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Chronic ankle sprain is the failure of an ankle to recover following an acute ankle sprain injury. Most acute injuries heal within 4 to 6 weeks.
The injured ligaments could be on the outside of the ankle (lateral), the inside (medial) or both.
As instability (feeling of weakness and sense of giving way) is typically the main complaint, it is also known as chronic ankle instability.
Stability to the joints is derived by two mechanisms:
Dynamic stability is the most important of the two during normal function and activities of daily living. It is only when dynamic stability fails, do the ligaments then come under tension. Poor dynamic control – which is weakness in core stability; gluteus medius, quadriceps, hamstring and peroneal muscle can predispose to ankle instability. Ankle proprioception: sense position, location, orientation and movement of the ankle is vital for ankle stability.
Instability can be subdivided into:
Many patients have an element of both mechanical and functional instability.
Medial aspect of foot and ankle illustrating the 2 main medial ligaments, Deltoid and the Spring ligament
Lateral aspect of foot and ankle illustrating the 3 lateral ligaments. ATFL is the most commonly injured ligament in the ankle
A failure of the ankle ligaments to heal properly or a lack of effective rehabilitation following an injury are the most common causes of chronic ankle sprain.
However a number of other conditions can also cause a chronic ankle sprain or prevent a full recovery, and these need to be investigated and treated in addition to any damaged ankle ligaments:
Patients typically complain of instability, a sense of ankle weakness or giving way when trying to twist and turn quickly while running or playing sports.
Patients may have a sense of weakness or actually find that their ankle gives way frequently and unpredictably.
The main symptoms of chronic ankle sprains are:
Your foot and ankle surgeon will assess you for generalised hypermobility which has a bearing on healing and treatment.
Examination of the ankle will focus on the site of pain and site of tenderness.
The anterior drawer test will also assess the degree of ligamentous laxity. Stress tests in inversion (turning in) and eversion (turning out) will also be performed.
Examination will also focus on confirming/excluding the presence of associated conditions as discussed above.
Investigations help confirm the diagnosis, grade the severity of the condition, help confirm or rule out any co-existing condition and where applicable, aid in pre operative planning.
Weight bearing plain radiographs are a quick and effective way of assessing stability and damage within the ankle joint such as arthritis.
Stress radiographs may also be taken. This involves turning the ankle in or out (depending on whether the lateral or medial ligaments are affected) and comparing with the contralateral normal ankle. Increased opening of the joint may indicate ankle instability.
MRI provides excellent high definition static images. This is a routine investigation in all patients with chronic ankle sprains as it provides detailed information of the hindfoot and not only confirms the diagnosis but also helps confirm/exclude any other pathology within or outside the ankle joint.
MRI is particularly useful in assessing:
MRI of the ankle revealing a torn ATFL lateral ligament
CT images give excellent information on bone structure and is superior to plain radiography in that respect. In suspected cases of a missed fracture this test may be requested.
CT is particularly useful in the following cases:
The natural history of chronic ankle instability is not fully understood.
Repetitive ankle sprains do increase the risk of damage to the ankle joint (osteochondral lesion) and peroneal tendons.
Non-operative management for chronic ankle stability aims at improving ankle stability and alleviating any pain.
It should always be the first line of treatment. Options include:
A period of rest from sports and exercise that bring on symptoms. New training regime and exercise program coupled with a comprehensive physiotherapy program (see below).
Wearing above-ankle sturdy walking boots will provide greater stability to the ankle joint.
An ankle brace can provide increased stability to the ankle joint and is useful in individuals participating in sports and exercise that places their ankle at risk.
The use of non-steroidal anti-inflammatory drugs (NSAIDs) can decrease discomfort and swelling in the ankle.
The aim of physiotherapy is to improve dynamic stability, core stability (balance) and ankle proprioception.
Improving Dynamic stability – involves strengthening the muscles of the lower limb: gluteus medius muscle, hamstrings, quadriceps and crucially the peroneal muscles.
In some patients after an ankle sprain, a number of problems can occur that cause pain and hamper effective rehabilitation. These include synovitis (inflammation in the lining of the joint) and excessive scarring and inflammation of the damaged ligaments for example. As inflammation is a key factor in these conditions a steroid injection can help reduce the inflammation and relieve symptoms.
This injection serves as both a therapeutic and diagnostic intervention. Steroids reduce inflammation and can ease painful symptoms. The local anaesthetic numbs an area of the body for roughly 12 to 48 hours.
