Mr Tristan Barton

Consultant Orthopaedic Surgeon

All aspects of foot and ankle surgery including complex hindfoot reconstruction, Arthroscopic (keyhole) surgery, Forefoot reconstruction including bunion surgery

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Ankle ligament surgery

An injury to a ligament in your ankle, more commonly referred to as an ankle sprain, is one of the most common sports injuries I see. Thankfully, these often heal well, although they often need assistance from an experienced physiotherapist in order to optimise recovery. Typically, an ankle sprain takes 6 to 8 weeks to recover.

Occasionally, the ankle sprain doesn’t completely heal and your ankle continues to ‘give way’ when you walk or run. This is called an ‘unstable ankle’. Symptoms include swelling and bruising, a constant ache around the ankle, and a feeling of instability. Your ankle may give way easily, especially when walking on an uneven surface. Many patients in this predicament tell me their ankle hasn’t felt the same since the injury, and this is a good indicator of an unstable ankle.

The reason that the ankle feels unstable following an ankle sprain is that the ligament on the outside of the ankle has stretched and so is unable to provide support. Think of it like the ropes supporting a tent, where one rope is tight and the other is loose. The tent will not be supported and will fall down.

A course of physiotherapy is frequently enough to strengthen the muscles around the ankle, but in some people the instability is recurrent. When this occurs, surgery to reconstruct the ligament may be your best option to bring pain relief and stability.

What is involved in ankle ligament surgery?

Surgery on your ankle ligament is predominantly done under general anaesthetic, and is performed as a day-case operation. The surgery itself typically takes 60 minutes.

The aim of the surgery is to reconstruct and ‘tighten’ the ligament on the outside of the ankle. This surgery is frequently combined with keyhole surgery of the ankle joint if there is a problem within the ankle joint as well.

I will make a 6cm incision over the outside of your ankle. I will then cut the damaged ligament, and reattach the cut ligament to the ankle bone. This ligament is re-attached at the correct tension in order to stabilise the ankle joint. To re-attach the ligament to the bone, I will use a device that drills anchors into the bone. The anchors are then attached to the new ‘tight’ ligament.

When the operation is complete, I will stitch up the incisions and apply a below-knee plaster cast.

You will need to keep your foot elevated in order to reduce swelling, especially in the first 48 hours following the operation. Before leaving the hospital, our physiotherapy team will spend some time helping you to walk with crutches, as you will need to keep any weight off the foot for the first two weeks.

After these two weeks, I will see you in the clinic for a follow-up appointment, where I can assess your progress and remove the stitches and plaster. I will then provide you with a removable walking boot, which you will need to wear for the next 4 weeks. You can put all your weight through the ankle in this boot when walking.

Normally, patients can return to work after 6 weeks unless you are able to work in the boot. If you have a physical job you may need longer. Your rehabilitation will need to be supervised by an experienced physiotherapist in order to optimise your outcome. You can return to gentle sport at 3 months, but it can take up to 6 months before you are able to return at full capacity.

I will see you for a final check-up after 3 months. You will most likely have healed by this point, but some swelling can remain for up to 6 months.

Are there any risks to be aware of?

There are some risks to be aware of when considering whether or not surgery is right for you. The main risks include the wound becoming infected (which can be treated with antibiotics) or tender (which usually responds well to massage). The ankle will be stiff, and this will be helped by regular physiotherapy. In some cases, the ligament reconstruction can fail, usually as a consequence of a further injury, and another surgery may be necessary to correct it.

Why should I choose Sulis Hospital Bath for my surgery?

Whether you’re an athlete hoping to get back to peak physical performance, or you simply want to be able to walk without pain, our dedicated foot and ankle unit at Sulis Hospital Bath gives you an unprecedented level of care and treatment.

Working towards a clear goal of improving your mobility and reducing your pain efficiently and effectively, I can offer you a personalised treatment plan best suited to your individual needs.

The dedicated foot and ankle unit at Sulis Hospital Bath is the perfect destination for anyone who may be considering foot or ankle surgery. By starting treatment within two weeks of your initial diagnosis, we can get you back to good health promptly. Don’t delay any further – get in touch with our reception team today, and let us help ease your pain and restore foot function, whatever your condition.