Lateral ligament instability

Unstable ankle

What is it

A damaged ligament from a sprain can cause instability and pain affecting the ankle.

Non-surgical options

Physiotherapy to strengthen the supportive ankle muscles and help with proprioception (the brain's ability to know where a body part is in space).

Surgical options

A Broström reconstruction involves a day case procedure under general anaesthetic. A cut is made over the outside of the ankle and the ligaments together with the baggy soft tissues are retensioned and reattached to the fibula (ankle bone) with a bone anchor. I usually carry out an ankle arthroscopy at the same time as a Broström reconstruction to deal with any problems within the ankle joint itself. Please also read the separate page about ankle arthroscopy.

I often use a device called an internal brace to strengthen the reconstruction. A video of the technique can be seen below. To find out more about the internal brace device, click here to view the manufacturer's website.

Risks of surgery

All surgical procedures carry some risk. These risks are usually rare, but can include infection, bleeding, damage to surrounding structures such as tendons or nerves, numbness, dysfunction of foot, ongoing pain, unsightly scar, painful scar, wound healing problems, swelling. There is also a risk that the procedure does not work fully and that the patient is left with some ongoing symptoms.

There are also some medical risks to surgery such as a clot in the leg (DVT), clot in the lung (pulmonary embolus or PE). The general anaesthetic has rare risks of problems such as heart attack, stroke, chest infection and in extremely rare circumstances, death.

What to expect after surgery

This will be done as a day case procedure under a general anaesthetic.
A local anaesthetic block is used around the ankle to decrease post-operative discomfort.
The patient is discharged home from hospital on the day of the operation with painkillers to use as necessary.
The patient must keep their foot up above the level of the groin for 23 hours every day for two weeks. This minimises swelling, decreases discomfort and reduces the risk of wound complications and infection.
The patient is in a cast for the first two weeks and will therefore be unable to weight-bear on the foot. The physiotherapists will ensure you are safe using crutches or another suitable walking aid before you are discharged.

Expected recovery milestones

Click here to download the Broström reconstruction rehab protocol.

At two weeks you will be seen for a wound check; if the wound is healed you will be taken out of the cast and placed into a special boot. You will now be able to walk in this boot, but it must stay on 24 hours/day. You will be in this until six weeks post-op.
At the six week appointment you will be taken out of the boot, an depending on your progress you will either be permitted to walk without any support, or given an Aircast (inflatable) splint for a further two weeks.
Between six weeks and three months you should expect to return to work and normal activities. I would expect to discharge you from further follow-up after three months.
Between three months and one year there will still be some swelling and minor discomfort.