Operative Treatment Aids in Treatment of Anterolateral Ankle Impingement in TeensSprained ankles are a very common injury and are frequently seen in doctors' offices and emergency rooms around the country. Teens are not immune to the injury and one study, done in Norway, found that most ankle sprains occurred in people under the age of 35 years, and most commonly in teens between the ages of 15 and 19 years.
Although they may take a while to heal, sprained ankles are usually treated conservatively, meaning that the injured person must refrain from putting too much pressure on the ankle, rest it, ice it, use a compression bandage or brace, and elevate it as much as possible. However, sometimes, this doesn't work as well as it should, resulting in chronic ankle pain in the ankle that was originally sprained. One of the main causes of this is a condition called ankle impingement, which occurs when the soft tissue in the ankle gets trapped in the joint, pinching the tissue.
In the past, there have been studies on adults on using surgery to manage ankle impingement after ankle sprains, but no such research exists on adolescents (teens). The authors of this article evaluated the surgical management of ankle impingement caused by a sprain in adolescents, and compared it with conservative, nonoperative treatments.
Researchers looked at 13 teens (11 girls) who were, between 11.9 years and 18.3 years old. They had experienced symptoms for between four to 15 months and were treated conservatively for between two and 12 months. The treatments consisted of nonsteriodal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation, activity modification, and physical therapy, for at least six weeks. Any bracing that the patients may have used occurred during the initial ankle sprain, but not later on.
None of the patients was able to return to their previous sports because of the pain. Using a rating scale called the Ankle-Hindfoot functioning rating scale, the researchers evaluated the extent of disability. With this scale, the higher the number, out of 100, the better the function. Forty points are related to pain, 50 to function, and 10 to ankle alignment. Before nonoperative management, the average scale rating was 68.4, ranging from 40 to 84. After the nonoperative management, the numbers barely moved: 68.2, ranging from 63 to 76.
All the patients had arthroscopic debridement, minimally invasive surgery using tiny incisions and long handled instruments that allow the surgeon to see inside the ankle using a camera. The debridement surgery is done to remove any dead or loose tissue that could be causing the pain. Most of the patients had more physical therapy after the procedure for a period of six week.
After the procedure and recovery time, the scale ratings rose to an average of 90.6, ranging from 52 to 100. Most patients were able to return to regular activity after 2.5 months (ranging from 0.7 to 4.7 months). Three patients did experience complications from the surgery however, and one patient had a deterioration of the ankle problem.
The complications were for two patients, a neuroma, a growth in the nerve tissue or neuropathic pain and the third patient had a painful condition called complex regional pain syndrome.
The authors concluded that doctors should be aware of the possibility of ankle impingement and once the diagnosis has been made, there does not need to be a waiting period before performing surgery to manage the problem. The procedure is noted to do well with adults and the results of this small study back this up for adolescents.
Erik W. Edomonds, MD, et al. Anterolateral Ankle Impingement in Adolescents: Outcomes of Nonoperative and Operative Treatment. In Journal of Pediatric Orthopaedics. March 2010. Vol. 30. No. 2. Pp.186-191.
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