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What does this surgery involve?
This refers to repair and reconstruction of the ligaments on the outside of your ankle. These are commonly injured when the ankle is sprained and on occasions will lead to symptomatic instability when your ankle repeatedly gives way especially on uneven ground or when participating in sports that involve cutting and turning frequently. If this isn’t resolving in time and following a course of physiotherapy, then you may need to have surgery. The two ligaments commonly injured are the Anterior Talo Fibular ligament (ATFL) and the Calcaneofibular Ligament (CFL). They attach the Fibula to the Talus and to the Calcaneus respectively and stop your ankle turning in or inverting.
What are alternatives to surgery?
Surgery to stabilise the ankle and repair ligaments is not always needed after an ankle sprain. In fact, most people manage to rehabilitate with Physiotherapy. This is because the muscles that control the ankle (peroneal muscles in particular) can be trained to compensate for some degree of ligament laxity and weakness. This forms the basis of physiotherapy and it is the reason why it can be successful.
Some people who are very hypermobile or have ligament laxity or those with a high arch foot may recover slower. Insoles and ankle braces can be helpful in some cases. Braces can help in the initial few weeks to allow the swelling to settle and the ligaments to heal without excessive tension. You may need to wear a brace when playing sports to protect the ankle.
What dose surgery involve?
This is normally a day surgical procedure performed under general anaesthetic. The incision is about 5 cm long and it is curved on the outside of your ankle. There are various repair techniques, but I use two small 3mm metal anchors to repair the injured ligaments back onto the fibula bone.
The surgery takes around 30-45 min. The surgical incision is closed with absorbable sutures.
During surgery a tourniquet is wrapped around your upper thigh to stop blood obscuring the operative filed. You may sometimes feel some soreness around your thigh for a day or two postop as a result.
After the operation you will be placed in a full below the knee plaster back slab. This is a half plaster with bandaging around. You will not be allowed to weight bear and will be given crutches to use. The plaster back slab is removed 2 weeks after the surgery when you attend your first post-operative appointment and at that stage a boot or brace is given to you.
What are the risks of surgery?
This information needs to be read in conjunction with the general risks of foot and ankle surgery but some of the specific risks to a Brostrom ligament surgery are discussed in more detail below.
What is the Post op recovery like?
Weeks 0-2
You will be in a plaster back slab and ‘non-weightbearing’ with crutches.
In this time, you can take the painkiller prescribed and elevate your leg as often as possible. Local anaesthetic given at the time of the surgery will start wearing off anywhere between 6-12 hours after the operation. If you have had a nerve block sometimes it can last 24 hours.
Unless you can work from home it is recommended that you stay off work in this time. Otherwise, the commute to work can be difficult on crutches, however if you can get to work safely and can elevate your foot under a desk than can consider returning within a few days.
It is important that you move around to reduce the risk of blood clots and to exercise the rest of your lower limb muscles, but don’t have your operated leg down for more than 20 mins at a time as it will swell and become painful.
You will be given a follow up appointment at 2 weeks postop for cast removal and wound inspection at which point most patients will be given a “moon boot”. You can then start to bear weight on the operated foot and get rid of the crutches as soon as you are confident to do so.
Weeks 2-6
In this period, you can walk with fully weightbearing. You may wish to discard the crutches as you gain confidence.
It is also a good idea to start some gentle rehabilitation with exercises of the ankle out of the boot but taking care to avoid turning the ankle in or out. You may wish to start seeing your physiotherapist for a few sessions in this time for some open chain exercises. We can discuss this at your follow up appointment.
You can start work and will manage most daily activities. Swelling may persist after heavy use and you should continue with elevation and icing when required.
You are also able to have a shower or bath if careful out of the boot. If the incision has healed, then it can now get wet if it is dried fully afterwards.
I will see you again at the six-week mark to assess your progress and at this stage you will be sent to start physiotherapy. The use of the boot can now be discontinued.
Weeks 6-12
Physiotherapy would have formally commenced by this stage and you will discard the boot at the beginning of this period.
Any impact activity or sports should be avoided but gentle none cutting or turning sports and exercises such as cycling, or swimming can commence. You may be able to start jogging on a treadmill and use a cross trainer towards the end of this time interval.
Week 12 onwards
You can gradually start playing competitive sports. Initially in line sports such as jogging or cycling but eventually sports involving cutting and turning such as football, hockey or netball.
I do recommend that you wear a sports ankle support such as the Air Cast A60 during any such sports for the first year after surgery to further protect the repair.
