Tom Huddlestone will undergo a second stage of surgery on Friday to further his recovery following ankle surgery at the end of last year.

The midfielder has progressed well since his initial surgery, with the specialist determining that the anticipated reconstruction of a lateral ankle ligament is the next step towards the England international making a return to full fitness.

The 23-year-old was injured when he was tackled by John Heitinga when Spurs played Everton Scans revealed that Tom has suffered damage to the ligaments in his right ankle and he left White Hart Lane in a protective boot.

So what is the procedure about?

This procedure is performed to address ankle instability. Patients will typically have a history of recurrent ankle sprains. Their physical exam will demonstrate increased looseness of the outside (lateral) ankle ligaments. This is often confirmed on x-rays with a stress view.

Technique

This procedure is performed through an incision on the outside (lateral) of the ankle.  The incision is opened up down to the ankle joint.  The anterior talofibular ligament is identified.

This ligament is typically stretched out.  The dissection is usually extended down to the tip of the fibula (prominent bone on the outside of the ankle) where the calcaneofibular ligament is identified.

This ligament is also often scratched out. The anterior talofibular ligament is tightened. This is done by cutting the ligament and repairing it in a tightened position with strong non-absorbable sutures.

This may also be performed on the calcaneofibular ligament if this ligament is also loose. A “modification” to the Broström procedure may be added by identifying the strong extensor retinaculum and incorporating this into the repair.

Following the ligament repair the wound is then closed in a layered manner.

Recovery

Patients undergoing this type of surgery typically need a 6-week period where the ligaments are allowed to heal.

During this time, patients are either non weight-bearing or putting only limited weight through the operated extremity.

Patients are sometimes are allowed to place the ankle through a gentle range of motion in order to limit the stiffness. At approximately 6 weeks physical therapy is usually started.

This program focuses on:

1. Regaining strength about the ankle
2. Regaining motion
3. Improving proprioception
4. Returning the gait to a more normal manner.

For a number of months after surgery, the repair is often protected with an ankle lacer or equivalent. It is common for patients to take 4-6 months to be able to return to high-level activities.

Potential Complications of the Surgery

There are some potential risks of surgery that are specific to the lateral ligament reconstruction procedure. This includes

• Injury to the superficial peroneal nerve: This nerve is often in the wound. The nerve is usually identified and is not normally cut. However, in the repair and healing process, this nerve can become scarred, leading to either decreased sensation over the top of the foot or in some cases, a painful burning sensation in this region. If this type of neuritis occurs, fairly aggressive therapy to desensitize this area is required.
• Stretching out of the repair: This is another potential risk of this surgery.  The repaired ligament is often strong and creates increased stability of the ankle.  However, it is not as strong as the original ligament and further ankle sprains will potentially stretch out this ligament. If revision of a Brostrum repair is required many surgeons will choose to perform a tendon reconstruction of the lateral ligaments.

Patients undergoing the surgery are subject to the potential for the usual risks associated with surgery such as the risk of:

• Infection
• Wound healing problems
• Nerve injury
• Deep Vein Thrombosis (DVT)
• Pulmonary Embolism (PE)
• Continued Symptoms / Failure to resolve all of the symptoms.

This procedure is designed to effectively treat ankle instability. The pain that originates from other sources such as the ankle joint itself will not necessarily be addressed with this procedure.

Tom tweeted earlier

“Thanks for msgs! My season is over b4 its even started, operation friday!! Main objective is to make sure I’m 100% for pre season ☹”