The diagnosis of ‘sprain’ literally means a ligament injury. Whilst most of us have probably suffered an ankle sprain at some point in our lives, the vast majority of these will recover without the need for surgery. Most simple ankle sprains will heal naturally over the course of a few weeks. More serious sprains may require physiotherapy and can take several months to recover. Whilst physiotherapy will help most achieve recovery, some patients experience continuing problems and these patients can be helped by daycase surgery using modern keyhole techniques.

Alternatives to surgery: 

• Accept level of symptoms and limit activity to control these symptoms 

• Wear an ankle foot orthosis (AFO “brace”) to stabilise ankle 

• Physiotherapy treatment will usually have been tried before discussing surgery 

Main Risks Of Surgery: 

Swelling/Scar -Initially the foot and ankle will be swollen and needs 

elevating. The swelling will disperse over the following weeks and months 

but will remain evident for up to 3-6 months. The scar can cause irritation 

to begin with but usually settles to a great extent over the first 4-6 weeks. 

Wound healing problems - The risk of serious wound healing 

problems is approximately 1%. It is important to keep the foot elevated 

over the first 10 days to reduce the swelling and risk of wound healing 

problems. In rare circumstances when the wound is problematic, further 

surgery can sometimes be required. 

Infection -The risk of deep infection occurring is approximately 1%. You 

will be given intravenous antibiotics to help prevent this. It is important to 

keep the foot elevated over the first 10 days to reduce the swelling and risk of 

infection. If there is an infection, it may resolve with a course of antibiotics 

but may require a period of hospitalisation or rarely, further surgery. 

Nerve damage -The superficial peroneal nerve is close to the 

incision. This supplies sensation to the top surface of the foot. This may 

rarely (1%) be damaged during the surgery and this may leave a patch of 

numbness on the top surface of the foot. This numbness may be 

permanent would not affect function. 

Main Risks Of Surgery Cont... 

Re-rupture of the Ligaments - Following surgical repair of 

the ligaments there is no evidence to suggest that you are at higher risk of 

repeat injury to them but in some cases the shape of the hindfoot can 

predispose you to ankle sprains and this will be discussed pre-operatively 

as very occasionally further surgery can be advised to try and reduce this 

risk. It is very important that patients follow the post operative instructions 

provided to minimise the risk of further problems. 

Deep Vein Thrombosis (DVT) - This is a clot of blood in the 

deep veins of the leg. The risk of a clot occurring is reported as less than 1% 

after foot and ankle surgery which is generally substantially lower than after hip 

or knee surgery. Suspicion of DVT is raised if the leg becomes very swollen 

and painful. There are tests that can be performed to confirm / exclude the 

presence of a DVT. If confirmed, you will probably require treatment with a 

blood thinning agent (heparin preparation and / or warfarin). The main concern 

with regards a DVT is that rarely (<1:1000 chance with foot and ankle surgery) 

a piece of clot can break away in the leg and travel to the lungs which is much 

more serious and can be life-threatening. This is called a pulmonary embolus 

and signs of this include chest pain and shortness of breath. 

For the first 2 weeks following surgery it is likely that you will be treated 

with a blood thinning agent (LMWH - low molecular weight heparin 

injections) to minimise the risk of DVT / PE but this does not afford total 

protection and exercises to keep the toes and knee moving are advised, as 

well as remaining generally mobile. 

If you are concerned that the leg has become more swollen and painful 

(some swelling always occurs after surgery), or if you experience chest 

pain / shortness of breath, then you should contact the hospital, general 

practitioner, or accident and emergency department immediately. 

Sick Leave 

In general 4 weeks off work is required for sedentary employment, 12 

weeks for standing or walking work and 16 weeks for manual / labour 

intensive work. We will provide a sick certificate for the first 2 weeks; 

further certificates can be obtained from your GP. 

Driving 

Usually you may return to driving after outpatient review at 2 weeks 

These notes are intended as a guide and some of the details may vary 

according to your individual surgery or because of special instructions 

from your surgeon. 

Lateral Ligament Reconstruction 

Post-Operative Course 

Day 1 

• Below knee cast (backslab plaster) applied at end of surgery 

• Expect some numbness in foot for 12-24 hours 

• Pain medication and elevation of foot 

• Blood drainage through cast expected 

• Mobilisation non-weight bearing with physiotherapist (crutches) 

• No weight through operated leg for 3 weeks 

• Treatment with LMWH injections 

• Discharge home usually possible on day of surgery (otherwise overnight stay) 

• May shower / bath if able to keep leg dry 

2 Weeks 

• Outpatient review of wounds (and removal stitches if necessary) 

• Cast replaced with stirrup splint 

• No weight bearing on operated leg until 3 weeks post surgery 

• Patient to remain in stirrup at all times (day and night) 

• Supervised and unsupervised physiotherapy may begin. Only include: 

• Swelling control - ice, elevation, effleurage and massage as appropriate 

• Scar mobilisation 

• Gentle active exercises until 3 weeks post surgery 

• Usually you may return to driving after outpatient review at 2 weeks 

3 Weeks 

• May begin full weight-bearing in stirrup splint 

• Stirrup splint to be worn until 10 weeks post surgery 

• Physiotherapy to continue as instructed by physiotherapist including: 

• Regime as for an acute lateral ligament sprain 

10-12 weeks onwards 

• Outpatient review 

• Physiotherapy to continue: 

• Re-introduce sport (consider AFO for further 4 weeks during sport)