Ankle injury (orthopaedics)

The orthopaedic surgeon makes a diagnosis through a thorough examination with imaging (radiology) if necessary. Based on the diagnosis, the doctor prescribes treatment, which may include medication and/or physical therapy. At some point or with certain injuries, surgery will be necessary.

Plan your appointment

Association orthopaedics 011 33 42 86 dr. Peter Bollars 011 69 96 60

Causes and symptoms

The ankle is a complex joint that has to endure a relatively high load. The ankle joint consists of three bone parts: the fibula, the shin (tibia) and the talus (talus).

The bone parts are covered on the joint side with cartilage. Surrounding it is the joint capsule and a number of ligaments that ensure stability to the ankle. There are several tendons running along the ankle that are important for the stability and movement of the ankle and foot.

Complaints of the ankle joint are common. These complaints are related to different aspects: position, strain, occupation, sports or age.

Ankle injuries usually occur after a sprain or sprain of the ankle, damaging the ankle ligaments and/or cartilage. In many cases, there is recovery without surgical treatment.

Ankle problems

Painful entrapment symptoms (impingement) on the front or back of the ankle.

These entrapment symptoms can be caused by soft tissue thickening due to scar tissue, caused by, for example, twisting of the ankle. Ankle entrapment can also occur due to extra bone growth around the joint (osteophytes). These can also be caused by frequent sprains or a long-term high (sports) load. The entrapment caused by extra bone growth or by thickening of soft tissues mainly causes pain symptoms around the ankle and sometimes other sterile inflammatory reaction (heat, swelling).

During exploratory (keyhole) surgery, this tissue (soft tissue or bone) can be removed, so that the entrapment is resolved.

Symptoms

Pain, which occurs particularly during terminal movements of the ankle. They can also restrict movement by causing tissue entrapment.

Diagnosis

The final diagnosis is made by asking specific questions about the symptoms and an examination of the ankle. In addition, an x-ray will be taken. If an X-ray does not provide enough information, an additional MRI scan or CT scan may be performed.

‍General treatment

During exploratory (keyhole) surgery, this tissue (soft tissue or bone) can be removed, relieving the entrapment.

For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.

Cartilage defects (osteochondral lesions) of one or more bone parts of the ankle (fibula, tibia, ankle bone). These can occur as a result of wear and/or (sports) injuries, but a cartilage defect can also occur spontaneously with no apparent cause.

Symptoms

With cartilage pathology, the ankle feels painful, unstable, is thick, "locks up" or creaks painfully and audibly. Basically, cartilage cannot fully repair itself because there are no blood vessels or nerves in it. Because of this, cartilage damage is not felt until the tissue around it becomes irritated. A small piece of cartilage may be broken locally, or the cartilage may be more or less damaged over the entire surface.

Diagnosis

The final diagnosis is made by asking specific questions about the symptoms and an examination of the ankle. In addition, an x-ray will be taken. If an X-ray does not provide enough information, an additional MRI scan or CT scan may be performed.

‍General treatment

During keyhole surgery, a cartilage defect can be treated by "drilling up" the defect. First, this technique involves removing loose cartilage pieces and damaged cartilage. Then a thin drill is used to make holes in the bone layer below the cartilage. Bone marrow cells that can produce scar cartilage will now fill the holes in the cartilage. This stimulates repair of the cartilage.

In case the cartilage defect is a large loose fragment, the defect may also be cleaned and then the fragment fixed with a small screw.

For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.

A joint mouse is a loose piece of bone or cartilage. This can occur as a cartilage defect as described earlier, but is also often caused by a bone fracture or major accident to the ankle, which causes a loose piece of bone to enter the ankle.

Symptoms

This loose piece can then cause pain symptoms and "lock" the ankle.

Diagnosis

The final diagnosis is made by asking specific questions about the symptoms and an examination of the ankle. In addition, an x-ray will be taken. If an X-ray does not provide enough information, an additional MRI scan or CT scan may be performed.

