FAQ Category: Ankle

It may depend on how soon the recital will take place. Most soft tissue injuries take six to eight weeks to fully heal. Dancing on it too soon (before full recovery) can result in reinjury or another ankle sprain.

And most dancers spend hours practicing in the final days before the performance. So, that pushes the time frame up sooner for returning to full activity.

Studies show that although the athlete (dancer) with a healed ankle sprian demonstrates what looks like normal motion and strength (when compared to the uninjured ankle), specific testing shows this isn’t always the case.

Even mild or occasional pain and/or mild, residual swelling can cause a dancer to favor that side. The best way to work through this may be with a physical therapist. The therapist can show her how to train to restore normal motion, strength, and flexibility needed for dance.

Attention will be paid to ankle proprioception (joint sense of position) and kinesthetic awareness (joint sensitivity moving through space). Both of these finely tuned functions are needed for complete restoration of normal movement and function.

Sometimes ankle sprains don’t recover fully without a little extra help. The joint seems to accomodate rather quickly to less strength and less motion caused by a sprain or other injury. A month goes by and it seems fine. But some people notice some lingering symptoms that just don’t seem to go away.

A recent study by physical therapists from Canada showed why you may be experiencing some trouble. They followed a group of patients with ankle sprain for one month after they were first treated in the local emergency department. At the end of 30 days, everything looked fine by external measures. But sensitive testing methods showed the injured leg was still weaker, more painful, and had less motion compared to the uninjured ankle.

The testing ended after 30 days so the researchers weren’t sure if further changes would be seen if given a little more time. The high rate of recurring (second) ankle sprains in the general population suggests a need for specific training and rehab to fully recover from even mild to moderate ankle results.

You may want to see an orthopedic surgeon or a physical therapist for further evaluation and suggests for complete recovery. It may be a good idea to have a short course of exercise therapy to regain full motion, strength, and proprioception (joint sense of position). This can help reduce the risk of recurrent sprains as well as restore function.

Treatment for ankle osteoarthritis has expanded over the years. In addition to debridement, cartilage transplantation is now an option. Debridement is the removal of bone spurs and smoothing uneven joint surfaces. The procedure can be done arthroscopically, avoiding an open incision.

Cartilage transplantation called allograft arthroplasty has great potential. By replacing damaged cartilage with fresh graft material, arthritic joints can be restored to a more normal joint surface.

Despite these advances in treatment for ankle osteoarthritis, ankle fusion is still the most common surgical procedure done for severe, painful ankle arthritis. But studies show that long-term results of fusion aren’t as good as expected.

Although the patient gets relief from pain, over time, adjacent joints start to break down. Pain and disability are the natural result of this process. And, of course, fusion means a loss of motion, which often means a loss of function.

The use of ankle implants is on the rise. The implants were first developed in the 1960s. Since that time, many changes and improvements have been made in design and materials. Third-generation total ankle arthroplasty (TAA) is now being investigated.

Third-generation refers to the third round of new and improved implants. Minimal bone resection makes it possible to use these implants with patients who have weak bones. Using the patient’s own ligaments helps stabilize and balance the ankle.

Results of TAA are good so far. There’s about an 11 per cent revision rate but a much higher rate of loosening (76 per cent). Delayed union is common, taking as much as six months or more to fully heal. Even with these problems, more than 90 per cent of the patients report decreased pain and a high level of satisfaction with the results.

If you haven’t been evaluated by an orthopedic surgeon in the last 10 years, an orthopedic examination is your first step. Discussing all the pros and cons of the implant procedure may help you make the decision.

Patients are selected carefully to ensure success. You’ll want to find out if you are still an acceptable candidate for TAA. If not, there may be other treatment options that can help reduce painful symptoms and preserve function.

Ankle arthritis can be caused by trauma. A sprain that never completely heals properly can cause significant ankle instability and foot malalignment. Over time, this type of imbalance can lead to excessive joint wear and tear. Painful, debilitating post-traumatic arthritis may be the end result.

