Ankle Ligament Reconstruction

There may be some numbness or pain over the top or outer side of the foot. In many people this gets better over six to eight weeks, but in about 50% of those affected it does not get better.

The ligament reconstruction is too tight; the ankle feels stiff and may not recover flexibility. Over a period of some years the ankle may develop aching pain and in some cases arthritis.

• Swelling. The ankle will swell after surgery in response to the surgery itself and the healing process. It will take more than six months for the swelling to settle.
• Failure. There is a small chance that your lateral ligament reconstruction will fail, and you may need further surgery. Often this happens following a second injury. You can reduce the risk by following our rehabilitation program to ensure your ankle is strong and stable before restarting sporting activities.
• Nerve injury. With an operation there is always a small risk of injuring or stretching the surrounding nerves, which can lead to numbness. These symptoms mostly resolve in time, but they can persist.
• Infection. The wound usually heals within two weeks. In a small number of cases the wounds become infected. The majority are minor infections that can be simply treated with antibiotics. Occasionally, some patients can develop a deeper infection that might require another operation.
• Blood clots (leg or lung). There is small risk of developing a blood clot (deep venous thrombosis – DVT) after ankle surgery. You will be assessed if you are high risk and need blood-thinning injections while you are in plaster.
• Chronic regional pain syndrome. Following foot and ankle surgery a small proportion of patients can develop chronic regional pain syndrome. Your foot becomes indefinitely painful, swollen and sensitive. If you develop this, you may require specialist care from a pain consultant.

We will give you detailed instructions about anything you need to do before your operation, such as when to stop eating and drinking.

In most cases the operation is performed under general anaesthetic. You will be able to go home the same day and must arrange for someone to drive you.

• Someone should stay with you until the general anaesthetic has worn off.
• Do not operate machinery or do any potentially dangerous activities (like cooking) until you have fully recovered feeling, movement and co-ordination.
• Do not sign any legal documents or drink alcohol.

Alternatively, you can have a spinal or regional anaesthetic, which just numbs the leg.

The consultant will make a 5cm surgical cut on the outside of the ankle. Small plastic anchors with stitches attached are drilled into the bone. The damaged ligaments on the outside of the ankle are then tightened up and anatomically reattached onto the bone. Occasionally, an artificial tape is used to reinforce the reconstruction. Often an ankle arthroscopy is performed in conjunction with a lateral ligament reconstruction.

Once the operation is completed, the wound is closed with stitches, local anaesthetic is given to provide pain relief for the first few hours after surgery and you will be placed in a temporary plaster.

A plaster cast from your toes to just below your knee will be applied while you are asleep. You should only be up on your feet for 5-10 minutes per hour in the first two weeks after surgery to minimise swelling. You must keep your foot elevated when not moving. Do not get your plaster cast wet. Waterproof protection devices can be purchased on the internet, and you will be given a leaflet for these.

You will be seen in clinic two weeks after your operation. The plaster will be removed, and the ankle examined. If your ankle is healing well, you will be given a boot to wear. Physiotherapy will be arranged to start getting your ankle going again. You will wear the boot for eight weeks. You can walk on your foot as soon as it comes out of plaster, wearing your boot.

You will be given painkilling tablets as required. Please follow the package instructions carefully.

How long you are off work will depend on where your job fits between these two scenarios:

1. If your ankle is comfortable and you have a desk job you can go back to work within a few days of surgery and can sit with your foot up.
2. If you do a manual job, you may need two to three months off work.

We can give you a Statement for fitness form if your employer requests one.

If you have your left foot operated on and have an automatic car, you can drive within a few days of the operation, when you feel comfortable enough. Otherwise, you will have to wait until the ankle is strong and flexible enough to work the pedals and be able to do an emergency stop. If you drive before you can stop or manoeuvre in an emergency your insurance will not cover you in the event of an accident. This will probably not be for 10 weeks after surgery.

Please remember it is an offence to drive a vehicle while restricted by a post-operative boot or shoe. 

Too tight. The ankle feels stiff and may not recover flexibility. Over a period of some years the ankle may develop aching pain and in some cases arthritis.

Too loose. The ankle still feels lax and gives way. Most people find it to be much better than before, but a few (about 5%) need to be operated on again. The ankle may continue to give way even with a good repair which is not loose. Physiotherapy usually improves this, but a few people keep wearing an ankle brace.

Red or painful wound. The wound is slow to heal or develops a minor infection. This usually settles with dressings or antibiotics.

Look out for these signs and symptoms of infection:

• Heat around wound.
• Increased pain.
• Wound discharge.
• High temperature.
• Generally feeling unwell.

If you have any of the above symptoms, please contact your GP or dial 111.