The Broström Procedure: Restoring Stability To Loose Ankles

Written by admin on April 12, 2013 – 10:42 am -

The arrival of spring’s warmer weather brings with it the desire to get more active. We are spending more time on the tennis courts, the golf course, the ball field, etc., providing opportunities to burn some energy and have fun … but unfortunately, being active also carries with it a risk of accidents and injury.

The ankle sprain is one of the most common injuries sustained by athletes and non-athletes alike. Simply stated, the “sprain” is a stretching or tearing of the lateral (outside) ligaments of the ankle: anterior talofibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talofibular ligament (PTFL). One or all of these ligaments may be damaged in a sprained ankle, and though uncommon, other ankle ligaments may also be damaged. The classic mechanism of such an injury is “rolling,” or inverting, the ankle after landing on another player’s foot or stepping on an uneven playing surface. This inversion mechanism of injury causes the ligaments to stretch, partially tear, or completely rupture. Very severe injury or repeated injury may ultimately result in chronic ankle instability. This results in decreased function of the ankle joint and becomes quite a nuisance for competitive athletes.

The primary treatment in both acute and chronic cases begins with external stabilization using ankle braces. This is combined with a rigorous rehabilitation program guided by a physical therapist. When conservative treatment measures fail and instability of the ankle becomes a daily issue, surgical intervention may be considered. The Broström procedure is primarily used to repair the ATFL; however, the CFL (and even more rarely, the PTFL) may be repaired during the procedure as well. By repairing these damaged ligaments, proper ankle mechanics and function are restored. The ultimate goal is to restore the ankle to its pre-injury state. The procedure has a 90% success rate, and athletes usually return to play within three-four months.

Recovery time after the surgery may vary depending on each patient’s response. Typically, there is a six-week period of time when the ligaments are allowed to heal. During these six weeks, the patient will be non-weight bearing or limited weight bearing status (in a boot) and only allowed to do light range of motion activities. After the initial six-week healing time, physical therapy is introduced to help regain proper ankle strength, range of motion, proprioception, and restoring a normal gait (walking without a limp). Returning to high level activities may take up to six months; however, it may be sooner depending on each individual.

Unfortunately, ankle injuries are a common result of today’s active lifestyles. If you happen to fall victim to an ankle injury and traditional treatments just don’t seem to help, remember that there are other alternatives available, and the Broström procedure may be the answer for you.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at 919-562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on Twitter @drmarkgalland.

Matt Rongstad, ATC/LAT is a post-graduate fellow of the GOSM program at OSNC.

The above article was published in Circa Magazine (April-May-June 2013).


Tags: , , , , , ,
Posted in Foot & Ankle, Sports Medicine | No Comments »

The Injured Ankle: When Is An Ankle Injury More Than Just A Sprain?

Written by admin on April 11, 2013 – 10:24 pm -

You stepped in a hole, landed on another person’s foot, tripped on a root, or simply took an awkward step. We’ve all done it – that is, “tweaked” our ankle and assumed it must be just a simple ankle sprain. You push through the pain limping for awhile, waiting, expecting your ankle to return to normal. The swelling slowly reduces, but the bruising worsens until you cannot take a step without intense pain. Unfortunately, a more significant injury is present. How do you know when an injury isn’t just an ankle sprain, but rather an injury that could prove an impediment to your active lifestyle?

Many conditions can, initially at least, be confused with a simple ankle sprain. Fractures are the most common, and can involve bones of the ankle or nearby portions of the foot. Most frequently injured are the malleoli – the ankle bones that protrude the most, each resembling a small golf ball on each side of the ankle. Another common fracture site is the talus, which lies between the malleoli. Last, and technically not an actual bone of the ankle, is the fifth metatarsal that connects to your pinky toe; it is a part of the midfoot, but is often injured by a similar mechanism as other ankle injuries. Perhaps the most serious soft tissue injury of the ankle is the now-infamous high ankle sprain. This is an injury to the ligaments that connect the two lower leg bones, the tibia and fibula, together at the ankle. This often requires surgical correction, or at the very least, immobilization and restricted weight-bearing for several weeks.

Clinicians have a variety of tools available to make the correct diagnosis. The Ottawa Ankle Rules is one such tool that is particularly important in the athletic setting – on the court and on the field, and is routinely used to determine when an x-ray is necessary. The rules are somewhat technical in nature, but can be easily summarized as any direct tenderness of an ankle or foot bone, combined with the inability to walk four steps, indicate the need for medical attention. As in all cases, the rules are generalized and one should seek medical attention for any injury that one deems serious. The true inability to bear weight is a red flag that should dictate the need to seek professional medical attention.

The initial treatment for all of these injuries is immediate use of R.I.C.E. (Rest – Ice – Compression – Elevation) and should be continued for at least three days to decrease pain, swelling, and bruising. A physician skilled and experienced in treating sports injuries should be consulted as soon as possible. Sports medicine specialists are usually orthopaedic surgeons with additional training or certification in sports medicine. These physicians frequently care for a number of athletic programs and teams, and are well versed in the diagnosis and treatment of a variety of athletic injuries.

Preventing these injuries is always preferred to treating them, but is not always possible. Select footwear appropriate for the sport or activity. It must fit well, providing support and stability to the foot and ankle. If a history of multiple ankle sprains is present – a sign of underlying ankle instability – it is good practice to employ ankle taping or to wear lace-up ankle braces during activity. Perhaps most important is maximizing strength, endurance, and balance, which are best obtained with sport-specific drills performed as a part of a supervised rehabilitation program.

Ruby Floyd is a senior athletic training student at Western Carolina University, studying this semester at the GOSM program.

Dr. Mark Galland is a Board Certified orthopaedic surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. He can be reached at 919-562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com, or on Twitter @drmarkgalland.

Above article published in Circa Magazine (January-February-March 2013, p. 46)


Tags: , , , , ,
Posted in Foot & Ankle, Sports Medicine | No Comments »