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Surgery for Instability in the Ankle

Ankle Sprains

Sports and physical activity are vital to maintaining a healthy life. However, people who frequently engage in these activities often end up with injuries, one of the most common being ankle injuries—particularly ankle sprains.


Ankle injuries are very common, representing about 40% of all sports-related injuries. The ankle is a complex joint and its optimal functioning is directly related to its ligament and bone structure. There are various ways you can sustain ankle injuries.

What damage do ankle injuries cause?

Ideally, the structure of the ankle needs to have the characteristics of flexibility and stability. This allows for sudden and precise movements, while also absorbing the impact of strenuous physical activities.

The way the ankle bones are arranged is reminiscent of the forceps. The talus accommodates in the middle of the fibula and tibia, surrounded by a thick sheath and two ligament complexes.

Formed by three ligaments, the lateral ligament complex of the ankle has the calcaneofibular, the anterior fibulotalar, the posterior fibulotalar and the transverse portion. When your ankle is sprained, the anterior talofibular and the calcaneofibular ligament are most affected.

Who’s more prone to ankle injuries? What are the symptoms?

In the event of an ankle sprain, your ankle bone may suffer some type of fracture and injuries sustained by the cartilage. Hematomas and edema are also frequent in cases of sprains. Another possible effect is synovitis (internal inflammatory process in the joint).

In some cases, the damaged capsule of the internal wall of the joint ends up entering the ankle, staying between the bones. This impaired healing results in pain and instability in the ankle, causing nerve and tendon injuries too.

Initially, after a sprained ankle, swelling, bruising and pain in the area usually occur. The location of these initial symptoms may vary depending on the direction the ankle twisted. When there is this pain in the ankle area that hinders you from putting your food on the ground, a thorough medical analysis is immediately necessary.

Diagnosing ankle instability

Physical exams, medical and health reports, and x-ray examinations are used for accurate diagnoses. The initial symptoms presented by the injury an indication of its severity too. Identifying the parts that are aching helps to determine the extent of the damage. Other examinations can also assess whether there is ligament instability in the injuries.

The Types Of Ankle Twists

The different types of ligament injuries of the lateral complex can be classified into three levels

  • Level 1 (Mild injury): This occurs when a part of the internal fibers of the ligaments ruptures. Characteristic features of this type of injury are pain and moderate swelling, but the ankle’s functionality isn’t compromised.
  • Level 2 (Moderate injury): This injury occurs when there is a partial rupture of the ligaments. Characteristic features of this type of injury are swelling, pain, and bruising. Additionally, the ankle shows instability in the anterior part.
  • Level 3 (Serious injury): This injury happens when there is a complete rupture of the ligaments. It’s accompanied by severe pain, bruising, and intense swelling. There is instability of the ankle and it becomes functionally incapable.

How can sprained ankles be treated?

Depending on injury’s severity, the treatment and management procedures differ. Since level 3 injuries are the most serious, they’re the only ones that may require surgery. In such cases, patients may be immobilized for up to six weeks, with an extended healing and rehabilitation period.

Surgical treatment

In cases of severe level 3 injuries, surgical treatment is often necessary. This usually includes cases of athletes or ones where there’s greater instability and opening of the joint clamp.

Post-ankle sprain instability may still occur after recovery in many instances. These cases usually occur due to the lack of rehabilitation and muscle strengthening.

However, when there are no positive changes with motor rehabilitation, surgically treating the instability is usually advised. This can occur with the re-tensioning of the lateral ligaments.


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