- Heterotopic ossification of the distal syndesmosis has
been reported in up to 25% of patients, although no
correlation to ossification with functional outcome has
been found (Taylor, Englehardt, and Basset, 1992).
NONSURGICAL TREATMENT RESULTS
- Primary ligamentous repair has not been supported by
studies comparing early surgery to functional treatment
of ankle sprains (Sommer and Arza, 1989; Weise, Rupf,
and Weinelt, 1988; Zwipp et al, 1989). Satisfactory
healing of lateral ankle ligaments with the use of a
functional ankle brace has been documented by MRI
(De Simoni et al, 1996).
•A prospective study of 146 patients with grade 3
ankle sprains who were randomized into operative
and nonoperative groups found that the group
treated with an ankle orthosis returned to work
faster. No difference in joint laxity was found on
stress radiographs 2 years post injury (Povacz et al,
1998).370 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE
FIG. 62-1 Chronic ankle pain algorithm.