Injuries to the external and internal ligament structures of the hindfoot are amongst the most common injuries overall. Conservative early-functional treatment with stabilizing splints and ortheses is now the generally accepted standard therapy in acute conditions.
Surgical stabilization is only medically indicated if the instability associated with pain, swelling and feelings of instability remains and after repeated sprain traumas, because otherwise this could give rise to the development of arthroses of the ankle joint in the medium term. Detailed knowledge of the exact location and course of the three collateral ligaments is an indispensable precondition for any successful surgical stabilization.
Course of the collateral ligament in the bone model
LFTA: anterior fibulotalar ligament, LFTP: posterior fibulotalar ligament, LFC: fibulocalcaneal ligament between the external malleolus (ankle) and the heel bone (calcaneus), A: external malleolus
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Typical tear of the anterior fibulotalar ligament and the fibulocalcaneal ligament
1: external malleolus
2/3: torn anterior fibulotalar ligament
4: torn fibulocalcaneal ligament
5: peroneal tendons
Depending on the nature of the injury, one of the following procedures is used to stabilize the joint:
- Suture of the ligament if the ligament is still in place, but deformed by scars or lengthened
- Periosteal flap for a ligament that is destroyed or no longer evident
- Free tendon transplant and ligament reconstruction with plantaris or extensor tendon for the replacement of 2 to 3 ligaments
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| Ligament reconstruction with resorbable anchors |
Periosteal flap reconstruction for a lost ligament |
After your operation
Immediately after the operation, your lower leg is fitted with a removable plaster splint and the foot elevated for the subsequent period. Rest until the wound is completely healed (10-14 days). Stitches are generally removed after about 12- 14 days. If the wound is healing well and swelling of the foot sufficiently reduced, generally on day 5 or 6 after the operation, you will be fitted with a special stabilization aid (Vacoped brace, Kuenzli shoe) during an out-patient visit, which prevents sideways slippage of the joint. Starting in week 2 after the operation, with the stabilization aid in place, a physiotherapist will guide you in active and passive mobilization exercises for dorsal extension and plantar flexion with partial weight-bearing. Functional treatment without the brace begins in or after week 5 following the operation, and involves gait training and exercises to stretch and strengthen the calf muscles.
Medication
Anti-inflammatory and analgesic tablets (diclofenac or paracetamol) prevent inflammation and control pain.
Recommended dosage: 3 x 1 tablet per day for 7-14 days
Anti-thrombotic injections (e.g. Fragmin) to prevent thromboses are to be administered for at least as long as you use crutches to ease the load on your foot.
Aftercare
Only a few weeks after the operation, largely pain-free walking with full weight-bearing should be possible. This permits a speedy resumption of normal daily activities.