Sports ankle injuries
What are common sports ankle injuries?
Ankle sprains and ankle fractures are common sports injuries. High ankle sprains or syndesmosis ligament injuries occur more commonly among athletes than in the general population. Low ankle sprains or ATFL/CFL (anterior talofibular ligament/calcaneofibular) injuries will be discussed in the next section on ankle sprains. The deltoid ligament can be injured in both high and low ankle sprains.
What are high ankle sprains (Syndesmosis ligament injuries)?
High ankle sprains cause injury to the syndesmosis ligament connecting the two bones of the lower leg around the ankle. This injury is common in athletes but can occur after a significant twisting or rolling injury of the ankle. Surgery is advisable for more serious and symptomatic syndesmosis injuries sustained in younger patients. Failure to address these injuries may risk the development of early-onset arthritis in the ankle.
What are the symptoms of serious sports ankle injuries?
Patients report hearing a ‘crack’ or a ‘pop’ with immediate swelling of the ankle. They usually limp off the playing field because they are unable to bear weight on the injured foot.
-
Dislocation of the ankle
- Some patients may report the ankle joint being partially dislocated and reduced on the field.
-
Pain, swelling and bruising
- Swelling and bruising develop immediately after more serious ankle injuries.
-
Ankle instability
- Most patients will report that the ankle feels unstable and that they have lost confidence in the stability of the ankle.
What does surgery involve?
X-ray and ultrasound scans are usually organised before you see a specialist for an assessment. An MRI and CT scan will determine the extent of your injury after you have been reviewed by a specialist.
A small incision is made on the side of your ankle, and one or two tight rope devices are inserted across the leg bones(strong suture material with metallic buttons). This is performed under X-ray guidance in the operating theatre. This device remains in your ankle and is not routinely removed.
You may also require a separate incision to reconstruct the lateral ankle ligaments (ATFL/ CFL) if they have been previously injured.
What are the risks associated with syndesmosis reconstruction surgery?
Swelling
Swelling of the foot and ankle is common after most ankle surgery. This can be minimised by rest, elevation and the use of a compression sock immediately after surgery.
Infections
Infection after surgery (reduced risk with keyhole and minimally invasive techniques) can be prevented by ensuring that you keep your foot dry, rested and elevated as much as possible in the first three to four weeks after surgery. Feet are closer to the ground and tend to swell more than other areas of the body. Feet and shoes are colonised with bacteria that can flourish in wet conditions and around fresh bleeding wounds.
Recurrence of symptoms
Recurrence of instability is multifactorial, but is more likely if return to sports occurs earlier than advised. The lack of a structured rehabilitation program supported by a physiotherapist could be responsible for prolonged ankle weakness and early onset arthritis.
Deep Vein Thrombosis (DVTs)
Deep Vein Thrombosis may occur when you have certain risk factors and are unable to bear weight on your leg for a prolonged period. We will prescribe blood-thinning medication to prevent DVTs from forming. Drinking plenty of fluids and frequent range of motion (ROM) exercises may prevent DVTs.
Joint stiffness
It is common to have early ankle stiffness that improves with exercise.
Scarring around surgical wounds
Foot wounds can take longer to heal and can sometimes scar poorly. Unlike other areas of the body (face, hands), we advise patients to avoid manipulating or massaging a foot scar until it is well healed (usually around five to six weeks following foot and ankle surgery).
Sports ankle injuries-surgery aftercare
General post-operative and wound care instructions will be emailed to you before your surgery. These documents also contain the date and time of your first appointment after surgery.
Dressings
Your foot and ankle will be heavily bandaged after surgery. These bandages are necessary to prevent bleeding after surgery. It is advisable to keep the foot dry, rested and elevated in the first three to four weeks after surgery. This requires you to seal the area when taking quick showers. Frequent change of dressings and getting your dressings wet and dirty may predispose you to an infection. We strongly discourage dressing changes at home.
A wound care document is emailed to you along with all your pre-operative paperwork.
Post-operative wound care is our priority. Following our instructions will ensure that all your wounds heal well. You are encouraged to call or email us to ask for advice or to discuss any concerns around wound care.
Boots, mobility aids and physiotherapy
A back slab is applied in the operating theatre after surgery is completed. The back slab is replaced with a boot at the first follow-up appointment.
Mobility aids like crutches, frames and knee scooters will be provided by the hospital physiotherapist. Feel free to take your own mobility aids with you when you present to the hospital. The physiotherapist will make sure that you are using them correctly.
