{"id":20753,"date":"2024-09-10T15:29:54","date_gmt":"2024-09-10T14:29:54","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=20753"},"modified":"2024-12-24T12:05:35","modified_gmt":"2024-12-24T12:05:35","slug":"ankle-pain-instability","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/ankle-pain-instability\/","title":{"rendered":"Ankle Pain & Instability"},"content":{"rendered":"\n

Information<\/strong><\/p>\n\n\n\n

Ankle pain can be for many reasons – arthritis , tendon tears, impingement, loose bodies for example, but can also be from pain in the adjacent joints \u2013 the subtalar and talonavicular joints. Ankle instability is frequently seen after previous ligament injuries but can also be seen as a result of cartilage damage, loose bone fragments of tendon injuries.<\/p>\n\n\n\n

Ankle arthritis<\/em><\/strong> is not as common as arthritis in the hip or knee and is most commonly seen after previous trauma or multiple sprains. In early stages this may respond to orthotic management, physiotherapy but occasionally an ankle arthroscopy will help to remove impinging osteophytes. In end stage ankle arthritis there are two potential operations \u2013 ankle replacement or an ankle fusion<\/em>. Both can have excellent outcomes in terms of relief of pain and improved function. The decision as to which one is best for the patient depends on many factors including age, deformity, range of movement and radiological changes.<\/p>\n\n\n\n

Arthritis<\/em> in the other hindfoot joints (subtalar, talonavicular or calcaneocuboid) can only be surgically treated with an arthrodesis or fusion<\/em>. This is an operation where a stiff painful joint is converted to a fusion and so there is usually only a small change in the movement. The operation generally means 6 weeks in a cast and six weeks in a boot. Often orthotic management or injections will be helpful.<\/p>\n\n\n\n

Impingement<\/em><\/strong> in the ankle may be from bone spurs, loose fragments of bone or soft tissue impingement. If this does not respond to non-operative management or an injection then an ankle arthroscopy is often considered.<\/p>\n\n\n\n

Ankle instability<\/em><\/strong> is generally seen following previous ankle sprains. If the ligaments do not heal properly then they can be lax, leading to instability and recurrent ankle sprains. There are several other pathologies following a bad ankle sprain that can also lead to symptoms such as peroneal tendon tears, osteochondral lesions, impingement. Recovery after a bad ankle sprain can take a year and physiotherapy is key. If symptoms do not resolve then an MRI is generally arranged. Instability can be addressed with a lateral ligament reconstruction (Brostrom)<\/em> and an arthroscopy<\/em> is often performed simultaneously.<\/p>\n\n\n\n

M.A. & J. McK. 11-09-24<\/strong><\/p>\n\n\n\n