Prognosis - Right Ankle?

[physiobob]

Here's a bit more info on that proceedure. In general a bone scan would be the best first investigation to look for any "hot" spots. This will rule out any stress fracture or confirm the value of further investigation.

You also have a nerve exit point, for memory of the superficial peroneal nerve about where you dot is. This is a common site of pain post ankle injury and one which if treated locally to that point with things like soft tissue massage release techniques and neural mobilization works rather well.

Please let us know how you get on.

BROSTROM/Brostroem/Brostrom-Gould repair

Recurrent sprains tend to stretch out or tear the lateral ligaments (on the outside of the ankle) resulting in further ankle instability. Pain is another symptom, especially when squatting is attempted. Ankle sprains can be stabilised by strengthening the peronei muscles and propioceptive training. If surgery is needed, the Brostrom-Gould repair plicates the torn ligament and uses a periosteal flap to further strengthen the repair. Athletes do return to sports after such procedures without loss of motion.

There is more information on this and modified proceedures here:

Modified Brostrom Procedure - Wheeless' Textbook of Orthopaedics

BROSTROM REPAIR: REHABILITATION PROTOCOL

FOR CHRONIC ANKLE INSTABILITY

General Considerations:

• Time frames mentioned in this article should be considered approximate with actual progression based upon clinical presentation. Careful observation and ongoing assessments will dictate progress. - No passive inversion or forceful eversion for 6 weeks.
• Avoid plantar flexion greater than resting position for 4 weeks.
• Carefully monitor the incisions and surrounding structures for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization) to decrease fibrosis.
• No running, jumping, or ballistic activities for 3 months.
• Aerobic and general conditioning throughout rehabilitation process.
• M.D. appointments at day 1, day 8-10, 1 month, 2 months, 4 months, 6 months, and 1 year post-operatively.

0 – 3 Weeks:

• 90° immobilizer for 3 weeks. - Nonweightbearing for 3 weeks--no push off or
toe-touch walking.
• Progress from posterior splint to pneumatic walker once most of swelling is gone.
• Pain and edema control / modalities as needed (i.e. cryotherapy, electrical stim, soft tissue treatments).
• Toe curls, toe spreads / extension, gentle foot movements in boot, hip and knee strengthening exercises.
• Well-leg cycling (bilateral once in walker with light resistance), weight training, and swimming in posterior splint after 10-12 days post-op.

3 – 6 Weeks:

• Progress to full weight bearing in walking boot. Walking boot weight bearing for 3-6 weeks post-op. Aircast splint for day-to-day activities for 6-12 weeks post-op. - Immobilizer for sleeping for 4weeks, then Aircast splint for 4-6 weeks.
• Isometrics in multiple planes and progress to active exercises in protected ranges.
• Proprioception exercises, intrinsic muscle strengthening, manual resisted exercises.
• Soft tissue treatments daily and regular mobilization of intermetatarsal and midtarsal joints. Cautious with talocrural and subtalar mobilization.
• Cycling, aerobic machines in splint as tolerated, and pool workouts in splint.

6 – 12 Weeks:

• Gradually increase intensity of exercises focusing on closed-chain and balance / proprioception. - Passive and active range of motion exercises into inversion and eversion cautiously.

3 – 6 Months:

• Progress back into athletics based upon functional status. - Wear a lace-up ankle support for athletics.

[dibblego]

Thanks physiobob for the reply.

I should point out that currently, I can barely walk, so I am not following the rehabilitation for a Broestrom Repair. It is not so much pain (though it is incredibly painful) but a mechanical limitation - I simply have no dorsiflexion at all and if I tried, it just won't happen no matter what I do.