Ankle Dislocation
There are three bones that make up the ankle joint. Those bones are called the fibula which sits laterally, the tibia which sits superior and medially (inside) and the talus that sits inferiorly. There are also several ligaments that help to hold the ankle joint in place. When an ankle dislocation occurs, the talus comes out from under the tibia to sit outside of the true ankle joint. It is possible for this to occur without a fracture, but this is usually not the case. When the ankle dislocates the ligaments by default are torn. If a patient has a simple ankle dislocation, with no fracture the patient can be treated with cast immobilization to allow the ankle to heal. One treatment option is to place the patient in a cast and progress them to a boot and gentle physical therapy at about 4 weeks, with likely return to play at approximately 3 months. The pictures below depict the normal position of the ankle.
Ankle Fracture & Dislocation
When the talus is forcibly pushed out of the ankle joint it can cause the surrounding bones of the fibula and tibia to become broken. Remember, this would be in addition to the supporting ligaments that are by default torn during the dislocation process. An MRI would be helpful to determine the extent of ligament damage as well as if any cartilage damage has occurred. When the tibia or fibula is broken, the surgical repair usually involves a screw fixation to stabilize the fractures. Gordon Hayward likely underwent a similar fixation to the tibia bone as well as ligament stabilization procedure. The picture below shows both a fracture of the tibia and fibula that can occur with an ankle dislocation. You will also see how the screw fixation is performed to stabilize the fracture.
Pre-Surgery
(Modified) Original Photo by Laurel F., Creative Commons
Post-Surgery
(Modified) Original Photo by Laurel F., Creative Commons
Treatment Timeline
Based on Gordon Hayward's timeline here how things should go. Post surgery athlete are typically placed on a non weight-bearing status in a cast or a boot. Approximately one month later the surgeon may opt to transition to a walking boot and placed on crutches. About 2 months post-op will generally be transitioned from the walking boot to an ankle brace and cleared for full walking. 3 months postoperatively likely cleared to light activity. At 5 months the intensity of the training is most likely cleared to agility drills and non-contact activity. Keep in mind an athlete should be doing cross training, conditioning and upper body lifting throughout the recovery process. In general, probable return to play is in about 6 months from time of injury.
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