What is the Surgery for Chronic Ankle Instability

Surgery for chronic ankle instability is a procedure to treat long-term ankle weakness (chronic ankle instability). This instability can be the result of repeated ankle sprains, or it can be be due to a torn ankle ligament. Ligaments are strong bands of tissue that attach one bone to another.

If your ankle ligaments tear or stretch, your ankle will become unstable. Your ankle may give way, causing you to roll over on the outside of your foot.

You may need surgery for ankle instability if bracing and physical therapy have not helped after several months.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to nerves or blood vessels near your ankle.
• A blood clot that forms in your leg and travels to your lung or heart.
• Instability that lasts after surgery.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home from the hospital or clinic.
• If you will be going home right after the procedure, plan to have someone with you for 24 hours.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• Your surgeon will make an incision over the outside of a bone that is part of your ankle (fibula).
• Your surgeon may insert a thin telescope (arthroscope) inside your ankle to examine the inside of the joint and find the ligaments that support your ankle.
• Torn ligaments may be sewn back together.
• Small holes may be drilled in your fibula to attach the ligaments to the bone.
• If the ligaments are too weak to support your ankle, ligaments from another part of your foot may be used. Your surgeon may also use tissue that attaches muscles to bone (tendon).
• The incision will be closed with stitches (sutures).
• A bandage (dressing) will be placed over the incision.
• A cast or splint will be put on to support your ankle while it heals.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• Do not drive for 24 hours if you received a sedative.
• You may be given crutches or a walker to keep body weight off your ankle.

Surgery for Chronic Ankle Instability, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Soreness in the ankle.
• Ankle pain.
• Numbness in the ankle.

Follow these instructions at home:

If you have a splint or brace:

• Wear the splint or brace as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint or brace if your toes tingle, become numb, or turn cold and blue.
• Keep the splint or brace clean.
• Do not let your splint or brace get wet if it is not waterproof.

If you have a cast:

• Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
• Keep the cast clean.
• Do not let your cast get wet if it is not waterproof.

Bathing

• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
• If your splint, brace, or cast not waterproof, cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• If directed, put ice on the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your cast or splint and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your toes often to avoid stiffness and to lessen swelling.
• Raise (elevate) your foot above the level of your heart while you are sitting or lying down.

Driving

• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Do not drive for 24 hours if you received a sedative.
• Ask your health care provider when it is safe to drive if you have a splint, brace, or cast on your foot.

Activity

• Do not use your ankle to support (bear) any of your body weight for 2–6 weeks. Use your crutches or walker as told by your health care provider.
• After 2–6 weeks, you may be changed from your splint, brace, or cast to a walking boot, and you may start physical therapy.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do physical therapy exercises as told by your health care provider or physical therapist.

General instructions

• Do not put pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Do not use any tobacco products, such as cigarettes, chewing tobacco, and e-cigarettes. Tobacco can delay bone healing. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your foot or toes feel numb or cold.
• Your pain medicine is not working.
• You have a fever.

Get help right away if:

• You have warmth, tenderness, swelling, or pain in your leg.
• You have chest pain or difficulty breathing.
• Your toenails get darker or they turn blue or gray.