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Severe Foot Sprain - surgeon recommended surgery?

My 16 yr old daughter severely sprained here ankle. The MRI results indicate a complete tear of the right anterior talofibular ligament as well as probable complete tear of the right calcaneal fibular ligament. Also there is a partial tear of the posterior talofibular ligament. The foot surgeon recommended surgery. Should we do it?
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replied October 20th, 2011
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That depends upon several factors, such as: the activity level and daily demands of the patient; how adverse one is to surgery; and how long ago the injury occurred.

In Grade IV ankle sprains, if the patient does not want to have surgery at the present time, an attempt to get the ligaments to scar down is an option. Usually, in this case, the patient is immobilized (usually casted) for several weeks, followed by physical therapy. If the patient is able to heal the ligaments and rehab to limb well enough to regain proprioception, then surgery may not ever be needed. If the nonoperative treatment fails to achieve a stable functional ankle, then surgery can be done.

If a patient is a high level athlete or participates in activities where he/she will need a very stable ankle, then surgery would probably be the best way to go.

If the patient sprained the ankle quite a while ago, and has been through a rigorous therapy program, has regained his/her proprioception, but is still having problems with stability, then surgery should be considered.

It also depends upon which procedure the surgeon wants to perform. Now days, the Modified Brostrom is the most common procedure done for chronic lateral ankle instability. This is a technique that is considered an anatomic repair of the ligaments. As opposed to the other procedures which are nonanatomic reconstructions, that sacrifice tendons to replace the ligaments (such as the Chrisman-Snook or Watson-Jones). Some times in the reconstructions, cadaver grafts are used instead of the patient's own tissue.

The Modified Brostrom does not require as much dissection and supposedly does not run the risk of over tightening the ligaments, resulting in decreased range of motion.

However, the patient has to understand, that having surgery does not mean that the patient will not have to do therapy. Physical therapy is still an integral part of recovery. If the patient is not committed to doing the therapy, then the surgery would be a waste of time, effort, and money.

Which is why some surgeons will have their patients go through a rigorous therapy program before the surgery. If the patient actually rehabs the ankle and resolves the instability, then surgery may not be needed. But if not, then the patient is in the best condition to undergo surgery and has shown that he/she is dedicated to rehabbing the ankle.

So, you need to determine exactly what you are looking for and go with the treatment options that best achieved that goal.

Surgery is usually done for chronic lateral ankle instability, rather than on acute sprains. The current procedure (modified Brostrom) is usually a very good procedure. The patient must be dedicated to doing rigorous therapy for the surgery to be successful.

You should sit down with your daughter and find out her desires. Try to determine if she is sincere and if surgery is elected, that she will be dedicated to doing therapy, especially when the ankle hurts from the surgery. She will not wake up from surgery and walk out of the hospital. Expect to be doing therapy for several months.

Then discuss all of your options, risks, and benefits with the surgeon. Find out exactly what the expected outcome is, the post-op protocol, and when can you expect to be able to return to athletic activities.

Good luck.
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