‍Treatment 

During keyhole surgery, this loose fragment is removed. 

For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.

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When speaking of the Haglund exostosis, the patient has complaints at the level of the attachment of the Achilles tendon. An exostosis is a bone protrusion. Pressure on a bone can cause the bone to thicken and create a protrusion (exostosis) at the site of that pressure.

If pressure on the back of the heel bone near the attachment of the Achilles tendon causes such a protrusion, it is called a Haglund's exostosis. Usually the cause is increased pressure due to (sports) shoes. A bursa can develop between the bony protrusion and the Achilles tendon. This bursa, in turn, can also become inflamed due to friction.

Symptoms

The exostosis causes a painful, hard and sometimes red swelling to occur on the back of the heel bone, on the outside of the Achilles tendon attachment.

Diagnosis

The final diagnosis is made by asking specific questions about the symptoms/complaints and an examination of the ankle. In addition, an x-ray will be taken. If an X-ray does not provide enough information, an additional MRI scan or CT scan may be performed.

G‍eneral treatment

During keyhole surgery, this bone protrusion can be removed. The bursa between the Achilles tendon and the heel bone is also removed and the Achilles tendon is inspected. Usually the Achilles tendon itself is also slightly affected and can also be cleaned during surgery. However , if the examinations (NMR) show that the Achilles tendon is too much affected, an open procedure should be considered.

Forced wear of the ankle joint

‍Treatment 

Through keyhole surgery, the remaining cartilage is removed and the bone is roughened to allow the tibia bone to attach to the talus bone. Two screws are usually inserted to attach the bones together. This procedure takes longer than the previously mentioned procedures.

It is, however, considered individually whether the arthrosis of your ankle can be fixed via keyhole surgery or open procedure.

For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.

When the ankle is twisted or sprained, the ankle ligaments may stretch or tear.

With an ankle sprain, the ankle often becomes immediately swollen and blue and is very painful. Usually an ankle can recover well after this with some rest (possibly a temporary cast and/or an ankle brace) and physiotherapy. If an ankle sprain occurs more frequently, symptoms may persist because the ankle ligaments have not healed properly. This can also damage cartilage of the joint.

Symptoms

  • swelling
  • pain
  • frequent spraining of the unstable ankle

Diagnosis

The ankle specialist at the Orthopedics association n Sint-Trudo diagnoses ankle instability based on the patient's symptoms and physical examination. Imaging is also done to rule out that there is no fracture in the ankle, to see if the cartilage is damaged and which ligaments are damaged. This is usually done through a standard X-ray and/or an MRI scan.

Treatments

  • Conservative treatment of ankle instability
  • Operative treatment of ankle instability
  • Arthroscopy of the ankle

Orthopaedic surgeons specialised in ankle injuries

dr. Daniël Janssen

dr. Daniël Janssen

orthopaedic surgeon
Read more
dr. Garcia Barrado Fernando

dr. Fernando Garcia Barrado

orthopaedic surgeon
Read more
dr. Annelies Moermans

dr. Annelies Moermans

orthopaedic surgeon
Read more

Examinations

The diagnosis is made in several ways:

  • Exhaustive questioning about the problems and how they might or might not have arisen.
  • Clinical examination in which the shape of the foot (flat foot / hollow foot / spread foot / sagging foot) may be at the base of the problem.
  • Ordinary radiography of the foot is almost always requested "standing" and already gives a lot of information. It is therefore often interesting to request this examination in advance (through your doctor or our secretariat) before your first consultation.

After extensive questioning and clinical examination, sometimes an additional examination (usually a specific scan) is necessary to determine the treatment.

Treatments

Operative treatment ankle instability

A stabilizing ankle ligament operation is chosen when there are permanent instability complaints despite adequate non-surgical treatment. Various surgical methods can be used for surgical treatment. The choice of the correct surgical method depends, among other things, on the quality of the stretched ankle ligament.

