There's a lot of ways to stabilize an ankle - why has the Broström procedure become the most popular surgical solution for lateral ankle instability?
Lateral ankle sprains are the most common injury seen by sports medicine physicians.(1) Many ankle sprains will result in chronic instability of the ankle leading to repetitive sprains.(2) Lateral ankle instability is the term used to describe the failure of the ligaments of the lateral (outside) of the ankle to support itself while walking, running and during daily activities. The severity of lateral ankle instability can vary post injury. Instability of the ankle can be mild and affect patients only in high stress activities such as soccer, basketball, or football. In severe ankle sprains, lateral ankle instability can be so severe that it results in recurrent sprains even when walking on flat surfaces.
Treatment of lateral ankle instability
Treatment of lateral ankle instability is based on a number of factors that can contribute to the instability of the ankle. Those factors may include:
- Injury of the lateral collateral ligaments of the ankle resulting in stretching (attenuation) or complete tear of the ligaments.
- Structural deformities of the rearfoot such as uncompensated rearfoot varus (heels turning in)
- Neuromuscular deformities that result in muscular imbalance of the rearfoot. These deformities include but are not limited to Charcot-Marie Toothe Disease, multiple sclerosis, and cerebral palsy.
- Trauma to the rearfoot that results in muscular imbalance of the rearfoot.
Treatment of lateral ankle instability begins with conservative care. In mild cases of lateral ankle instability, a simple elastic ankle support or use of a Lateral Sole Wedge Insert may help to inhibit the tendency to sprain the ankle. In more severe cases, braces such as an Arizona Brace or AFO are indicated.
When conservative care proves to be ineffective for treatment of lateral ankle instability, surgical care is indicated for correction of one or more of the factors described above that contribute to lateral ankle instability. A short Google search on the history of lateral ankle surgery will describe a host of surgical procedures used to correct lateral ankle instability; Nilsonne 1932, Elmslie 1934, Watson-Jones 1940, Hambley 1945, Haig 1950, Evans 1953, Windfeld 1953, Pouzet 1954, Lee 1957, Storen 1959, Gschwend 1958, Francillon 1961, Castaign and Munier 1961, Broström 1966, Chrisman-Snook 1969.(3) Older surgical procedures focused on reconstruction of the anterior talo-fibular (ATF) ligament with a split transfer of the peroneus brevis or peroneus longus tendons. There are a number of variations of these tendon transfer procedures, but collectively, tendon transfer procedures require large surgical exposures that may lead to delayed healing times and increased risk of complications. Surgical procedures that include transfer of the peroneus brevis tendon are still employed in cases where the expected post-operative activity is high risk such as a football lineman.
Indications for surgical correction of lateral ankle instability for each individual patient may vary, but for the vast majority of lateral ankle surgical candidates, the Broström procedure is going to be the procedure of choice. First described in 1966, the Broström procedure was the first surgical procedure that specifically targeted anatomic reconstruction of the damaged ATF ligament of the lateral ankle.(4) When compared to the tendon transfer procedures, the Broström procedure can be performed through a smaller surgical incision. A number of modifications of the Broström procedure have been developed since it’s original description in 1966. The newest modification of the Broström procedure includes use of surgical tape to reconstruct the ligaments of the ankle and arthroscopic (small incision) techniques.(5,6)
The recovery protocol following a Broström procedure varies by provider. Many doctors will require non-weight bearing in a hard cast for four weeks with guarded ambulation in a walking cast for and additional four weeks to follow. Long term success of the Broström procedure is quite good with the majority of patients returning to all of their pre-surgical activities.
Why is the Broström procedure so popular? Easy to perform, reliable outcomes for patients and fast healing – the Broström procedure is the go-to for most foot and ankle surgeons. If you are considering a lateral ankle stabilization surgery, be sure to talk to your doctor about the pros and cons of the Broström procedure.
Jeff
Jeffrey A. Oster, DPM
Medical Advisor
Myfootshop.com
References
- Hølmer P, Søndergaard L, Konradsen L, Nielsen P, Jørgensen L (1994) Epidemiology of sprains in the lateral ankle and foot. Foot Ankle Int 15:72–74
- Gerber JP, Williams GN, Scoville GR, et al. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int, 1998; 19(10):653-60.
- Di Matteo, B., Tarabella, V., Filardo, G. et al. A historical perspective on ankle ligaments reconstructive surgery. Knee Surg Sports Traumatol Arthrosc 24, 971–977 (2016).
- Broström L (1966) Sprained ankles. VI. Surgical treatment of “chronic” ligament ruptures. Acta Chir Scand 132:551–565
- Foot and ankle Surg. 2021 Apr;27(3):278-284.
- Foot and Ankle Int.2015 Apr;36(4):465-73.
Ankle Support - Elastic
Lateral Sole Wedge Inserts
