Foot and Ankle
Our feet and ankles are being used everyday for various daily activities. Hence, injuries to the foot and ankle are very common.
The ankle is made up of 3 bones that meet at the ankle joint: the tibia (shinbone), fibula (smaller bone of the lower leg) and talus (small bone in between the tibia and fibula and the calcaneus). The ankle joint where these 3 bones meet are encased by a joint capsule, which contains synovial fluid. This synovial fluid is important as it allows for smooth movement of the joints. The ankle is surrounded by ligaments, which help to stabilise it.
The foot is a complex structure of the body, consisting of 26 bones, 33 joints, 107 ligaments, and 19 muscles. The bones can be categorised into 3 sections:
The forefoot consists of your toes (phalanges) and metatarsals
The midfoot consists of bones that make up the arch of your foot
The hindfoot consists of the heel and ankle, where the talus and the calcaneus (heel bone) are found.
Muscles, ligaments and tendons in the foot help stabilise your foot and allow for complex movement and motions. As there are many bones in the foot, fractures can occur at many locations in the foot, such as toe fractures, metatarsal fractures or calcaneus fractures. Another type of fracture that can occur in your foot is a stress fracture, which develop due to stress overtime.
WHAT IS CHRONIC ANKLE INSTABILITY?
The ankle is one of the most commonly injured parts of the body in sports, with ankle sprain being the most common ankle injury. An ankle sprain occurs when there is injury to the ligaments that support the ankle, when they get stretched and torn due to a force that is beyond the normal range of motion, for example twisting the ankle.
Ankle sprains can be classified into 3 categories:
- Grade 1
Mild ankle sprain with no significant tearing to the ligament
- Grade 2
Moderate ankle sprain with a partial tear to the ligament
- Grade 3
Severe ankle sprain with a complete tear to the ligament
It is important to seek treatment for an ankle sprain before returning to their regular activities, especially for people involved in sports. If not, this may lead to chronic ankle instability.
Chronic ankle instability refers to the recurrent ‘giving way’ of the outer (lateral) side of the ankle, which develops when ankle injuries do not heal properly, such as an ankle sprain.
WHAT ARE THE SYMPTOMS OF CHRONIC ANKLE INSTABILITY?
Symptoms of chronic ankle instability include:
- Pain and swelling in the ankle
- Persistent discomfort
- A wobbly feeling when putting weight on your ankle, as if it is about to give way
- Your ankle rolls over repeatedly when you engage in vigorous activity or when you are walking on uneven surfaces
WHAT IS THE DIAGNOSIS OF CHRONIC ANKLE INSTABILITY?
A history of the injury and a physical examination of the ankle will be conducted by the Doctor to check for tenderness and swelling of the ankle.
Imaging tests will be taken, such as a MRI scan where the doctor can check if there is any injury to the ligaments around the ankle.
WHAT ARE THE TREATMENT OPTIONS FOR CHRONIC ANKLE INSTABILITY?
The initial treatment for chronic ankle instability is nonsurgical methods. These include:
- Medications such as nonsteroidal anti-inflammatory drugs such as ibuprofen to relief pain and reduce inflammation
- Physiotherapy involving strengthening and balancing exercises to regain muscle strength and improve your balance
- Ankle guards to provide support to your ankle
- Exercises for weight loss, should there be a need for it
Should your ankle condition not improve after 3 months of nonsurgical methods such as physiotherapy, surgery may be recommended.
There are a few types of surgery, but the preferred one is minimally invasive surgery (MIS) using the Arthroscopic Broström-Gould Repair. Compared to open surgery, MIS uses smaller incisions, which result in lesser bleeding and a lower risk of wound complications.
WHAT IS THE RECOVERY PROCESS AFTER SURGERY FOR CHRONIC ANKLE INSTABILITY?
After the surgery, expect to wear a cast on your ankle which will immobilize it, promoting healing. Medications will be prescribed for pain relief as you may experience mild pain for a few days. After your stitches are removed, you will be wearing a walking boot and assigned simple ankle exercises to reduce the stiffness of your joints which will help to improve your range of motion.