tunnel syndrome (CTS).

This can be caused by a tunnel that’s too small, scar tissue from past injury, or tight soft tissues outside the tunnel. There is a band of fibrous connective tissue called the cubital tunnel retinaculum that crosses the elbow. Its purpose is to keep the nerve inside the tunnel during elbow flexion and extension.

The retinaculum is cut during surgery to decompress the nerve. The surgeon may opt to make sure the nerve slides and glides inside the tunnel and leave it at that. It may be necessary to lift the nerve out of the tunnel and move it to another location. This operation is called an anterior transposition.

A recent study of CTS showed that the cause of the problem may be increased pressure inside the tunnel. If this is true, then a simple decompression may not be enough. It may be necessary to move the nerve out of and away from the narrow confines of the tunnel.

You can opt to do this operation in two stages. In the first operation, the retinaculum is cut. If you don’t get relief from the symptoms, then the nerve transposition can be done at a later time.

Ankle fusion has become a more popular way to treat end-stage arthritis in younger adults. It’s a way to save the ankle and preserve some function. The operation is called a salvage procedure.

Long-term, functional outcomes of ankle fusion aren’t known yet. Studies are underway that will be following patients for many years and reporting results. A recent report of intermediate results has been published. Patients were followed for an average of three to four years. Results were compared between the fusion group and a healthy (control) group of adults who didn’t have a history of ankle problems or pain.

The researchers report most of the patients were satisfied with the results and would do it again if they had to. Pain relief was the number one advantage to this operation. Although they could still walk without crutches, cane, or other assistive devices, their gait was slower with shorter steps than adults in the control group.

There’s also a good chance you may develop arthritis in the other joints of the foot and ankle. Your surgeon will monitor for this. Additional surgery may be needed sometime further down the road.

Minimally invasive surgery (MIS) is a fairly new development in spinal surgery. Openings called portals are made just big enough to pass the needed instruments including wires, rods, and screws. It’s called percutaneous placement.

The surgeon uses special X-ray imaging called fluoroscopy to guide each step of the operation. Standard CT scans are also used to make sure everything is in its proper place.

Scientists are just beginning to explore the use of percutaneous placement with MIS to fuse the cervical spine. Studies are done first on cadavers and then on animals before attempting the operation on live humans. A special C-arm 3-D fluoroscopy unit has made this possible.

The fluoroscopy unit moves around the patient in a 190-degree arc giving the surgeon a clear view of the anatomy. This is important in the cervical spine because the spinal nerves and the spinal cord are very close and easily damaged. Likewise, the vertebral artery to the
brain runs alongside the cervical spine and can be cut by mistake.

Don’t look for this type of surgery at every orthopedist’s office. The machinery is expensive and it takes time for surgeons to learn the technique. Most likely it will be offered first through large university or teaching hospitals where research is a vital part
of the ongoing services.

Studies show that ankle injuries in sports accounts for 10 to 30 percent of all athletic injuries. Basketball players seem to have the highest incidence of ankle sprains when compared with soccer and football players. Basketball players are also more likely to resprain their ankles.

Physical therapists and athletic trainers are studying the problem. They are looking for risk factors for ankle sprains. Once these are identified, then training can be geared toward preventing ankle injuries.

Several studies using force plate technology have been able to show that decreased standing balance is linked with ankle sprains. Being overweight is a risk factor for male athletes. Overweight athletes who have sprained their ankles at least once before have an even greater risk of reinjury. A high body mass index (BMI) in football linemen has been linked with an increased risk of leg injuries.

For now it looks like improving one-legged standing balance can make a difference. Weight loss in football players may reduce ankle injuries but could increase injury to other parts of the body. More study is needed on this topic.

The bone that is broken is the fibula, the smaller of the two bones in the lower leg. It is situated on the outside of the lower leg. The fibular fracture is located closer to the knee (proximal) end of the bone, rather than down by the ankle.

A Maisonneuve fracture is often accompanied by a severe ankle sprain called a syndesmosis injury. The ligament and connective tissue (interosseus membrane) holding the tibia and fibula together are torn.

Maisonneuve fractures and syndesmosis injuries occur most often in athletes. The foot is planted on the ground and the lower leg rotates around it. The force of the injury is translated through the interosseus membrane, travels up the leg, and exits through the top of the bone. The result is a proximal fibular fracture.