Now is a good time to address your concerns. An orthopedic evaluation may serve you well. X-rays of the ankle may be taken. This will show the joint spaces and articular surface of the joint. Any signs of joint space narrowing, uneven surfaces, or the presence of bone spurs may point to a diagnosis of arthritis.

Many people have significant signs of arthritic changes without symptoms, so doctors don’t put a lot of stock in X-ray results. They can provide some additional information not possible with a physical exam.

After taking a history and conducting a physical exam, the orthopedic surgeon will be able to advise you of your treatment options. A physical therapist can help identify areas of weakness and instability and plan an appropriate rehab program. Muscle strengthening is important but treatment will also address joint proprioception (sense of position) needed to prevent chronic reinjury.

If there is too much ligamentous damage, surgery may be needed. A conservative rehab program is advised before having surgery, so that’s the first step even for severely damaged soft tissue structures.

The sural nerve (also known as the short saphenous nerve) is a sensory nerve, which means it conveys sensory messages. Damage or compression of the sural nerve can result in burning pain and diminished sensation or loss of sensation (numbness).

This nerve passes down from the back of the knee along the outside of the lower leg. It’s located along the surface of the lower one-third of the leg. It passes along the outer bone of the ankle, just behind the malleolus (ankle bone). Then it goes along the outside edge of the heel to the base of the fifth (baby) toe.

Injury usually occurs along the superficial portion where it is closer to the skin and more likely to be crushed or compressed. It supplies the skin and soft tissues along the lower third of the lower leg with sensory function. Tingling, burning pain, or loss of sensation anywhere along this pathway suggests a sural nerve injury.

The specific treatment of ankle sprains depends on the location and type of injury. Most ankle sprains affect the lateral ankle (outside of the leg). But a medial (inside) ankle sprain can occur.

In the case of a mild to moderate sprain, rest for a couple of days is advised. Slow, gentle, full motion of the foot and ankle is important. Movement exercises should be performed to keep the ankle from stiffening up and losing motion. In these cases, we say: Motion is lotion.

Studies show that the standard practice of applying ice and taking antiinflammatories should be modified. The inflammatory process has a special purpose to bring about healing. But too much inflammation can cause adhesions and scar tissue. By using limited amounts of ice, the healing inflammation can still occur, but in moderation.

If the sprain is severe enough, immobilization may be needed. An aircast is the most popular type of splint. It provides the stability of a plaster cast but can be removed to wash and move it. Limited weight bearing may be necessary. In such cases, crutches can be used for a few days up to a week or so.

If there is any nerve damage, it’s important to avoid taping or immobilizing the ankle. Pressure on the injured nerve can cause even more problems. Any symptoms of numbness and/or tingling may be a sign of nerve involvement. The doctor can conduct several tests to check on the condition of the nerve and advise your son accordingly.

Severe injuries with torn or ruptured ligaments and/or nerve damage may take longer to heal. When the ankle is recovered enough to resume dance activities, an ankle brace may be helpful for a short time. When full weight can be placed on the joint without painful symptoms or swelling later, then the patient is ready for full activity.

Many physicians believe that it’s important for fracture patients who also have diabetes to be aware of the potential problems that can occur. Every effort must be made to avoid the kinds of serious complications that can develop in this group of patients.

Diabetes affects the blood vessels and nerves of the hands and feet. With less than normal supply of oxygen, nutrients, and nerve messages, there’s a big risk of delayed healing. It’s even possible that healing won’t occur at all.

You probably heard the list of possible problems: infection, nonunion, malunion, and destruction of the joint. Any of these can delay recovery and even reduce long-term function. Impaired walking ability is at the head of the list. Gangrene and loss of limb are among the worst possibilities.

