When the ankle fracture is unstable or in bad position, surgery is needed to repair the ankle. In some cases, the bones of the ankle may poke through the skin. These are called open ankle fractures and require surgery.

Ankle fracture surgery is not needed if the ankle is in position and stable despite the fracture. Surgery may be too risky when patients have a severe medical condition

The arthroscope has been around for a long time, and it’s been used successfully in the shoulder and the knee for many years. And it’s an instrument that allows surgeons to see inside the joint and project an image onto a TV screen so they can see what they’re doing, and they get a much better view of the joint on the TV screen than they’d ever get trying to look in the joint after making a large incision and looking through retractors holding the skin and soft tissue apart.

The arthroscope gives good detail, but has the added benefit that during the surgery the dissection is kept to a minimum so that the swelling and pain that occurs after the operation is much less. The arthroscope, therefore, has a lot of benefits in the foot because the foot is the part of you that is lowest down and therefore gets the most amount of blood pressure if you’re standing up.

And so keeping the cuts or incisions during the surgery down to the very minimum is very helpful in reducing wound complications as well as swelling and pain after a foot and ankle operation. So the arthroscope has been introduced into a number of joints in the foot, and in particular it’s used now for the ankle joint to allow us to see within the joint and treat conditions within the joint.

But there are other joints around the ankle now that are fairly routinely scoped, such as the subtalar joint or the big toe or the metatarsophalangeal joint. The big toe joint can be approached through two small cuts on the top side, and injuries to the cartilage surface or arthritis or boney protuberances on the top of the joint or splitting of the little bones underneath the joint can be seen and treated through the scope with less swelling and less pain. Local Orthopedic Surgeon

There are other joints that might be beneficial to scope but they’re hard to get to, such as these very tight joints in the middle of the foot that are hard to see at the current time. So there are many exciting developments in foot and ankle in the use of the arthroscope that’s getting miniaturized in time, and you might want to consider talking to your family doctor to see if you need to see an orthopaedic surgeon to see if this type of technology might be beneficial for you and the foot and ankle pain that you suffer.   Often seeing a local family physician or a pharmacist in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.  

Presenter: Dr. Alastair Younger, Orthopaedic Surgeon, Vancouver, BC

Now Health Network Local Practitioners: Orthopaedic Surgeon

One variant of the typical ankle sprain, which is more serious, is the high ankle sprain.So this involves a sprain of different ligaments. These are the ligaments that attach these two bones together, so the tibia and the fibula, and also the ligament that wraps around the front of the ankle and holds the tendons in place.

When those ligaments are sprained, it can make the entire ankle complex unstable causing these bones to spread apart from one another. So in a third degree or complete tear of those ligaments, a screw needs to be placed across these bones in order to hold them back together.

Most high ankle sprains that are less severe will require a few weeks of not bearing weight on the foot. So typically people will have to use crutches. Once you’re allowed to bear weight, then it takes somewhere between four and six weeks to be able to go back to do most of your normal activities. If you think you have a high ankle sprain or have more questions, you could consult a sports medicine physician or a physiotherapist.

With more serious injuries that requires surgery, you may not be weight-bearing for up to six weeks and then another six to 12 weeks after that before you can resume activity. The typical treatment for lesser sprains would include ice, anti-inflammatories, physiotherapy, and of course in terms of diagnosing these injuries, sometimes you will need an x-ray.

There are times where these kinds of injuries are hard to pick up even on an x-ray, and we may need to do an MRI, for example. The best way to prevent these kinds of injuries typically would be to make you’re doing a good ankle strengthening and balance program in advance of starting your season.