With a Maisonneuve fracture, there can even be a fracture of the tibia (the other lower leg bone) at the bottom near the ankle. It’s important to rule out a Maisonneuve fracture with traumatic ankle injuries. An X-ray is needed to do this.

You are fortunate that your doctor recognized the true nature of the problem early on. Syndesmosis injuries are often missed during the acute phase. This can lead to many problems later on.

The syndesmosis is made up of several soft tissue structures in the ankle. The first is the interosseus membrane. This sheet of connective tissue holds the two lower leg bones together. The second is a set of ligaments between the two bones. These are called the tibiofibular ligaments. There are three segments to the ligament: anterior, inferior, and posterior. They are named for the location (front and back; top and bottom).

It’s a well-known fact that syndesmosis ankle injuries often take longer to heal than other ankle sprains. The lack of ligamentous support for the bones of the ankle transfers a tremendous amount of force directly to the bones rather than up the leg to the knee.

The physician usually diagnoses the type of injury as grade I, II, or III. Surgery may be needed for grade III. The bones are pinned together and the patient is put in a non-wearing boot for six weeks. At 12 weeks the screws are removed and the patient is allowed to start putting weight on the foot. There may be some rehab needed to restore strength and proprioception. Proprioception is the joint position sense needed to make cuts and quick moves.

Radiographs are X-rays usually used to identify fractures after a severe injury or injury that doesn’t heal. Stress X-rays look at the function of the bone or bones. Are they lined up correctly when the body part is moving? Sometimes a bone can look perfectly normal at rest. The fracture or displaced bone doesn’t show up until the person moves.

In the case of an ankle sprain, stress radiographs are usually looking at the talus, a bone in the ankle. It sits just below the two bones from the lower leg (the tibia and the fibula). The first X-ray is taken with the foot in a non-weight bearing position. The second X-ray is taken with the patient standing on that foot and leg.

Ligaments in the ankle hold the two bones of the lower leg together and keep the talus in line. This connective tissue structure is called the syndesmosis. It is made up of several ligaments in the ankle and a sheet of tissue between the two bones called the interosseus membrane.

A severe ankle sprain can tear the syndesmosis. The syndesmosis keeps the talus in its proper place under the tibia when the ankle is under various loads and weights. It keeps the tibia from sliding to one side or the other.

If the syndesmosis has been damaged and the talus is affected, then the stress X-rays will show it. There will be a greater than normal gap between the bottom of the tibia and the talus below the tibia. If the movement (gap) is too great, then surgery may be needed. Without proper treatment at the right time, the patient can develop severe arthritis later.

It’s not entirely clear what causes this condition or its symptoms. Complex regional pain syndrome (CRPS) comes with a wide range of symptoms. Most people report a cutting, sharp, or stabbing pain. It’s intense and it’s constant. They may also notice increased or decreased sweating of the area. Hair patches or hair loss (or both) are common.

Some patients’ have a change in temperature, too. The limb may become very hot and sweaty or cold and clammy. Some recent research has taken a look at the nerves, blood vessels, and hair follicles of patients with CRPS. They have reported a few interesting findings.

First, the fibers around the hair follicles are very thin and disorganized. The nerves and blood vessels to the upper layers of skin and hair follicles are changed, too. There are far less of them and they seem to be missing some of the chemicals that make them work.

Tiny nerves to the blood vessels are also missing. The walls of the arteries become hypertrophied (thicker) cutting down blood flow to the area. Even the layers of the blood vessels are disrupted.

All of these changes probably contribute to the symptoms described with CRPS.

Watch your child carefully for any skin problems. Sometimes the harness can cause skin irritation and other skin difficulties. Keep all medical appointments. It’s important to have an orthopedic surgeon examine the hip on a regular basis.

The goal is to develop a nice round head of the femur that fits into the socket of the hip. An incorrectly fitting harness can result in flattening of the bone or other abnormal changes in the growth plate.

It’s also possible the child can get “stuck” in this position. Loss of hip motion can occur; this can affect walking later.

You may be referring to something called joint proprioception. Proprioception describes the joint’s ability to tell that it is moving, how far and how fast it’s moving, and in what direction. This skill allows you to feel when you’ve stepped on a rock, when you’re walking on an incline, or when you’ve changed directions.

