In the January 23 episode of “Elisir” on RAI3, Dr. Fabrizio Forconi discusses ankle instability and the arthroscopic approach for its treatment.
What type of joints are ankles?
The ankle is a joint essentially formed by three bones: two in the leg, which are the tibia and fibula, and one in the foot, which is the talus. The ankle is very important for our sports activities, and it is particularly crucial that it is stable. The stability of the ankle is indeed the most important factor for its proper function.
What can cause a sprain?
A small distraction is enough to cause a sprain, but very often, among the predisposing factors, there is a previous sprain: an old traumatic event that patients almost always underestimated, but which likely left a small, even partial, ligament lesion. It is precisely this small ligament lesion that makes the ankles more fragile and more prone to further sprain injuries.
This is the main predisposing factor, but there are others: for example, congenital hyperelasticity, which is a personal characteristic of each individual; certain foot placements; being overweight; certain high-impact sports with sudden changes of direction, jumping, or game contact.
How to know if the joint needs strengthening?
It is very important that the patient does not underestimate, for example, a painful symptom on the outer part of the ankle, almost always in front of the fibular malleolus: this is the typical point of pain for someone with an unstable ankle, someone who has had an old injury and therefore a ligament lesion they no longer think about.
Then there is the subjective sensation of instability: it is not necessarily a patient who has frequent sprains; an unstable patient is also one who simply has a symptom.
It is important to see an orthopedic specialist who, from the clinical examination, by comparing the two ankles, the healthy one and the affected one, will very likely notice that there is a bit more laxity in the affected ankle and will request instrumental exams, particularly an MRI or ultrasound, which are important for studying the soft tissues.
What types of shoes reduce the risk of injuries?
The most suitable shoes for a patient who already has instability or wants to protect themselves from potential sprains are certainly shoes with a firm and stable sole, and preferably with a height above the malleoli, thus going slightly beyond the ankle, and having laces. A lacing similar to mountain boots, designed for walking on rocks, uneven and rough terrains.
How to proceed when prevention is not enough?
The first therapeutic attempt is always conservative: therefore, one goes to the physiotherapist who will teach the patient the exercises to do, initially with the therapist, but then it is especially important for an athlete to incorporate a routine of at least 2/3 times a week to strengthen their ankles.
When there is good physiotherapy behind that has not yielded the expected results, surgical intervention may be recommended. The most modern approach to ligament repair is with arthroscopic techniques, thus with a minimally invasive procedure with surgical accesses of just over 1 cm.
What does the arthroscopic approach involve?
The arthroscopic approach allows for a diagnostic study of the entire anterior portion of our joint, thus diagnosing the ligament lesion with certainty and potentially repairing it with the same arthroscopic procedure without having to make larger incisions.
The great utility of this procedure is that, being an examination that spans from one side of the joint to the other, it allows for the detection of lesions associated with ligament lesions that accumulate over time: small osteophytes, small loose bodies, or small cartilage lesions that themselves cause pain and can be treated with the same minimally invasive procedure.
