An ankle sprain involves rolling the ankle which can cause ankle fractures or damage to the ankle ligaments. Radiographs or x-rays taken after such injuries show bone and joint but not the soft tissues of the ankle such as tendons and ligaments. Patients are often relieved to hear that “nothing is broken” after xrays are performed. Soft tissue injuries can be significant too because ankle ligaments that fail to heal properly lead to “weak” ankles or ankles that are unstable or turn easily. We have seen many patients who are concerned that they twist their ankles easily, sometimes on level ground. They may avoid or limit certain activities to avoid injury.
Is is possible to live with an ankle with weak or torn ligaments? The answer may be yes for some. One may tape their ankles or wear ankle braces. A person who is more sedentary will have less limitations than one who is active. One’s occupation matters too. An unstable ankle that hardly limits someone doing deskwork can be dangerous in, say, a roofer, who requires balance or a fireman who has to be stable on ladders.
There are three ligaments that can become stretched and torn leading to lateral ankle instability: the ATFL or anteriortalofibular ligament, the PTFL or posterior talofibular ligament and the CFL or calcaneofibular ligament. The ligament most likely to become injured is the ATFL which runs in front of the outside (lateral side) of the left ankle.
Traditionally, several surgical procedures have been used to stabilize the ankle by repairing the ligaments. One of the more common procedures is known as the Brostrom procedure in which the surgeon basically sews up the ATFL. The ligament can take up to 6 weeks to heal with this procedure and requires a cast for about 4 weeks. The procedure can work well but one issue is that often the ligament is weak or frayed so that limits the strength of the repair.
Dr. Davis has embraced a newer and potentially more effective technique that provides a stronger repair, reduced casting time and quicker return to activity developed by Arthrex, known as the internal brace system. The technique involves placement of a “ribbon” of a very strong flexible material: According to Arthrex, “The flexible FiberTape® suture is composed of ultra-high-molecular–weight polyethylene (UHMWPE), a strong, stress-resistant material with Kevlar®-like properties that has been used safely and effectively in millions of patients.” This creates essentially a second ligament sewn underneath the ATFL repair creating immediate strength. Learn more about lateral ankle instability.
Dr. Davis has performed lateral ankle stabilization utilizing the internal brace system on athletes allowing fast return to rehab and function. He feels that the technique is not just for athletes but beneficial to all who need strong stable ankles.