Scientists think the loss of proprioception after ankle sprain puts you at risk for another sprain. Retraining the joint may help prevent further injuries.

Rehab after ankle sprain is usually directed by a physical therapist. A variety of methods are used to retrain the joint. Much of the program can be done at home or at the gym.

Your ankle is designed to recognize even the tiniest movement and let your brain know what’s happening. Then your brain tells the joint how to adjust its speed and direction. This process is called proprioception.

Damage to the joint capsule and/or surrounding tendons or muscles from a sprain can also damage your proprioception. The twinges you feel may occur because of a delayed message relay system, a weak muscle around the joint, or both. Recurrent ankle sprains result in pain, swelling, and loss of motion.

The “twinges” may be a signal that your proprioception isn’t working well. This puts you at risk for another ankle sprain. Current thinking is that a rehab program can help restore joint proprioception and prevent another injury.

In human anatomy, accessory usually means an extra helper. The tissue may be like the main structure. An accessory ligament is usually in addition to the primary ligament. It’s not always present in every human.

A recent study from the University of Athens in Greece reported an accessory ligament. It was an accessory to the anterior inferior tibiofibular ligament (AITFL). The accessory is located just below the main ligament. It’s a separate structure with a
dividing wall between the two ligaments. This partition was made of fat and fibrous tissue.

Researchers report this ligament can get pinched up against a bone in the ankle. This happens most often after an ankle sprain. Surgery may be needed to remove or repair damaged tissue from this injury before symptoms will go away. In a small study of 24 cadavers, 22 of the ankles had this extra ligament. It’s not usually a problem until the ankle is injured or sprained.

A grade II or moderate sprain causes partial tearing of a ligament. The patient has bruising, pain, and swelling. A person with a moderate sprain usually has some trouble
putting weight on the foot, and there’s some loss of function.

Patients who have a grade III or severe sprain completely tear or rupture a ligament. Pain, swelling, and bruising are usually severe. The patient can’t put any weight on the joint. An X-ray is usually taken to rule out a broken bone. MRIs tell if the ligament is torn partially or completely.

The long-term outcome of your ankle sprain depends on how severe it was and how it was treated. A broken ankle is more likely to lead to arthritis, especially if it’s not stabilized with treatment. It sounds like your symptoms are getting better over time. That’s a good sign that you will recover without further problems.

The term pilon fracture was first used to describe a break at the very end of the shin bone (tibia). The bone is shattered into several pieces. Usually the patient’s foot is flat on the ground and a heavy force comes against the lower leg. Both bones of the
lower leg can snap.

A pilon fracture occurs most often as a result of a sports injury or car accident. Surgery is needed to stabilize the bone. Healing can take as much as four months instead of the usual six weeks needed for the average bone fracture.

Ankle replacement hasn’t been easy. The ankle joint is made up of many bones that offer a wide variety of ankle motions. Early implants had many problems with bone or implant fracture, infection, and loosening or movement of the implant.

At first there was only one type of ankle implant available. Over time three sizes were developed. Doctors have the option of choosing the right size and fit from many more choices now. Materials have improved and so have the surgical methods.

Researchers and doctors have worked together to reduce bone loss and implant shifting. Plates and screws are used more often to hold the implant in place until fusion occurs. Long-term studies show fewer implant fractures and less arthritis in the rest of the joint.

Total revision can have different meanings for each doctor and each patient. You’ll need to ask the doctor for a more complete description.

Usually major or total revision means removing or replacing the main part (or all) of the implant. Sometimes a new implant is put in place of the failed one.

In the case of infection with major bone loss, the joint may have to be fused.

In some very specific cases, yes. A well-fitting prosthesis can give patients a more functional foot with less pain. A fused angle is rigid, making walking and climbing
stairs very difficult. Walking on uneven ground can be impossible.

Amputation is a disappointing option for most people. That’s why researchers are working hard to find an ankle joint replacement that works. The first implants haven’t turned out
as good as hip or knee replacements. A second group of ankle implants with a different design are being studied.

Early results show many patients can convert from an ankle fusion to ankle replacement. They have the best chance for a good result if the ankle bones and ligaments around the joint are all intact. Pain of unknown cause or location is a sign that the implant may not work. More study is needed before joint implant is a good option for everyone.