Ankle Syndesmosis (High Ankle Sprain) Treatment

High ankle sprain treatment is a technique used to treat ankle syndesmosis. Read on to learn more about ankle syndesmosis, TightRope Fixation and ZipTie Fixation surgery, and how they can help you get moving again.

What Is Ankle Syndesmosis (or High Ankle Sprain)? 

What Is Ankle Syndesmosis (or High Ankle Sprain)? 

The ankle joint is composed of a complex hinge with bone and ligaments supporting the ankle. This anatomy stabilizes the joint and allows for a range of motion in the ankle. There are two groups of ligaments - the lateral ligaments located on the outside of the ankle and the medial ligaments located on the inside of the ankle.

High ankle sprains, also known as ankle syndesmosis, occur when the two ligaments holding two of the bones that make up the ankle joint (the fibula and tibia) are either strained or completely torn. Ankle syndesmosis surgery repairs and stabilizes the fibula and tibia, making it an effective way to treat high ankle sprains.

When Is Ankle Syndesmosis Treatment Necessary?

Ankle syndesmosis treatment is necessary when someone hurts their ankle in a way that causes the ligaments holding the bones together to get stretched or torn. This can happen from twisting or rotating the ankle, like during sports or a fall. People who experience ongoing ankle pain and weakness despite trying rest and other treatments may need TightRope Fixation or ZipTie Fixation surgery.

The goal of surgery is to fix the bones and stabilize the joint, so it heals properly and reduces the risk of long-term problems like arthritis, chronic pain, and difficulty moving. This treatment can help you get back to your regular activities and improve your ankle's strength and stability.

What Procedures Are Used To Treat Ankle Syndesmosis?

Your doctor will recommend a procedure based on your specific needs. There are two types of procedures available for people with ankle syndesmosis injuries:

ZipTight™ Fixation

The ZipTight procedure is a surgical technique used to stabilize and reinforce the fibula (the outer bone of the lower leg) and the tibia (the shinbone). The procedure involves a specialized system called ZipTight, which consists of a fixation plate, surgical screws, a guidewire, a ToggleLocTM device, and a ZipLoopTM cord.

Here's a step-by-step explanation of what happens during a ZipTight procedure:

  1. Before the procedure begins, the patient is positioned comfortably, and anesthesia is administered to ensure they do not feel any pain during the surgery.
  2. The surgeon makes an incision on the outer side of the ankle to gain access to the joint area.
  3. If there are any loose bony fragments from the fibula, they are either removed or stabilized by the surgeon.
  4. f the fibula has separated, the surgeon carefully realigns the pieces.
  5. The surgeon uses a fixation plate, which is a specialized metal plate designed to stabilize the fibula. The plate is placed on the fibula and secured in position using surgical screws.
  6. With the aid of a guidewire, the surgeon drills a tunnel through one of the lower holes of the fixation plate, passing through the fibula and extending all the way through the tibia.
  7. The surgeon then passes the ToggleLoc device, which is threaded with the ZipLoop cord, through the tunnel created in the previous step. The ToggleLoc is a mechanism that can swivel and lay flat against the tibial bone.
  8. After the ToggleLoc has cleared the tibia, the surgeon pulls it back toward the tunnel, causing it to swivel and lie flat against the tibial bone. The surgeon then pulls the ends of the ZipLoop cord to tighten the system.
  9. As the ZipLoop cord is tightened, it draws a metal button against the fixation plate on the fibula, providing stabilization and reinforcement to the joint. The ZipLoop cord remains tight, so no additional knot is required.
  10. In some cases, if the surgeon deems it necessary for additional stability, they may choose to drill a second hole and place a second ZipTight using the same procedure.

TightRope™ Fixation

The TightRope procedure is a surgical technique used to stabilize and reinforce the relationship between the fibula (the outer bone of the lower leg) and the tibia (the shinbone). The procedure involves a specialized system called TightRope, which consists of a fixation plate, surgical screws, a guidewire, an oblong TightRope button, and a TightRope cord.

Here's a step-by-step explanation of what happens during a TightRope procedure:

  1. The patient is positioned and anesthetized to ensure comfort and prevent pain during the surgery.
  2. The surgeon makes an incision on the outer side of the ankle to gain access to the joint area.
  3. If there are any loose bony fragments from the fibula, they are either removed or stabilized by the surgeon.
  4. If the fibula has separated, the surgeon carefully realigns the pieces.
  5. To stabilize the fibula, the surgeon attaches a fixation plate to it and secures it in place using surgical screws.
  6. Using a guidewire, the surgeon drills a tunnel through one of the lower holes of the fixation plate. The tunnel extends through the fibula and all the way through the tibia.
  7. The surgeon passes the oblong TightRope button, which is threaded with the TightRope cord, through the tunnel created in the previous step. The TightRope button is a specialized component that can swivel and lie flat against the tibial bone.
  8. After the TightRope button has cleared the tibia, the surgeon pulls it back toward the tunnel. As a result, the button swivels and lies flat against the tibial bone. The surgeon then pulls the ends of the TightRope cord to tighten the system.
  9. As the TightRope cord is tightened, it draws a second metal button against the fixation plate on the fibula. To secure the system in place, a small knot is tied.
  10. In cases where additional stability is required, the surgeon may choose to drill a second hole and place a second TightRope using a similar procedure.

Are There Risks Associated With Ankle Syndesmosis Treatment?

Ankle syndesmosis surgery is usually successful in fixing high ankle sprains. However, like any surgical procedure, it has some associated risks:

  • Risk of infection
  • Potential nerve injury
  • Possibility of experiencing numbness
  • Chance of tendon injury
  • Longer-than-expected recovery period
  • Potential intolerance, breakage, or failure of hardware used in the procedure
  • Potential wound or scar problems
  • Risk of pain transfer or arthritis to a new site
  • Difficulty wearing desired footwear
  • Risk of losing toes, foot, or limb
  • Possibility of developing complex regional pain syndrome (CRPS or RSD)
  • Potential need for additional surgery
  • Risks associated with anesthesia
  • Possibility of blood clots in the leg (deep venous thrombosis)

Consult your physician about the risks and benefits of getting syndesmosis treatment.

Post Ankle Syndesmosis Treatment & Recovery 

Post Ankle Syndesmosis Treatment & Recovery 

After undergoing ankle syndesmosis treatment, you will wear a non-removable splint and/or cast for around six weeks or longer, depending on your specific case. During this time, you'll need crutches or a walker to help you move without putting weight on the affected foot/ankle. The recovery process involves two weeks of critical "couch time" with your foot elevated above heart level for most of the day, followed by a non-weight bearing phase lasting 6-8 weeks, which may be adjusted based on surgical findings.

You'll then transition to a non-removable below-knee cast for 6-8 weeks, followed by a removable walking cast for 1-4 weeks. Depending on your specific circumstances, you might have a 'water cast' that allows you to shower with it.

Your surgeon will recommend an at-home physical therapy program and formal physical therapy appointments. However, remember that total recovery time, until swelling, tenderness, and stiffness subside, and near-full functional capacity is regained, usually takes more than 12 months. Patience and commitment to the rehabilitation process are key to achieving a successful outcome.

Learn more about our treatment options by visiting the Foot and Ankle Center at Resurgens Orthopaedics.

Learn More About Our Treatment Options

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