After ankle rotational injuries, some patients may develop chronic ankle instability, despite adequate treatment of the acute injury. The persistent local-specific symptoms, such as sensation of “giving way”, recurrent sprains, reduced range of motion, joint locking, edema, and pain, raise suspicion. In this scenario, the assessment with complementary tests such as MRI and WB-CT scan is conducted to confirm the Chronic Ankle Instability.
Associated injuries such as osteochondral lesions and peroneal tendon pathologies should be evaluated to conduct a proper and complete treatment. In addition, to determine possible coexistence of more than one instability in the ankle (lateral, medial, syndesmal) it is important due to the high frequency of combined instabilities.
Treatment Protocol
Post-op Weeks 0-3
- Patients are instructed to remain non-weight-bearing for the initial 3 weeks following the surgery. The first week are immobilized with a splint, followed by two weeks in a short leg cast.
Post-op weeks 3-6
- In the third postoperative week, patients are transitioned to a pneumatic postoperative boot, initiating progressive loading. Active range of motion is permitted at this stage, with limitations to approximately 10° of plantarflexion and 20° of dorsiflexion. Eversion, inversion and rotational movements are restricted during this period.
Post-op weeks 6+
- At 6 weeks, patients are referred to physical therapy and they are placed in a TayCo Acute XAB Brace. At the 10th postoperative week, coronal and rotational motion is permitted. Low-impact activities might begin at 8 weeks and high-impact activities at the 12th week.
In patients with an osteochondral talar lesion associated, non-weight bearing should be maintained for the initial 6 weeks.
Outcomes
The TayCo Acute XAB Brace offers several benefits for patients during the post operative period in ankle instability cases. One of its keys advantages is its high level of tolerance by patients, making it comfortable to wear for extended periods and ensuring that patients can easily incorporate it into their daily routines without significant inconvenience. Furthermore, the Acute XAB provides crucial support by allowing for the fixation of the ankle position at the beginning of the postoperative period. Overall, the Acute XAB as a valuable tool in managing ankle instability postoperatively, offering comfort, ease of use, and essential support for patients as they progress through their post-operative treatment.
Bio
Currently, Dr. Cesar de Cesar Netto, MD, PhD, practices at Duke Orthopaedics in Durham, North Carolina. He completed fellowship programs in Orthopaedic Foot and Ankle Surgery at various esteemed institutions including the University of Sao Paulo in Brazil, the University of Alabama at Birmingham, the Hospital for Special Surgery in New York, and MedStar Union Memorial Hospital in Maryland. Dr. Netto actively participates in international foot and ankle meetings through his lectures and contributes to research advancements in the field of foot and ankle surgery.
