Ankle sprains can become a huge restriction against mobility, cause pain, and lead to joint instability. While most sprains heal after proper care, in some instances, ankle sprains may become chronic. When you find the best doctor for ankle sprains in Kansas City suited for your needs, you are more likely to alleviate chronic ankle sprains and their symptoms.
At APEX Orthopedics & Sports Medicine, Dr. Kneidel reserves a majority of his practice for ankle sprain treatment, including both conservative and surgical options. For decades, he has helped patients of all ages recover from ankle sprains so they can return to normal life. He even works with athletics to help them strengthen their ankles to play the sport they love without pain.
Read on to learn more about ankle sprains and how a foot and ankle orthopedics at APEX can help.
Foot and ankle joint anatomy
As with other joints in the body, the foot and ankle are composed of bones, nerves, muscles, ligaments, and tendons to stabilize the area and promote a full range of motion. One of the biggest differences between the foot and ankle and other joints is the number of bones.
For example, the hip joint is created by the ball-shaped head of the thigh bone (femur) articulating with the hip socket (acetabulum)—two pieces to create movement on various planes. On the other hand, the foot and ankle are a collection of joints; you can imagine this as a cluster of small bones working in harmony. Some of the joints are essential, meaning they are more mobile; others are considered non-essential from a biomechanical standpoint (but it doesn’t mean they are less important).
With strong ligaments to support the joints, the foot and ankle are able to move properly without causing pain. However, that is not always the case. Whenever anatomical elements become injured or have abnormalities, that can greatly impact someone’s daily life, including the ability to walk.
The importance of ankle and joint stability during recovery
Joint stability plays a crucial role in the ability to walk. During the recovery process, avoiding weight on your foot and ankle promotes proper ligament and tendon healing. This allows you to become strong enough to begin physical therapy and later return to regular activities.
How is instability determined?
Patients with severe instability often visit Dr. Kneidel and complain they are “rolling their ankle” a lot or their ankle keeps “giving away.” This is a typical sign of chronic ankle sprains due to ligament laxity. If the condition isn’t as severe, patients may have subtle instability that may gradually decrease physical performance. For example, if someone is a runner, subtle instability could cause their running times to fall.
Instability may also come with uncontrolled pain and swelling that doesn’t resolve itself. In that case, it is important to have a physician thoroughly examine your ankle, including proper imaging (i.e. X-rays or MRIs).
In many cases, instability comes from the resulting ligament injury after an ankle sprain. Remember, the ligaments are the primary stabilizers of the ankle; the tendons surrounding them are the secondary stabilizers. Therefore, whenever you have an ankle sprain, strengthening those secondary stabilizers (specifically the peroneal tendons) is vital for the ligaments to heal themselves.
Once you have spent about six weeks off of your ankle, you need to protect the ligaments with a brace and rehab the tendons. This allows you to break the instability cycle to prevent injuries in the future.
Does instability only come from sprains?
No, instability isn’t limited to sprains. Instability may also come from generalized ligamentous laxity or diseases that cause loose joints (such as Ehlers-Danlos syndrome). However, most cases are post-traumatic, meaning there was an initial injury that led to the instability.
How to find the best ankle sprain doctor for your needs
When searching for an ankle sprain doctor in the Kansas City area, you should consider a doctor’s speciality. In some cases, surgical ankle sprain procedures go beyond the reach of a general orthopedic surgeon. The more complex and advanced the ankle surgery, the more you would benefit from a foot and ankle specialist. You want to find someone who is fellowship trained in whatever your injury or issue comes from.
Throughout the recovery process, you want to remain in contact with your surgeon. As a result, finding someone who sticks with you for the months following your procedure is vital for your success. Even through physical therapy, Dr. Kneidel schedules follow-up appointments. The ankle is far away from the heart, so poor circulation could negatively impact wound healing. Therefore, Dr. Kneidel monitors the wound until he knows everything is healed properly.
Outside of experience and recovery assistance, being able to mesh well with your physician leads to increased trust. An orthopedic surgeon who values having a good rapport with his or her patients can help boost mutual understanding. For example, after surgery, a patient has to be non-weight bearing, and without a strong doctor-patient relationship, a patient may not fully comprehend the requirements and potential challenges to follow. In the end, try to find a physician whose personality matches your own for the most productive outcomes.
What to expect from your first appointment with Dr. Kneidel
Most patients come to Dr. Kneidel through a referral from their primary care physician or a recommendation from family or friends. Even if you don’t fit that mold, you can always contact our office to learn more about getting started at APEX.
When you come in for your first appointment you should bring imaging with you (typically an X-ray). For people who suffer from chronic ankle sprains, Dr. Kneidel will also obtain an MRI. Your initial appointment is all about education. First, Dr. Kneidel will discuss what an ankle sprain is and how they generally heal. However, if they do not heal, he has surgical options to fix the issue.
