CHRONIC RECURRENT LATERAL INSTABILITY OF THE ANKLE: RESULTS OF A COMBINED SURGICAL TREATMENT

Abstract

Purpose of the study: Chronic lateral instability of the ankle is often associated with residual varus deformity of the rear foot and exaggerated plantar flexion of the first ray. Several surgical techniques have been described to treat this problem, but recurrence can occur if all the components of the instability are not corrected. The purpose oft his work was to present was to present a new diagnostic and therapeutic approach to the treatment of recurrent lateral instability of the ankle.

Material and methods: Eight patients with talipes cavovarus(9 feet) were treated for recurrent chronic instability of the ankle. All patients had undergone at least one prior procedure to stabilize the rear foot and suffered persistent pain as well as subjective ankle instability. Mean age was 25 years. All patients underwent a calcaneal osteotomy for lateralization and transfer of the long fibular onto the short fibular ligament, with an additional Bronström ligament reconstruction in four cases. Clinical and radiological follow-up was 37 months on average.

Results: All patients were very satisfied. The AOFAS score improved from 58 points preoperatively to 97 points (max 100 points) at last follow-up. Postoperative alignment of the rear foot was considered physiological in all cases.

Conclusion: Recurrent chronic lateral instability of the ankle is often associated with chronic misalignment of the rear foot, leading to gait disorders and persistent pain. Ligament insufficiency, varus misalignment, and over-solicitation of the long fibular should be investigated and treated with an individually adapted surgical procedure in order to correct the recurrent instability. The results of this approach have been very promising and have been associated with very strong patient satisfaction.