These are not meant to be scare tactics. The simple fact is that adults with diabetes are more likely than adults without diabetes to fracture a bone. And when they do, half of them will develop one or more serious problems.

Patients and their families who are aware of the potential complications will take the directions seriously and follow them very carefully. A lot of education and a little prevention can go a long way in obtaining a good result for patients with diabetes.

It’s wonderful that your mother is in good hands at home. Hospital staff don’t always know all the details about a patient’s home situation. And in the case of patients with diabetes, there are some very special concerns.

First of all, healing in this group can be very, very slow. Even with the best of care, the fracture may not heal. This can mean a nonunion or a malunion of the bones. Walking, balance, and coordination can be affected.

There is a serious risk of complications that could lead to amputation of the foot. In fact, complications among adult patients with diabetes and a fracture almost triple compared to someone without diabetes. And almost half of this group experiences some kind of problem during recovery.

There are several reasons for the delayed or non-healing response. Damage to the small blood vessels needed to supply the injured soft tissues and bone is common with chronic diabetes. This can keep oxygen and nutrients from reaching the healing area.

Likewise, high glucose levels over a long period of time can cause nerve injuries. Damage to the peripheral nerves can result in a loss of protective sensation in the feet. This, in turn, can lead to trauma, pressure ulcers, and even gangrene.

Strict adherence to the postoperative protocol is essential for a good result. Good communication with her primary care physician and other involved health care staff is vitally important during these next few months of recovery.

And to add one more Don’t to your list: Don’t hesitate to contact the nurse or doctor with any unusual changes that you see or concerns that you may have. Recognition of potential problems early in recovery can prevent more serious complications later.

There is no standard screening tool for use with dancers at this time. Some of the elite preprofessional ballet boarding schools use various musculoskeletal screening tools. Professional ballet companies have physical therapists who work with the dancers to prevent and manage injuries.

But there are few very studies to support the use of screening to predict risk of injury. Some studies show that female dancers who are amenorrheic (not having a menstrual cycle) are at increased risk of injury.

Other studies report a link between decreased standing leg turnout and lower extremity injury. A more recent study of injured versus uninjured dancers revealed a history of low back pain among the injured dancers.

Dancers in a preprofessional ballet boarding school were screened before beginning the program. Five years later, the researchers looked at injury rates and patterns.

They found very few differences in risk factors between the two groups. The trend was for injuries around the time of increased training for exams, performances, and at the start of the year after the summer break.

Screen your dancers for previous injuries. It may be possible that a program of strengthening, improved motor control, and increased joint proprioception (sense of position) can help prevent future injuries. A physical therapist can help you with this.

Monitor your dancers for overuse and overtraining. Keep a running total of classtime, rehearsal time, and performance time for each dancer. This may help identify who is at risk and when they have reached the maximum tolerance time before injury occurs.

Intradiscal electrothermal therapy (IDET) is a form of heat treatment applied directly to the disc. After the patient is anesthetized, the surgeon inserts a long, thin needle through the skin into the center of the disc. A special X-ray device called fluoroscopy guides the surgeon throughout the procedure.

Next, a heat-resistant coil is inserted through the needle into the disc. The coil is positioned in the outer portion of the posterior (back of the) annulus. The annulus is the outside covering of the disc. It surrounds the inner core called the nucleus. A heating electrode is placed next to the protective coil. Only the area in contact with the electrode heats up.

Heat is applied until the temperature of the annulus reaches a pre-determined point. This is decided according to the surgeon performing the procedure. The target temperature is maintained for at least five minutes. One or two discs can be treated this way per session.

The patient is anesthetized under conscious sedation. This means the person is awake but doesn’t feel anything. This way, the patient can report any signs or symptoms of nerve root irritation right away. If all goes well, the needle is removed and the operation is over. The procedure is done on an out-patient basis. The patient goes home the same day.