The steroid is unpredictable in its success at easing painful symptoms but has very low risk of complications and therefore is an attractive therapeutic option prior to further more invasive surgical intervention. The local anaesthetic on the other hand is very predictable in its action. If there is an area of damage it will definitely ease symptoms for 12 to 48 hours. If symptoms do not ease during this period, one has to question whether the diagnosis is correct.
Steroids reduce inflammation and ease pain when injected directly into an inflamed joint.
We carry out almost all injections under a short general anaesthetic (1 minute) as injecting into a painful joint can be quite sore. While you are asleep and lying still a small needle is inserted into the joint and the position is confirmed using an x-ray in theatre. A small amount of dye is injected first to make sure the needle is in the correct spot and then a mixture of methylprednisolone (steroid) and Bupivacaine (long lasting local anaesthetic) is injected. Undertaking the injection in this manner ensures a pain free experience for the patient and the best outcome clinically as there is no doubt about the placement of the injection.
The local anaesthetic will cause numbness in the area injected for approximately 12 to 48 hours. This action is predictable. What is not predictable is the duration of action of the steroid. It may work for one month, several months or even more than a year.
Injections are not repeated less than at 6 monthly intervals and generally not more than twice.
Please read here for more information regarding injections and possible complications.
A – Placement of fine needle in ankle joint B – Radio-opaque dye confirms needle is in the ankle joint
Surgical management is reserved for patients who have failed to respond to non operative treatment.
Patients should understand that the decision to undergo surgery should not be taken lightly.
Any intervention is considered in a step wise manner, with the least invasive procedure carried out first.
A variety of surgical options exist for patients with chronic ankle sprains. Surgery needs to be tailored to the individual and the underlying cause of the chronic instability. One or more procedures may need to be undertaken, either combined in one sitting or as a staged procedure depending on the underlying problem(s).
Arthroscopy allows for not only direct visualisation of the joint surfaces (diagnostic) but also treatment as well, such as:
The operation is carried out via keyhole surgery. It is performed under a short general anaesthetic as a day case procedure.
During this operation water is used to inflate the ankle joint. Inevitably some fluid leaks into the soft tissues causing swelling of the ankle, as a result some patients who require reconstruction of their ligaments may have to have a second operation at a later date.
In patients with stretched and lax lateral ligaments the Modified Brostrom Gould procedure can be carried out. This operation is done as a day case procedure under a general anaesthetic.
A small incision is made on the outer aspect of the ankle, anterior to the distal end of the fibula. The stretched ATFL and CFL ligaments are divided and tightened and secured to the distal end of the fibula using a special surgical device called bone anchors.
This operation has excellent outcomes in terms of restoration of stability, pain relief and return to full activity in 85-90% of patients.
As the operation involves using the native ligament, this operation is also described as an anatomical repair. In some patients the native tissue is of poor quality and the repair fails. If this occurs then a non anatomical repair is carried out.
An anatomical repair is always the first choice because:
Patients who have had a failed Brostrom anatomical repair or re-injured their ankle having had a previous repair are candidates for this procedure. The operation involves using artificial ligament to augment/reconstruct the lateral ligaments. A larger dissection is required and recovery can take longer. The operation is undertaken as a day case procedure and under a general anaesthetic.
In patients with recurrent instability or failed ligament reconstruction surgery due to a turned in heel (varus hindfoot), realigning the heel can improve the biomechanics of the lower limb and reduce the risk of instability and enhance any surgical repair of the ligaments.
The operation involves cutting the heel bone, realigning it and fixing it with one or more screws. The operation is done under general anaesthetic.
Please read ankle medial ligament injury for more details regarding surgical reconstruction.
Please read spring ligament injury for more details regarding surgical reconstruction.
It should be borne in mind that complications can result from a condition with or without surgery.
Complications can occur as with any type of surgery. Please see Complications for more detailed explanation of post surgical complications.
Please read the information regarding what to expect post surgery on this website.
Remember that below is a guide to recovery and that everyone heals at different rates and some people do take longer. Use this information to help you understand your condition, possible treatment and recovery. The timeframes given below are a minimum, it is important that you appreciate this when considering surgery as your healing and recovery may take longer.
All surgical procedures for chronic ankle sprain will be carried out under a general anaesthetic.
