Chronic Ankle Instability
Treatment
Nonoperative
- physio
- peroneal muscle strengthening, proprioception training
- brace
- modify activities
- orthotic
- lateral heel wedge
Operative
- Types
- anatomic vs non-anatomic repair/reconstruction
Anatomic repair (Brostrom)
- relative contraindications for anatomic repair
- failed prior surgery
- long-standing (>10 years) instability with severely attenuated tissues
- connective tissue disorders
- fixed heel varus (Coleman block test)
- Procedure
- lateral incision that curves around tip of fibula & incise extensor retinaculum
- ID anterior talofibular ligament, calcaneofibular ligament & posterior talofibular ligament
- ankle arthrotomy & examine for inta-articular pathology
- incise ligaments near fibular attachment & perform pants-over-vest repair (possibly drill holes thru bone)
Non-anatomic reconstructions
1. Watson-Jones: (reconstructs anterior talofibular ligament)
- PB tendon (leave attached distally)
- run from posterior » anterior thru bone hole in fibular, thru bone hole in talus & suture back on itself
2. Chrisman-Snook: (reconstructs calcaneofibular & anterior talofibular ligaments)
- anterior ½ of PB thru drill hole in fibula & cancaneus then into talar neck with screw
Postoperative
- cast/foam walker boot x 6 weeks with full WB followed by walker boot for another 6 weeks
Results
- all procedures about 80% successful