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)

KUALA LUMPUR FOOT ANKLE CLINIC (KLFAC) - AOTrauma Foot and Ankle Course 2011 (Kuala Lumpur) - Dr Khairul Faizi Mohammad

Dr Khairul Faizi Mohammad (KLFAC, Malaysia - centre)

Dr Les Grujic (Australia) centre

Dr Andrew Beischer (Australia) demonstrating.

Participants and Faculty members

KLFAC would like to congratulate Dr Khairul Faizi Mohammad on chairing and organizing the world accreditted AOTrauma Foot and Ankle Course in Kuala Lumpur on the 6th of June til the 8th of June 2011.

This course was over subscribed and attended by surgeons from Malaysia, Singapore, Indonesia, Thaiand, Myanmar, India and Australia. Speakers at this course included Dr Les Grujic (Australia), Dr Andrew Beischer (Australia), A/Prof Inderjeet Singh (Singapore), Dr Chong Keen Wai (Singapore) and Dr Khairul Faizi Mohammad (KLFAC, Malaysia).

DR KHAIRUL FAIZI MOHAMMAD: FLAT FEET (Kosmo - Malay version)

The end of the first quarter of the year is ending and Foot and Ankle Problems has been relatively quiet. The Kuala Lumpur Foot Ankle Clinic, headed by Dr Khairul Faizi Mohammad has been very busy with clinical and academic activities related to foot and ankle surgery. We will be updating everyone with more information in the days to come. So as a start, this is a newspaper footage (in malay) on flatfeet and a patients account of his experience.

http://www.kosmo.com.my/kosmo/content.asp?y=2011&dt=0320&pub=Kosmo&sec=Kesihatan&pg=ke_01.htm

If you do have questions or suffer from flat feet, please consult you Consultant Foot and Ankle Surgeon.

EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT) FOR FOOT PROBLEMS - DR KHAIRUL FAIZI MOHAMMAD (KLFAC)

ESWT being applied to the insertion of the achilles tendon

Close up view

WHAT IS EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT)?

ESWT is a non invasive surgical procedure that uses shockwaves to simulate the healing process in certain conditions of the foot such as achilles insertional tendinitis and plantar fasciitis. Extracorporeal means outside the body. This refers to the method in which the therapy is applied. There are no incisions. Patients benefit from no associated complications of surgery and it can be applied as an outpatient procedure.

WHO ARE THE CANDIDATES FOR EXTRACORPOREAL SHOCKWAVE THERAPY (ESWT)?

Candidates for ESWT are those in which conservative treatments for their condition have failed. Conservative treats for heal pain include non steroidal anti inflammatory medication, point specific steroid injections, insoles, stretching exercises and physical therapy.

Patients who suffer from bleeding tendencies or who are on medication that leads to bleediong tendencies are contraindicated for the treatment. Your Foot and Ankle Surgeon will determine whether this treatment is suitable for you.

WHAT TO EXPECT FROM THE TREATMENT?

ESWT is mainly done on an outpatient basis. Anti inflammatory medication is stopped 5 days prior to the treatment. Shockwaves are applied using a machine to the respective areas in various intensities. Treatment usually takes around 30 minutes to be performed. Treatment will be performed 3 to 5 times, on a weekly basis dependant on the response to treatment.

Do contact your Consultant Foot and Ankle Surgeon if you are interested in knowing more about this treatment.

Dr Khairul Faizi Mohammad

Consultant Foot and Ankle Surgeon

KUALA LUMPUR FOOT ANKLE CLINIC

(KLFAC)

Pantai Hospital Cheras

Pantai Hospital Kuala Lumpur

Pantai Hospital Ampang

DR KHAIRUL FAIZI MOHAMMAD (KLFAC) talks at BFM 89.9 on "BAREFOOT RUNNING"

left to right:

Pete Pereira, Dr Khairul Faizi Mohammad (KLFAC), Shazmin Shamsuddin (BFM89.9)

The debate on shod running and barefoot running has been going on for the pass 40 years. Dr Khairul Faizi Mohammad from the Kuala Lumpur Foot Ankle Clinic and barefoot runner Pete Perriera are interviewed by Shazmin Shamsuddin from BFM 89.9. Listen in to our discussion!

www.bfm.my/barefoot-running-health.html

Kuala Lumpur Foot Ankle Clinic - Majlis Pelancaran Majalah i-Sihat - Dr Khairul Faizi Mohammad

Utusan Karya Sdn Bhd has recently launched a new health based magazine called i-Sihat (i-health) This magazine will feature interviews, health related articles and advice pertaining to various aspects in a persons health.

Our Dr Khairul Faizi Mohammad from the Kuala Lumpur Foot Ankle Clinic has been appointed as a member of the Advisory Panel to the magazine. Once again we would like to congratulate Dr Khairul on his appointment and we hope the knowledge given will be beneficial to our society.

Malaysian Foot & Ankle Society (MFAS)

We would like to congratulate Dr Khairul Faizi Mohammad from the Kuala Lumpur Foot Ankle Clinic (KLFAC) on his appointment as secretary at the inaugural meeting of the Malaysian Foot and Ankle Society on the 18th of May 2010.

This society has been inaugurated to cater for the growing interest in foot and ankle diseases amongst clinician in Malaysia.