Following ankle arthroscopy and debridement
You will have a small waterproof dressing applied to the front of the ankle to cover the arthroscopy portal sites and a bandage applied. It is advised not to remove this bandage for 48 hours and certainly not to remove the underlying dressings covering the wounds until reviewed by Mr Malik at the 2 week post operative check up. For 2 weeks following surgery it is recommended that you keep the area dry. You may wish to get a Limbo bag which will stop the wound getting wet.
Weight bearing status will really depend on how much has been done in side the ankle. Most patients are touch weight bearing for 48 hours and then weight bear as tolerate after that with or without the use of crutches. A physiotherapist will guide you before your discharge from hospital. Please ensure someone is able to drive you home after the operation. It is important that you commence ankle range of motion exercises as soon as possible after the operation to prevent stiffness. Activities can be gradually increased as pain allows.
In addition following an ankle lateral ligament reconstruction and/or lateralising calcaneal osteotomy –
You will have a backslab applied post operatively for two weeks.
A picture of a backslab
Please do not remove your backslab until you are seen by your surgeon Mr Malik at the two week post operative clinic appointment.
You will be non weight bearing for approximately 2 weeks. The physiotherapist will guide you with the use of crutches after your operation and before your discharge from hospital.
For the first two weeks following your surgery please keep your foot elevated to the level of your heart for 95% of the time.
A picture demonstrating high foot and ankle elevation after surgery
Naturally most people do not have a hospital bed at home. The same effect can be achieved by lying in a bed or lengthways on a sofa, with pillows behind your back and under your foot. You cannot have your leg elevated sitting in a chair. It is strongly advised that during the first two weeks you are house bound.
To minimise risk of infection keep the foot dry and cool. Avoid humid and hot environments. Keep the foot dry and when showering wear a Limbo bag.
To minimise the risk of blood clots please move your foot and ankle at regular intervals. Please ensure you are well hydrated. If you have a risk of blood clots please notify Mr Malik who may organise for you to have blood thinning injections as a precaution.
You will be reviewed at the clinic and your dressings removed. Your wound will be checked to see that it has healed and there are no signs of infection.
At this stage if your healing is progressing satisfactorily swelling and bruising should have subsided considerably, although expect some degree of swelling for at least 3 to 4 months. If completely healed you will be given advice regarding soft tissue massage and scar desensitisation. Scar desensitisation should start as soon as the wound has completely healed. You can do this by massaging cream (E45 for example) into the scar and around the wound area. You may shower and get the area wet only if the wound has completely healed and is dry.
A referral to physiotherapy will be made at this stage. This is the earliest you may return to work.
At this stage if the swelling has subsided sufficiently you will be advised to keep your foot in an elevated horizontal position whenever possible to minimise swelling. Your ankle will most likely be placed in a walking boot for 4 weeks. Short trips can be made outside, within limits of pain and swelling.
Scar desensitisation should start as soon as the wound has completely healed. You can do this by massaging cream (E45 for example) into the scar and around the wound area. You may shower and get the area wet only if the wound has completely healed and is dry.
Significant improvement in swelling and pain. You will be able to start wearing normal footwear (swelling permitted), although stiff soled shoes are advisable. You will require physiotherapy for approximately 3-6 months. This will help optimise the outcome of your operation.
At this stage if your healing is progressing satisfactorily swelling and bruising should have subsided considerably, although expect some degree of swelling for at least 4 to 6 months.
After removal of the walking boot you will require the use of an ankle brace particularly when participating in certain activities Your physiotherapist will guide you.
Final clinical examination. Discharge if satisfactory.
Following an ankle lateral ligament reconstruction or lateralising calcaneal osteotomy –
Final clinical examination. Discharge if satisfactory. Stable ankle.
This is probably the most common question asked of surgeons. Total operation time is different from the actual total surgical time. For example a flight involves not just the flying time, but the time checking in, going through security and boarding the plane for example.
The time given below is only a guide to the actual surgical time.
For an ankle arthroscopy and debridement
Up to 60 minutes.
For an ankle lateral ligament reconstruction
For a lateralising calcaneal ostetomy
Up to 45 minutes.
For an ankle arthroscopy and debridement –
Most patients are able to drive after two weeks. Please see guidance below.
For an ankle lateral ligament reconstruction/ lateralising calcaneal osteotomy –
Not for at least 6 weeks post surgery (if the right foot has been operated on).
Please see guidance above and information here. Ultimately it is the responsibility of the patient to decide if they are safe to drive. A good way of knowing is if you can stamp your right foot heavily on the ground to mimic an emergency brake. If you have any hesitation or pain then it should suggest you are not safe to drive. Remember prolonged driving involves keeping your feet in a dependant position. This will worsen the post operative swelling.
