A 49-year-old female presented with persistent right ankle pain and instability that significantly impacted daily activities. Initially, she experienced mild discomfort, but over time, the pain escalated, limiting mobility and function. Conservative treatments, including anti-inflammatory medications, rest, and physical therapy, were attempted but provided minimal relief. Due to ongoing instability and functional limitations, further medical evaluation was pursued.
Diagnostic Findings and Decision for Surgery
Imaging revealed:
Syndesmotic instability
Deltoid ligament insufficiency
Loose fracture bodies within the joint
Synovial thickening and cartilage irregularities
Given the failure of non-operative treatments, surgical intervention was recommended to restore stability and alleviate symptoms.
Surgical Management
The patient underwent:
Right ankle arthroscopy
Removal of loose fracture bodies
Ankle arthroscopic partial debridement
Repair of multiple syndesmotic ligaments
Repair of deltoid ligament
The procedure involved debridement of damaged tissue, removal of loose bodies, and ligamentous repair using suture anchors and fixation devices. The surgery was completed successfully with no complications.
Postoperative Recovery
Initial Recovery
The patient was instructed to remain non-weight-bearing (NWB) on the right lower limb. A pneumatic walking boot was provided, and pain management included NSAIDs and acetaminophen.
Follow-Up Progression
At two weeks post-surgery, the surgical incisions had healed well, and pain was manageable. The splint was removed, and the patient continued using the walking boot. Non-weight-bearing physical therapy was initiated, focusing on range-of-motion exercises.
By eight weeks, the patient began transitioning to weight-bearing as tolerated (WBAT). While some stiffness remained, steady progress was noted. Additional therapy and custom foot orthotics were introduced to address tibialis posterior insufficiency and pes planovalgus.
At this stage, the patient had moved into the strengthening and balance phase of rehabilitation. Swelling remained but was manageable with elevation and ice therapy. While stability had improved, long walks continued to cause mild discomfort.
By week 16, the patient was walking independently without assistive devices. Swelling had significantly reduced, and ankle range of motion was fully restored. Mild discomfort was noted only after prolonged activity.
At six months, the patient had regained near full function with minimal discomfort. Custom orthotics and continued strengthening exercises were recommended for long-term management. Full return to daily activities was achieved.
Rehabilitation Plan and Long-Term Outcome
The patient was prescribed a structured rehabilitation program, including:
Strengthening exercises to improve stability and mobility
Gradual return to full weight-bearing activities over several weeks
Custom orthotics for biomechanical optimization
Ongoing monitoring for potential complications such as stiffness or instability
Despite early challenges, adherence to post-operative protocols contributed to a successful recovery. Follow-ups continue as needed for long-term monitoring.
Conclusion
This case highlights the importance of:
Addressing ligamentous injuries early to prevent long-term instability
Structured rehabilitation and gradual weight-bearing progression
Custom orthotics in managing residual biomechanical issues
With expert surgical intervention and dedicated rehabilitation, the patient successfully regained mobility and functionality, demonstrating the effectiveness of a well-planned recovery approach.
Disclaimer: All identifying details, including names and specific dates, have been removed or modified to ensure privacy.
Dr. Mo Athar