Next, he will examine and test your ligaments through physical maneuvers. This allows him to compare motion of the injured ankle to your healthy one. He also assesses whether you have generalized ligamentous laxity, which causes your bones to become loose. In those cases, operation would be a little different than for someone with normal joint security.
Another important factor he notes is the occurrence of your ankle sprains. It is one thing to have a new sprain; it’s another to have sprains that continually arise. From there, he can discuss treatment options and recommendations. At the end of the day, it is your choice to decide whether you want to try rehab or go through surgery. However, even if you opt for physical therapy, Dr. Kneidel will describe the surgery so it can remain in the back of your mind.
Since Dr. Kneidel usually obtains a lot of information from previous X-rays or MRIs, nerve studies, or other examinations beforehand, the appointment typically doesn’t last longer than 15 to 20 minutes.
Brostrom ligament reconstruction surgery process
Ankle sprains are a tear of one or two ligaments, and the severity lies on a broad spectrum. For instance, you could have a partial tear or a complete tear. About 95% of the time, people recover from ankle sprains and return to their normal activities. However, there are times when a person may have neglected proper treatment or failed to rehab the joint. When that happens, the joint isn’t protected enough to allow the ligaments to repair themselves, leading to instability and chronic sprains.
Conservative treatments are always an option (especially if the sprain is recent and non-recurring). For the most part, conservative measures center around lace-up ankle bracing and physical therapy to strengthen the peroneal tendons. On the other hand, if you keep spraining your ankle due to major instability, then surgery is often the best bet. In fact, many patients who come to Dr. Kneidel for chronic ankle sprains have already exhausted conservative measures, and surgery has become their last step.
As an ankle sprain doctor, Dr. Kneidel often performs a Brostrom ligament reconstruction to repair chronic ankle sprains. During surgery, he starts with an arthroscopy where he guides a small camera (arthroscope) into the joint to clean up scar tissue. After, he makes a small incision (about 2 to 3 inches) over the ligaments at the lateral ankle. From there he repairs the two ligaments:
- Anterior TaloFibular Ligament (ATFL): The ATFL is the most commonly injured ligament after a sprain and is important for stabilizing the ankle to prevent inversion.
- CalcaneoFibular Ligament (CFL): The CFL is also important for preventing inversion, particularly during dorsiflexion (pointing the toes upward).
Typically, repairing the ligaments includes sutures, then reinforcing those sutures with a covering over the tendons at your ankle. In some cases, Dr. Kneidel may add more reinforcements via an internal brace—a suture attached to two screws stretching from the talus (ankle bone directly under the shin bone) to the fibula (smaller leg bone lateral to the shin bone). He may use an internal brace for obese patients or patients with general ligamentous laxity (loose ligaments).
Ligament reconstruction recovery:
The surgery itself only takes about 30 to 45 minutes, but recovery may take several months. Directly following surgery, Dr. Kneidel will put you in a cast, and you will have to remain non-weight bearing for six weeks.
You will go into the office to change your cast several times after surgery. After the first two weeks, you will have your first follow-up visit. This gives Dr. Kneidel a chance to assess the wound and provide a more comfortable cast. During your second visit, he completely takes off your cast, re-examines the wound, removes the staples, and reapplies the cast. After six weeks, most patients are free from the cast, able to walk with a brace, and can begin physical therapy.
There is a specific protocol we follow at APEX we have patients take to their therapists. For most patients, physical therapy lasts for around three months, though sessions for athletes may be slightly more aggressive to return to play.
People who may not be candidates for surgery:
Dr. Kneidel takes special care understanding a person’s health history to determine candidacy. If a diabetic patient doesn’t have good sensations in the leg, reconstructive surgery typically is not the best idea; there is a greater risk for complications. Smokers are also patients who could face wound complications, and sometimes they don’t heal as well as non-smokers.
It’s important to realize your foot and ankle lie at the end of your body far from the heart. That means you need to have good circulation in the area for your body to heal properly.
Get to know Dr. Kneidel at APEX Orthopedics & Sports Medicine
Dr. Kneidel is our only physician who focuses on orthopedic foot and ankle diagnoses and treatments. In 2002, he gained a fellowship in foot and ankle at the American Sports Medicine Institute, and since then he has grown his practice to serve young children, adolescents, and adults. With his dedication to his patients and passion for foot and ankle complexities, he offers the best treatments for his patients’ needs.
APEX’s private practice model ensures Dr. Kneidel can provide his patients with the most value that doesn’t involve hidden fees or outlandish pricing.
The core of his success lies in proper diagnosis. An appointment with Dr. Kneidel includes the highest quality technology to pinpoint a patient’s underlying musculoskeletal conditions. From there, he can better understand which foot and ankle treatment will work best for you.
For a thorough evaluation with Dr. Kneidel, call us at 913-642-0200 or schedule an appointment today.