Following ankle arthroscopy and debridement –
Most patients are able to return to work within 10 to 14 days.
This really depends on you and your job. If you have a job that involves a lot of standing, walking and is manual it may be 8 to 12 weeks. If you have a sedentary job, for example in an office and you have a reasonable commute you may be able to go back to work at 2 weeks, although this would be exceptional and not the norm.
Following an ankle arthroscopy and debridement –
Excellent pain relief and return to sports by 3 to 6 months. Failure of this outcome warrants further investigation and possible treatment.
Excellent pain relief, stability in the ankle and return to full activities of daily living. In some cases return to sport.
Ankle sprains are the commonest sports musculoskeletal injury.
The injury involves damage to one or more ligaments around the ankle. Ligaments are a type of tissue in the body that connects bone to bone. Ligaments provide stability to the joints. Please read more about the ligaments of the foot and ankle here.
The most common ankle sprain is a lateral ankle ligament injury. This typically occurs after inverting (turning in) the ankle.
Medial ligament injuries are rarely sustained in isolation and indicate a more serious ankle injury.
High ankle sprains are a complex spectrum of injuries which are often missed. Your orthopaedic foot and ankle surgeon will have a low index for suspicion in the presence of a very swollen and injured ankle.
It is not unusual for patients to have a combination of these injuries.
For more information about these injuries please see below:
Before describing the condition, you may wish to read about the normal anatomy of the plantar fascia here.
You may also wish to read about plantar fasciitis.
The plantar fascia ligament is a thin band on the sole that has a very important role in the foot, maintaining the shape and arch of the foot.
Plantar fascia tear is when a part or all of the fascia is torn.
MRI of the hindfoot. A – normal thin band of plantar fascia B – thickened and wavy appearance of plantar fascia which has a 50% partial tear
The plantar fascia can be torn acutely in a patient with chronic plantar fasciitis. In this condition the plantar fascia is degenerative and damaged. In the presence of tight calf muscles the frayed and weakened plantar fascia is put under tension and can snap. Patients usually have pre-existing symptoms of plantar fasciitis but occasionally it can be sudden with no prior symptoms.
Patients who have any medical intervention for the treatment of plantar fasciitis are also at risk. Steroids (corticosteroids) can weaken normal tissue particularly ligaments and tendons making it susceptible to rupture. For that reason steroids should never be injected directly into tendons or ligaments. We minimise the risk of this by only performing image guided injections.
Pain is the main symptom.
It is typically very severe, constant in nature and made worse by weight bearing.
Patients often have a marked limp.
An ultrasound is a quick and pain free investigation that can confirm the diagnosis.
MRI is particularly useful in making the diagnosis and ruling out other conditions that cause heel pain. It is also requested if there are atypical symptoms and examination findings.
MRI of the heel viewed from the front demonstrating injury to the plantar fascia origin
MRI of the hindfoot demonstrating rupture of the plantar fascia
Non-operative management aims at relieving pain ad allowing return to normal function.
A period of rest from sports and exercise that bring on symptoms. Avoiding high impact activities and sports. Reducing the amount of time standing and walking particularly on hard surfaces.
Wearing shoes with cushioned heels.
Immobilisation in a walking cast or boot for 4 weeks is sometimes indicated and may help alleviate symptoms. Depending on degree of symptoms patients may be advised to non weight bear or partial weight bear.
The use of non-steroidal anti-inflammatory drugs (NSAIDs) can decrease discomfort from the acute inflammation and swelling that results from plantar fascia tear.
It can take up to a year or more for symptoms to settle.
In very few select cases an image guided local anaesthetic and steroid injection at the plantar fascia origin is performed. This is carried out under a short general anaesthetic and under x-ray control.
This is reserved for patients with severe pain who have failed to respond to conservative measures.
Patients are always immobilised in a walking boot and are usually non weight bearing for several weeks to allow symptoms to settle.
There currently is no operation for acute plantar fascia tear.
As the name suggests it is when there is an injury and damage to the plantar plate.
The plantar plate and plantar fascia resist upward (dorsal) displacement of the toe. The plantar plate is a fibrocartilaginous thickening of the plantar capsule of the MTP joint. This is continuous with the periosteum (surface layer on bone) of the base of the proximal phalanx. It is attached to the metatarsal head by the collateral ligament.
The plantar plate
Read more about the plantar plate under lesser toe anatomy and ligaments of the foot and ankle in Foot and Ankle Anatomy.