If you are receiving treatment for a sore back with massage, the amount of time you can or should have treatment is an issue that can only be addressed by you, your massage therapist, and perhaps your doctor. For some people, relief is almost immediate and a few massages are all that are needed. However, for some people, massages are a regular long-term treatment.

Bone marrow edema (BME), which can happen after a trauma, is usually what is called a self-limiting disease. This means that it goes away on its own.

Pain from BME can come on gradually or very suddenly – there is no specific pattern. With rest, medication if needed, and time, the BME should go away on its own.

The treatment technique you are describing is called microfracture. This approach helps bring about a healing response in an area that doesn’t normally heal well on its own.

The surgeon carefully drills tiny holes around the edge of the defect. Then holes are drilled directly inside the defect. This second group of holes is spaced far enough apart to allow for the area to fill in and heal.

The rehab program is as important as the surgery. The patient must follow the steps of recovery very carefully. Too much weight too soon on the joint can stop the healing process.

Movement is important after surgery. The patient’s knee is usually placed in a device called a continuous passive motion (CPM) machine. The machine is set to allow a certain amount of knee motion. The specific settings depend on the location of the lesion. Sometimes bracing is also used. Again, this depends on where the lesion is located.

After the first eight-week phase of healing is over, then patients are weaned off crutches. They can start to put full weight on the joint. Exercises are prescribed to regain full joint motion. At this point, resistance exercises are added.

A physical therapist usually helps athletes move through each phase of the recovery and rehab program. Phase three builds on the results of the first two phases. Endurance is the focus of the next phase. Patients must be careful not to overload the joint.

Agility drills, running, and speed drills are gradually added into the program. Returning to the game may be delayed for six to nine months in cases where pivoting, cutting, and jumping are required.

Triplanar ankle fractures occur in children between the ages of 10 and 16. Boys are affected more often between 13 to 15 years and girls between 12 and 14 years. The difference has to do with when the growth plates close (sooner in girls than boys).

Triplanar refers to three directions or orientations of fracture. These include the sagittal (front-to-back) plane, transverse (side-to-side) plane, and frontal (top-to-bottom) plane.

The location and degree of damage depends in part on the status of the growth plates. Since these growth areas don’t close all at the same time, some areas are at greater risk for fracture than others.

Treatment is determined based on two things: fracture reduction and joint incongruity. Reduction refers to how well the bones can be matched back up to their normal alignment. Surgery is usually needed to pull the bones back down into place.

If this can be done without an open incision by using traction, then it is referred to as a closed reduction. This procedure is done under general anesthesia. Then the patient is put in a long leg cast while the ankle heals.

If the fracture remains displaced by more than three millimeters, then the surgeon will likely use an open reduction. The standard procedure involves making as many incisions as needed to correct the alignment. Metal plates, screws, wires, and/or pins are used to hold everything in place once the bone fragments are realigned as close to normal as possible.

More recently, surgeons have started using arthroscopic surgery. The scope allows the surgeon to see inside the joint. This makes it possible to get better alignment and fixation. Surgical trauma is less with this method. Direct visualization allows for more accurate joint congruity.

Ankle sprains are a fairly common injury among all adults, but especially among sports enthusiasts. A chronically sprained ankle can really put a damper on activities. Sometimes even walking can be difficult. And an unstable ankle puts you at risk for other injuries of the lower extremity.

The first step is to have a medical exam and find out exactly what’s wrong. The physician will use the history of injury and location of symptoms to decide what tests are needed.

Once the specific area of injury is identified, then special tests such as X-rays, CT scans, or MRIs can be ordered. An accurate diagnosis allows the physician to come up with the best plan of action for the problem at hand.

Many recurrent ankle sprains occur because some of the soft tissue structures have been damaged. This can include the ligaments, cartilage, and/or tendons. When the soft tissue structures don’t hold the joint steady during motion, instability can occur.

The foot and ankle may give way during daily activities. Trying to move beyond that to sports and recreational fun may not be possible. Conservative care is usually advised first. Physical therapy to restore normal joint sensation and muscular strength is important.