You must leave the boot on when mobilising with a knee scooter, crutches or a frame. You may take the boot off in bed, but be sure to put it back on when you are up and about. You are required to bear limited weight in the boot for four to six weeks. Gradual weight bearing in the boot is allowed after this period and progresses to full weight bearing over the next few weeks.
Early gentle ROM exercises and rehabilitation are encouraged in order to get the best outcome following surgery. You may continue upper body and abdominal strengthening as well as straight leg raising (SLR) exercises while recovering from your surgery.
Formal physiotherapy sessions to regain balance and strength may commence when you are able to bear full weight on your foot.
Rest and elevation
Feet and ankles are more likely to swell after surgery. Swelling can cause a lot of pain and discomfort, requiring the use of excessive pain-relieving medication. The most reliable way of reducing immediate post-operative swelling is to keep your foot elevated above the level of the heart. Reducing physical activity can help control swelling and pain, especially in the first three to four weeks after surgery.
Blood-thinning medication to prevent Deep Vein Thrombosis (DVTs)
You may be prescribed a dose of a blood-thinning medication to be taken for a specified duration after your surgery if you have had a DVT in the past or have certain risk factors for developing DVTs. Drinking plenty of fluids and frequent range of motion (ROM) exercises may also prevent DVTs.
Pain medication
Our anaesthetists will provide you with adequate pain-relieving medication to take home after your surgery. The anaesthetist may also discuss having a nerve block for pain relief before surgery. The most reliable way to reduce pain and swelling after surgery is to rest and elevate your foot as much as possible.
Prevention of infections
Intravenous antibiotics are administered at the start of every operation, and the foot is thoroughly cleaned. You will be given a script for antibiotics upon your discharge from the hospital. Rest and elevation, using your post-operative shoe or boot and leaving all dressings dry and intact can help prevent postoperative infections.
Driving
Driving is unsafe for six weeks following surgery and for as long as you are required to wear post operative moon boot, as advised by us.
Holidays and long-distance travel after surgery
It is advisable to avoid surgery if you have a planned holiday or long-distance travel plans within weeks after surgery. Please discuss these plans with us so that we can advise you on the most appropriate time to have surgery.
Struggling with a painful sports injury? Find specialised help.
Connect with our team and start your journey to recovery.
Why choose SA Foot & Ankle Surgery?
Quick bookings at multiple locations
With multiple clinic locations across Adelaide, we offer immediate availability, often seeing patients within 24 hours of receiving a referral.
Advanced care for your condition
Our specialised procedures, including advanced surgeries like ankle fusions, prioritise quicker recovery and less discomfort.
Foot and ankle specialist surgeon
Unlike general practices, we specialise exclusively in foot and ankle conditions, ensuring you receive expert care tailored to your specific needs.
Tailored treatment plans
We thoroughly assess your needs and present personalised treatment options, including non-surgical solutions where appropriate.
Patient-centred care
We take the time to explain your condition and treatment options, ensuring you’re fully involved in every decision regarding your health.
Low gap (total out-of-pocket cost) *
For most operations, your gap paid to the practice is the only out of pocket cost for surgery, without additional or hidden costs. There is a separate gap payable to the anaesthetist and the surgical assistant who work alongside, but independently of Dr. Silveira.
* Complex procedures may attract additional costs that will be discussed with you at the initial consultation.
Meet Dr Gayle Silveira, the surgeon behind your care
Gayle Silveira is a fellowship-trained foot, ankle and trauma surgeon. She completed Orthopaedic training in Adelaide and is a Fellow of the Royal Australasian College of Surgeons.
Gayle gained further experience in complex surgical techniques through advanced training in foot and ankle surgery under the guidance of Dr. Simon Platt. She is proficient in keyhole surgery/minimally invasive techniques and management of sports injuries. In addition, her Master’s in Biomechanics and Sports Physiology complements her expertise in foot and ankle pathology.
Gayle is committed to offering her patients high-quality care with compassion and respect. She spends time listening to you whilst carefully formulating a tailored management plan. Her goal is to help you achieve your desired outcome.
Fellow of the Royal Australasian College of Surgeons (Orthopaedics)
Member of the Australian Foot and Ankle Society
Bachelor of Medicine and Surgery
Master's Sports Studies (Biomechanics and Sports Physiology)
Member of the American Foot and Ankle Society