MRI of the foot – injected dye into the MTP joint is shown to leak outside the joint indicating tear in the plantar plate and capsule
The following conditions may cause plantar plate injuries:
Please read 2nd MTP joint instability and crossover toe for related information.
Pain is by far the commonest symptom. Pain may be felt in the “ball” of the 2nd toe joint, on the plantar (sole) aspect of the foot. Pain may also be felt across the dorsum (top) of the foot at the 2nd MTP joint. The pain is typically of gradual onset and has been present for over 6 months at presentation to an orthopaedic foot and ankle specialist.
Swelling may be present particularly as the condition progresses, and there may be increased warmth in the joint.
Deformity can occur as the condition progresses. The 2nd toe elevates initially, a hammer toe deformity (flexion at the PIP joint and extension at the MTP joint) frequently occurs and finally the toe crosses over.
Examination initially may reveal nothing but tenderness across the 2nd MTP joint. As the condition progresses swelling can occur, and the 2nd toe starts to drift (medially) towards the big toe. Later the 2nd toe crosses over or under the big toe. Thickening of the skin (callosity) under the 2nd MTP joint is typically a manifestation of increased load and forces going through the joint. The callosity may be painful and attempts to remove it will be temporary as the skin will thicken again in response to the abnormal load.
Your surgeon Mr Malik will look for the following on clinical examination:
Radiographs will be arranged at your initial clinic consultation. These will help confirm the diagnosis, the severity of the deformity and aid in pre operative planning.
Radiographs (x-rays) are a useful first line investigation to rule out any other problems in the forefoot. They may be normal in the early stages of the condition. The 2nd MTP joint may appear distended. In later stages of the condition there is dorsal and medial subluxation of the toe.
Radiograph of left foot demonstrating 2nd MTP joint instability
Ultrasound is used to confirm swelling (synovitis) in the 2nd MTP joint, and to see if there is anything else that may be causing the symptoms for example, Morton’s neuroma or intermetatarsal bursitis.
MRI is one of the most sensitive imaging techniques for plantar plate injury. It provides excellent high definition static images.
An MRI of the foot demonstrating inflammation (synovitis) in the 2nd MTP joint
An MRI in combination with a small injection into the joint can help confirm any injury to the plantar plate (if there is a tear, fluid leaks out of the 2nd MTP joint, see image below), it can also confirm any stress lesions in the bone itself. If the underlying diagnosis is not clear an MRI can be a useful investigation.
MRI of the foot demonstrating leaking out of dye injected into the 2nd MTP joint indicating that there is a likely tear in the plantar plate and capsule
The natural history of this condition is not clearly understood.
It could be that many people with plantar plate injuries get better with time and rest and never report their symptoms to a doctor. As orthopaedic foot and ankle surgeons we are seeing more of this condition but that is probably due to increased awareness and understanding of this problem rather than a true increase in incidence of the condition.
Left untreated and despite conservative treatment plantar plate injury can progress and cause increasing pain and deformity in the foot.
The following are radiographs taken over 3 years with a patient with 2nd MTP joint instability with a plantar plate injury:
A radiograph showing a normal 2nd MTP joint
X-ray showing mild medial deviation of the 2nd toe
Subluxation at the 2nd MTP joint
MRI showing dislocation at the 2nd MTP joint with attenuation of the plantar plate
The patient eventually underwent surgical correction with a plantar plate repair and had a good result in terms of deformity correction, restoration of normal anatomy and pain relief
Non-operative management aims at relieving pain and possibly preventing disease progression. It is likely to be most effective in the early stage of plantar plate injury.
A period of rest from sports and exercise that bring on symptoms. Avoiding high impact activities and sports that involve lots of turning, twisting and bending of the toes such as running, dancing, basket ball etc.
In the acute stage, RIE (rest, ice, and elevation) may help alleviate the pain.
Made of silicon can be worn over the toe to protect from direct pressure and rubbing against footwear.
Position the toe in neutral alignment using cross over taping or toe straps. Provide stability to the joint and alleviate symptoms. If there is no deformity then taping may allow healing to occur. If deformity is present, then prolonged taping will not correct this.
An example of taping which has failed to correct the deformity
An insole with a metatarsal dome pad just proximal to the 2nd MTP joint can take some of the pressure off the joint and alleviate the pain. Stiffening the area under the 2nd metatarsal head with an orthoses can reduce the forces across the 2nd MTP joint. A rocker bottom sole may also help relieve dorsiflexion of the toe, which again would reduce the forces across the 2nd MTP joint. An insole that has a recess for a callosity may also reduce pain.