Shoe wear will be evaluated. You may need a heel lift or wedge. Sometimes inserts inside the shoe are helpful. Splinting or bracing may be required. Many patients recover well after an adequate course of rehab.

If non-operative care is not successful in restoring pain free, stable, and full motion, then surgery may be needed. But before you hit the panic button, make an appointment with an orthopedic surgeon and find out what’s wrong first. There could be a simple solution available to get you back up on the slopes!

A knee transplant, or a total knee arthroplasty (TKA) involves removing the natural, damaged knee, and replacing it with a mechanical implant that will mimic the action of the natural knee.

Literally, the surgeon removes the knee bone and cartilage, the tissue that holds the muscle to bone. This is replaced by the implant of metal and plastic.

There are different types of implants a surgeon can use. Some implants are cemented; they are fixed to the bone. Others are fit into the knee area and the bone around the knee grows around it holding it into position.

The type of fusion you are describing is called a tibiotalocalcaneal arthrodesis. Tibio-talo-calcaneal refers to the three bones that will be fused together. Essentially, your ankle and subtalar joint will be fused. Arthrodesis is the medical term for fusion.

There are various ways to surgically fuse these joints together. Screws, nails, and plates are possible options. These devices are used to hold the joint in place until the bone graft fills in and forms a solid fusion.

There will be a loss of ankle motion but bracing isn’t usually needed. The fusion provides the stability you need. But without movement at the ankle, you may need a good, supportive shoe. Shoe modifications can be made to accommodate any residual deformity that might be present.

Some patients require a high orthopedic shoe. Others may only need a heel raise or modification to the sole. Most (90 per cent or more) patients who have this type of fusion need some kind of shoe modification at least.

It’s always a good idea to complete all follow-up care after any type of surgery. This is especially true when there is hardware left in the body. If you can’t travel back to see the surgeon who performed the operation, then make an appointment with someone in your area instead.

Call your former surgeon and make arrangements for copies of your medical records to be sent to the new surgeon. X-rays are usually taken to confirm the results of the fusion. It’s important to know the status of your joints. Sometimes patients have a nonunion but remain free of symptoms for a while.

It is standard in some operations to leave the hardware in permanently. But in an operation of this type, some of the screws are removed after three to four months. This helps reduce irritation of the bone and soft tissues around the tip of the nail. Removing hardware can also decrease the risk of stress-related problems.

You may want to ask your former surgeon if he or she was planning any further surgery to remove some or all of the hardware. This might help you put together a list of questions for the surgeon who will follow-up your care in your current location.

When someone has severe pain in the ankle from a disease like arthritis, like your mother, it can cause a lot of problems, particularly pain and difficulty moving around. Some orthopedic surgeons are doing ankle replacements for patients who are in situations like this. The other, older and more common surgery is called arthrodesis, or bone fusion.

The research is showing, right now, that patients who have a total ankle replacement have a higher rate of having to have a revision surgery within five years of the initial surgery. For a fusion, the surgeon grafts some bone to the ankle joint and joins them together so they do not move, therefore eliminating the pain from the joint. The drawbacks from this surgery include the future fusion of the other joint in the ankle and the limited range of motion in the ankle after it has been fused.

Your mother should speak to her doctor about the type of surgery he or she is offering and ask questions about why one is preferred over the other.

How quickly you recover from an ankle replacement will depend on your health, how the surgery went, and if there are any complications.

In general, if you are relatively healthy and the surgery goes well without any complications, you can look at being discharged from the hospital anywhere from a day or two after surgery to a few days. You will likely have been seen by a physiotherapist to show you what types of exercises you should do for your ankle.

These exercises and following instructions about what you can and cannot do are vital in your recovery. You should not overdo it and cause stress to your ankle, but you should make sure to do as much as has been suggested by your physiotherapist.