When do you need to see me for an ankle sprain? Typically when you can’t walk, and there is excessive bruising and swelling, then it’s a good idea to get checked out. Also, for those sprains that persist or if the pain continues beyond six weeks, those should receive a further evaluation to evaluate for ankle instability.
Ankle Instability / Chronic Ankle Sprains:
Ankle instability can result from acute sprains (i.e., less than 20%) or recurrent sprains. Patients commonly describe their symptoms as, “I don’t trust my ankle,” the “ankle just gives out,” or “my ankle always feels weak.” Ankle sprains are one of the most common sport injuries that bring patients to a doctors office. Most ankle sprains can be treated conservatively with brace, physical therapy and functional rehabilitation. However, a select few do not respond to conservative care. Before a surgical plan is made a thorough evaluation and workup is needed given that ankle instability can also present with osteochondral lesions of the talus, peroneal tendon pathology and arthritis. Given the variable presentation, Dr. Kim focuses on systematically evaluating each individual to find the source of pain and pathology of his patients since not all ankle instability presentations are identical. If an ankle ligament procedure is warranted, Dr. Kim uses anatomic reconstruction of the ligaments and typically uses biologics (ie, stem cells) to aid in healing and recovery. Additionally, Dr. Kim uses the Internal Brace from Arthrex to allow his patients to begin weight bearing 2 weeks after surgery!
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No two ankle fractures are alike. Depending on the pattern and stability of the ankle fracture, some may be treated conservatively with no surgery. Given the discrepancy on treatment patterns, it’s highly recommended to be evaluated by a specialist for any and all ankle fractures. Ankle fractures can occur from low energy injuries, such as a simple trip and fall, to a high energy injury, such as a motor vehicle accident. Depending on the mechanism, ankle fractures can present as stable or unstable. Stress radiographs along with a detailed clinical exam can decipher stable vs unstable injuries. Unstable injuries typically necessitate surgical intervention, especially those who are community ambulators. Dr. Kim is facile at treating ankle fractures and typically operates on patients with ankle fractures on a weekly basis. Depending on the x-rays, its not uncommon to obtain a CT scan to delineate the fracture more acutely and may potentially change the operative plan. For instance, if the CT scan reveals a bone fragment in the joint, Dr. Kim then advocates for an arthroscopic procedure to remove the loose fragment. As in all patients, Dr. Kim approaches each patient and case methodically and ultimately has had excellent success in getting patients back to their preinjury level of activity.
Achilles pain and ruptures are treated with or without surgery; it depends on the injury and patient goals. Non-ruptured Achilles pain is classified into insertional and non-insertional Achilles, regardless, most occasionally, both should be treated with a bout of conservative care such as Physical Therapy before any invasive options. For ruptures, the pendulum of treatment tends to shift from operative to nonoperative; a recent prevailing trend has been to treat acute Achilles ruptures with surgery in “athletes” and functional rehabilitation in our sedentary patients.
Osteochondral Lesions of Talus:
Osteochondral lesions of the talus (OCL) are cartilage defects that can occur from trauma but can occur with no known cause such as osteochondritis dessicans. I compare OCL’s to having a small “pothole” in the ankle. Despite this, not all OCL’s need to be treated surgically. Many OCL’s can be treated non operatively with NSAIDs (ie, ibuprofen), physical therapy, modified activities and protected weight bearing. Surgery is usually reserved for the patients with OCL’s who have tried conservative care for about 3 months.
Surgery for OCL’s depend on one major criteria: its size. To gauge the size of the OCL, I typically recommend x-rays, MRI and some occasions CT scan. When the size is determined treatment can range from marrow stimulation (AKA microfracture), Biocartilage (ie, morcillized cadaver cartilage) mixed with stem cells, or osteochondral plugs (AKA mosaicplasty).
Ankle arthritis treatment falls into conservative (e.g., bracing and PT), semi-conservative (e.g., injections) and surgical (e.g., ankle fusion vs. replacements). For surgical, the advent of new and improved implants have made ankle replacements an excellent option. I am proud to say that I was the first surgeon ever to perform the first ankle replacement procedure at Marin General Hospital and he is doing exceptionally well, last time I saw him he had just finished his morning hike of 6 miles when before he couldn’t even walk a nine-hole golf course! Arthritis of the ankle is most commonly a result of prior trauma (eg, ankle fracture or persistent ankle instability with recurrent sprains). It can cause debilitating pain and limit the quality of life for individuals. Nonoperative treatment includes ankle brace, injections and modified activities. Like most arthritic conditions, ankle arthritis tends to progress with time. End stage ankle arthritis can be surgically treated with either an ankle fusion or ankle replacement. However, if you are younger then 65 years old, Dr.Kim focuses on preservation of the joint with the aim of getting “as many years possible” from the native joint. This can be achieved via minimally invasive procedures, such as arthroscopic debridement, marrow stimulation, Biocartilage, etc…
History has proven that joint replacements can be very successful and despite ankle replacements not having had the long term success of knee and hip replacements, it has shown more recently that the newer technique & refined implants now work very well. More recent studies have revealed that the current modern ankle replacements now rival the success of ankle fusion, which has for decades been the standard of care for end stage ankle arthritis.
The definitive treatment of your ankle arthritis depends on many factors and would be insufficient to categorize all ankle arthritic conditions under one category, thus if you have received a diagnosis of ankle arthritis, please call Dr. Paul Kim at 415-927-5300 for an appointment and after an evaluation an optimal treatment plan will be tailored to get you back to your active lifestyle.
When Should You Seek Help for Your Ankle Pain?
- When you sprain your ankle and can’t walk and have excessive bruising and swelling.
- You’ve tried self-diagnosing your ankle pain, but you are not any better or even worse…yikes!
- You want a second opinion since someone told you, “you have to have surgery!”
- You’ve tried constant care for your ankle pain, and now it’s impeding with your daily life, and you can’t be as active as you would like.
San Francisco Ankle Surgeon
Thank you for your interest in my specialty. If you have any questions please feel free to call my office or send me a message using this contact form. I will get back to you as soon as possible. My clinics are located in San Francisco and Marin, but I treat patients throughout the Bay Area.