Standard procedure

In case of an ankle instability with good tissue, the standard procedure is performed. This involves making an incision across the outer ankle forward. The ankle ligament is exposed, passed through and sutured back onto the outer ankle with an anchor (small screw from which solid sutures come out) to make it shorter and firmer again. Next, the firm capsule that runs across the entire ankle (the retinaculum) is exposed and sutured over the ankle ligament for added stability. The wound is closed with dissolvable sutures.

Additional procedures

During surgery, the orthopedic surgeon can really see whether the tissue of the ankle ligament is strong enough to suture. Sometimes there is insufficient strong tissue and the choice is made to use an internal brace. This is a type of lace strap that the doctor can attach like a new ankle brace with two anchors in the places where the ankle brace normally attaches. The follow-up treatment does not change if one of these additional procedures is performed.

Sometimes, keyhole surgery of the ankle is also performed in the same operation if, for example, there is also cartilage damage that needs to be treated.

Post-treatment

The ankle is immobilized with a cast and walker for some time to allow the ankle ligaments to heal. This must remain on for six weeks, both day and night. For the first two weeks you may not put any weight on it and must walk with crutches. After that, you may walk without crutches. After six weeks, you must wear an ankle brace all day for another six weeks. For the first year after surgery, you should not play sports without a brace. For more intense sports such as soccer/basketball/volleyball/hockey, among others, you are advised to play sports with the brace even longer.

‍Conservative treatment ankle instability

To treat ankle instability, different treatment methods can be chosen. Initially, non-operative treatment is usually chosen to increase ankle stability. This involves an intensive exercise regimen with a physiotherapist to train ankle stability and, in particular, to improve the control of the muscles around the ankle. This is also known as improving propriocepsis. This intensive exercise therapy is usually done in combination with wearing a brace.

‍Arthroscopy of the ankle

For certain conditions of the ankle, the orthopedic surgeon may recommend keyhole surgery (arthroscopy) if nonoperative treatment proves insufficiently effective. During keyhole surgery, the surgeon not only looks inside the joint, but can also treat any abnormality immediately.

A keyhole surgery of the ankle takes about 30 minutes to 1 hour and is performed under general anesthesia (deep sleep) or with an epidural. The surgery involves making two small incisions in the skin on the front or back of the ankle. Through the first, a (camera) arthroscope is inserted into the ankle joint. This provides an image of the ankle joint on a monitor in the operating room. The joint is continuously flushed with a saline solution. This causes the ankle to expand slightly and a clearer image can be obtained. For an even clearer image, the ankle joint is "blood drained" with an inflated blood pressure band around the thigh. Various instruments can be inserted through the second skin opening for the procedure.

Benefits of keyhole surgery

The procedure is safe; the risk of complications is much lower than with "open" surgery.

With keyhole surgery, a better view of the entire ankle joint can be achieved than with 'open' surgery. This also makes it possible to directly treat an injury that was not predicted.

Keyhole surgery is much less stressful than "open" surgery. The muscles around the ankle do not have to be loosened and sutured back together. Surrounding tissues are also less damaged. As a result, recovery is smoother than with an "open" procedure.

Post-treatment

Most keyhole surgery does not involve staying overnight in the hospital. Thus, one can go home the same day. Because keyhole surgery is less stressful on the ankle than "open" surgery, recovery can be smooth and functional to quickly recover enough to resume daily activities.

When fixing the ankle joint (arthrodesis) in connection with osteoarthritis, the follow-up treatment does differ from other keyhole surgery on the ankle. After the ankle is fixed, the ankle is treated with a cast and/or a walker boot for 3 months to allow the bones to grow together. However, each surgery remains unique, so recovery also varies from patient to patient.

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Departments

For diagnosis and treatment, you can visit our orthopaedic surgeons. As part of certain treatments or after any surgery, you can visit our rehabilitation centre.
Orthopaedics

Plan your appointment

Association orthopaedics 011 33 42 86 dr. Peter Bollars 011 69 96 60