ANKLE INSTABILITY (SEVERE SPRAINS) - DR KHAIRUL FAIZI MOHAMMAD

Picture during surgery showing a torn ligament of the ankle

stress xrays to show ankle instability

Ankle instability is a condition characterised by the ankle "giving way" or feeling unstable particularly when walking on uneven surfaces. The stability of the ankle is supported by ligaments on the outer aspect of the foot named the anterior talo fibular ligament and the calcaneo-fubular ligament. These ligaments arise from the fibular bone (next to the shin) and the to talus and calcaneum (heel) respectively. Ankle sprains damage these ligaments to varying degrees.

SYMPTOMS

Instability is characterised by the foot giving way. The feeling that the ankle is not reliable and loose. It may also be associated with pain and swelling to the outer aspect of the ankle.

CAUSES

Chronic instability of the ankle is the result of the ligaments not healing after a severe sprain or more commonly, repeated sprains. This is a very common occurence during sporting activities such as football, futsal, rubgy and badminton. These injuries may range from stretching of the ligament to complete tears.

When this occurs, small nerve in the ligament are damaged. This does not allow the brain to sense instability. Therefore the surrounding muscles are not reacting to the unstable condition. With this, you are more prone to strains and repeated trauma to your ankle.

DIAGNOSIS

If your ankle feels unstable or you have sustained repeated ankle sprains, please consult you Consultant Foot and Ankle Surgeon for a full assessment.

The diagnosis is usually achieved simply from the history and examination. The clinical examination will show that the ankle in unstable (positive anterior drawers test). The foot is able to be drawn forward on the ankle joint beyond normal. The ATFL and CFL tendon may be tender.

Stress radiographs (xrays) are best to demonstrate that the ankle joint is unstable. This is best done under anaesthesia. An MRI may also be taken if there is a suspicion of cartilage damage to the ankle joint.

TREATMENT

Treatment is dependant of the level of one activity.

1. Simple ankle sprains are treated with physiotherapy. This is to retrain the ankle to gain its nerve functions again. This also allows the surrounding muscles to strengthen.

2. Surgery may be of 2 types:

a) Damaged ligaments maybe tightened and reattached to the bones. This is a very successful procedure and is usually performed in active individuals and athletes.

b) If all has failed, tenodesis surgery can be performed. This involves ligament reconstruction using a tendon harvested from another part of the body. This is very durable but it will lead to stiffness of the ankle.

Should you have any of the symptoms above, please consult your Consultant Foot and Ankle Surgeon

Dr Khairul Faizi Mohammad

Consultant Foot and Ankle Surgeon

Kuala Lumpur Foot Ankle Clinic

Pantai Hospitals

(CHERAS (HQ), KUALA LUMPUR, AMPANG)

CLUBFOOT (TALIPES) - DR KHAIRUL FAIZI MOHAMMAD, KUALA LUMPUR FOOT ANKLE CLINIC (KLFAC)

CLUBFEET

(CONGENITAL TALIPES EQUINOVARUS - CTEV)

TREATMENT by SERIAL CASTING

WHAT IS CLUBFOOT (TALIPES)?


Clubfoot or Talipes equino varus is a condition which leads to deformity of the foot in babies. This condition occurs in the womb and leads to feet to be turned inwards and downwards. This treatable condition affects approximately 150000 - 200000 births per year worldwide. This is one of the most common congenital deformities to occur at birth. It has been observed that fetuses develop with normal and the deformity can be detected in the womb at around 3 months. Most are born without any absences of bone, muscles or connective tissues. One or both feet can be affected and this condition is not painful but if neglected in a child who is walking, it may be painful and causes difficulties in walking. It is easily detected by observing the deformity at birth. The deformity can be flexible (easily correctable or stiff and rigid).





HOW WILL I KNOW?


The condition is detectable at birth. The foot are turned inward and downwards (refer to picture above). Before the child is born, the condition can be appreciated during ultrasound scans performed by the Obstetrician. If you are wondering if your child has clubfoot, please contact your Physician or Foot and Ankle Surgeon who has experience in diagnosing this condition.



WHAT HAS CAUSED IT?


It is still unknown why clubfeet occur. Many have postulated it to be cause of a tight womb leading to a packing disorder of the fetus. It is inherited. The likely hood of a sibling to develop the condition if very high.



HOW IS IT TREATED?


Clubfeet has been treated by either serial casting or surgery. Dr Ignacio Ponseti has developed a method of treating clubfeet by serial casting and bracing. This method is currently the gold standard for the treatment of clubfeet. It involves serial casting above the knees, gentle manipulation and a special protocol. It has been shown to be able to treat clubfeet in 95 per cent of cases. Treatment is usually started immediately after birth.


Clubfoot in older childer and in those with failed surgery can also be treated by Ponseti method. This method is used widely in developing countries where children present later with this condition.

If you would like to know more about Clubfeet, please contact:

Dr Khairul Faizi Mohammad

BMedSci(Hons), BMBS(Nottingham), MRCS(Edinburgh), MSOrth(UKM)

CONSULTANT ORTHOPAEDIC, FOOT AND ANKLE SURGEON,

KUALA LUMPUR FOOT ANKLE CLINIC,

PANTAI HOSPITAL CHERAS.

t: +603-91322022 ext 3333 (appointments)

f: +603-91320687

KUALA LUMPUR FOOT ANKLE CLINIC (KLFAC) - DR KHAIRUL FAIZI MOHAMMAD

DR KHAIRUL FAIZI MOHAMMAD

BMedSci(Hons), BMBS(Nottingham), MRCS(Edinburgh), MSOrth(UKM)

CONSULTANT FOOT AND ANKLE SURGEON

The Kuala Lumpur Foot Ankle Clinic (KLFAC)

was inaugurated on January 4, 2010.

CENTRE OF EXCELLENCE

This centre is lead by Dr Khairul Faizi Mohammad, a very experienced Consultant Foot and Ankle Surgeon who can provide a comprehensive diagnosis, selection of treatment and surgery and physiotherapy.

The focus of this centre is to provide the safest and most advanced treatments options to deliver maximum recovery of mobility to our patients. The specialist expertise of Dr Khairul in the Kuala Lumpur Foot Ankle Clinic (KLFAC) is essential to successful diagnosis and treatment.

With 28 bones in the foot and over 100 operations, this is a highly complex field which is relatively new in Malaysia.

The Kuala Lumpur Foot Ankle Clinic works closely with leading medical research departments and expert medical suppliers in the development of newer treatment options. This enables us to treat foot and ankle disorders where previous treatments have failed.

Situated in along the middle ring road in Cheras, Hospital Pantai, Cheras is part of the public listed Pantai Group of Hospital and provides some of the most up to date hospital facilities in Malaysia:

• four operating theatres


• 200 beds


• ICU


• physiotherapy


• MRI, CT scan

DIRECTIONS

It is strategically located in Taman Cheras Makmur, Cheras. Situated at the intersection of the Middle Ring Road (MRR2) and the Cheras Highway. There is ample parking on the premises of the Hospital.

CLINIC TIMES

SUITE 21, 3rd FLOOR, HOSPITAL PANTAI, CHERAS

Monday to Friday (0900 - 1300)

afternoons by appointment only

CONTACT US

+603-91322022 ext 3333

(CLINIC NURSE MANAGER)

drkhairulfaizimohammad@gmail.com

khairul_mohammad@yahoo.com