The use of non-steroidal anti-inflammatory drugs (NSAIDs) can decrease discomfort from an inflamed synovitic 2nd MTP joint.
The use of stiff soled shoes that do not bend and therefore protect the 2nd MTP joint.
Stretching tight calf muscles will help reduce the forces going across the forefoot. This will help reduce pain in the 2nd MTP joint.
A variety of surgical options exist which need to be tailored to the individual and the stage of the disease. In general, mild deformities can be treated by soft tissue procedures; severe deformities may require the addition of a bony corrective surgery (resetting the bone).
Please see 2nd MTP joint instability, crossover toe and hammer toe for related details of operative treatment options. Below we will discuss only the surgical procedure for plantar plate repair.
The procedure is carried under general anaesthesia. The operation will take roughly an hour. It will almost always be a daycase procedure which means you can go home the same day.
An incision is made over the top of the foot at the level of the 2nd MTP joint (most commonly involved joint). The 2nd metatarsal is shortened and the torn plantar plate identified. It is then reattached to the base of the 2nd toe.
Illustration of the key steps during a plantar plate repair operation
Animation of Plantar Plate Repair Surgery
At the time of surgery any other toe deformity such as a hammer toe and bunion will also be corrected.
A – Clinical picture of crossover toe with corresponding B – x-ray of the foot, note severe Bunion (hallux valgus) deformity and dislocation at the 2nd MTP joint
This patient had an ulcer form at the site of their callosity which subsequently became infected
Complications can occur as with any type of surgery. Please see foot and ankle complications for more detailed explanation of post surgical complications.
Note – this list is not exhaustive and is meant as a guide.
Almost all surgical procedures for plantar plate injury will be undertaken as a day case.
You will have a bandage applied similar to this during the operation.
Post operative bandage of the foot
Please do not remove your bandages until you are seen by your surgeon Mr Malik at the two week post operative clinic appointment. You will also be provided with a stiff soled black post operative shoe. Please ensure you wear this whenever you are weight bearing.
Post operative stiff soled shoe
For the first 48 hours you will be allowed to touch weight bear using two crutches. After 48hrs you can weight bear as tolerate. The physiotherapist will guide you after your operation and before your discharge from hospital with the use of crutches and mobilising.
For the first two weeks following your surgery please keep your foot elevated to the level of your heart for 95% of the time. It is recommended you stay at home during this period.
High elevation of the foot and ankle
You will be reviewed at the clinic and your dressings removed. Your wound will be checked and your toe taped or strapped in a toe splint.
An example of taping of the foot to help maintain the surgical correction and allow the structures to heal in the correct position
At this stage if the swelling has subsided sufficiently you will be advised to keep your foot in an elevated horizontal position (50-75% of the time). You will require to wear the special post operative shoe for another 4 weeks. Short trips can be made outside, within limits of pain and swelling.
Driving will be permitted for short trips if the left foot has been operated on and you drive an automatic. If the right foot has been operated on it will be at least 8 weeks before any driving is advisable.
Scar desensitisation should start as soon as the wound has completely healed. You can do this by massaging cream (E45 for example) into the scar and around the wound area.
Commence exercises of the lesser toes 3 weeks after surgery and continue for 3 months. These exercises included active resistive and passive toe flexion and extension. They also include intrinsic foot muscle strengthening exercises.
You will have radiographs taken just before you are seen in clinic. You will go over these with Mr Malik and compare the before and after images. If you have had a bony procedure, it will take a minimum of 6 weeks to heal.
At this stage if your healing is progressing satisfactorily swelling and bruising should have subsided considerably, although expect some degree of swelling for at least 3 to 4 months.
You will be able to start wearing normal footwear (swelling permitted), although stiff soled shoes are advisable. Continue to do the lesser toe exercises for another 6 weeks.
This depends on your rate of healing and how much pain and swelling you have. For the first 6 weeks we advise you to use the stiff post operative shoe. After 6 weeks it is advised that you wear a stiff soled shoe with a wide toe box while your foot continues to heal.
Excellent pain relief and deformity correction. Ability to participate in sports by 6 months. Sometimes up to a year before the foot feels “normal” and fully healed.
Orthopaedic Outpatient Department
30 Devonshire Street, London, W1G 6PU
tel: +44 (0) 203 7956053
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