The outer ligaments of the ankle known as the ATFL, the anterior talar fibular ligament and the CFL, the calcaneal fibula ligament, are the most commonly injured ligaments in the body with one in ten thousand of us injuring these per day. These ligaments are injured when you twist or invert your ankle. Frequently they will have been injured on more than one occasion to produce an ankle that is unstable.
Alternatives to Surgery
Acutely torn ligaments should be immobilised for three to four weeks in a walking Aircast boot or a plaster cast. If there is a delay in diagnosis, and the ligaments have not been immobilised, then a physiotherapy programme can be undertaken to strengthen the other muscles and tendons that act around the foot to compensate for the stretched and damaged ankle ligaments. Some patients will also use, in addition to physiotherapy and exercise treatments, off the shelf ankle supports such as the Bauerfiend MalleoTrain S ankle support to offer them stability when they are doing sporting activities.
The Brostrum Repair Operation
This is a commonly performed surgical procedure. Under a general anaesthetic the ankle is first examined for the degree of instability, then a full diagnostic arthroscopy of the ankle joint is performed to check for, and deal with any other intra articular ankle injuries. After this is done, an oblique incision is made over the outer aspect of the ankle in the skin creases and there are a range of techniques but the one we prefer is a direct anatomic repair of the stretched and torn lateral ligaments to allow the surgeon to double breast this stretched ligaments back over themselves to return them to their normal length, thickness and strength.
Patients are able to go home the following day fully weight bearing in an Aircast boot with crutches for support. The boot is worn for three weeks but taken off to rest and sleep, then from weeks three to six post operatively a physiotherapy programme is undertaken.
