San Francisco Podiatry Video


Wednesday, February 3, 2010

Can I Run After Ankle Ligament Surgery?

Question from Mike in Corte Madera:
For years I had unstable ankles and repeated ankle sprains. It seemed like every time I would walk on any sort of uneven ground, my ankle would roll under. Although it wasn't always painful, it was bothersome. My doctor said this unstable ankle (continually giving way) was porbably caused by a bad ankle sprain I had back when I was playing high school basketball. I had surgery about a year ago to repair the torn ankle ligaments. The ankle ligament surgery was called a Brostrum repair. Now the ankle seems fine, but I want to know if I can run in a marathon. Ultimately I would like to participate in a triathlon this year as well. Is this possible?

Answer from My Running Doc:
Ankle sprains are very common. Some estimates show that there are nearly 25,000 ankle injuries in the U.S. every day. The vast majority of these ankle injuries (about 85%) are ankle sprains. Many people try to treat ankle sprains at home with ice, rest, elevation, and maybe an over-the-counter brace or ACE wrap to keep the swelling down. But many more will seek treatment at the Emergency Room or from an ankle expert like a podiatrist.

When doctors try to determine how severe the sprain is, they base it on a grading system from 1 to 3. A grade 1 ankle sprain means that you have sort of stretched the ligaments a little. A grade 2 ankle sprain means that you have partially torn one of the ligaments supporting the ankle. Although this is more severe, the ankle ligaments are still mostly intact. A grade 3 ankle sprain means that you have completely torn at least one of the ankle ligaments.

It is often difficult for a patient to tell the severity of the ankle sprain, but there are some indicators that it might be severe and needs to be treated by an ankle specialist. Bruising and swelling are clues that you have had some level of tissue damage. With severe bruising, your ankle doctor should also be suspicious of a fracture. But even if there is no fracture and the ankle isn't broken, that doesn't mean you don't still need serious treatment.

In your case it sounds like you had one of the classic ankle sprains that resulted in Grade 3 ankle injury. Because the ankle ligaments never healed, you were left with an unstable, wobbly ankle. By performing a Brostrum ankle ligament repair, your ankle surgeon has attempted to rebuild and repair the torn ankle ligaments. If the ankle surgery has been successful, you should gain full mobility and use of the ankle. If I were to have performed your ankle surgery, the goal would be to have a much stronger ankle after the surgery than before. This of course means that you should be better able to run and bike once the ankle surgery is all healed.

In short, anyone who has ankle surgery to repair the torn ligaments should be able to run or ride a bicycle without any trouble. Marathon training and triathlon training are reasonable goals, once you have healed. Having said all of that, you should check with your current treating ankle surgeon and make sure your ankle surgery has healed before you start running, cycling or any new training routine.

Best of luck in your 2010 season!

My Running Doc - Dr. Chistopher Segler is a San Francisco based foot & ankle surgeon with a unique perspective on foot and ankle injuries.  He is a rock climber, skier, marathon runner, and Ironman triathlete.  Because of this, he understands when someone has an injury, they want to get better, just to get back to activity.  He understands that the common doctor's notion of "just stop running" or "find another hobby," or "take up Scrabble" are all unacceptable to the athletically minded.  He believes that any active athlete can suffer an injury yet return to sport stronger than ever.


  1. thanks for the article what are the success rates of fhl tenosynovitis in ankle ?

  2. The FHL tendon is the Flexor Hallucis Longus. It starts in deep in the back of the leg and runs down behind the inside (medial aspect) of the ankle and the continues out the big toe. It functions to pull the toe down against the ground and allow you to push off when you run.

    Behind the ankle, it passes through a groove in the posterior process of the talus bone. Some runners get pain in this area that can either be true FHL tendonitis or may be related to a condition called "os trigonum syndrome."

    The rate of success of course depends upon both the condition (determined through physical exam by your sports medicine podiatrist) as well as the intended treatment (decided upon by you working with your foot surgeon to make sure you will attain your goals).Without an exam and treatment plan, it would be a wild guess as to the succes rate you might expect. For a more info on ankle pain and tendonitis see or

    Dr. Chistopher Segler is a San Francisco based sports medicine foot & ankle surgeon with a unique perspective on foot and ankle injuries. He believes that any active athlete can suffer an injury yet return to sport stronger than ever.

  3. Hello Dr, I would want information. I wish you could check this diagnosis who recently left a artroressonancia right ankle.

    "The joint capsule in the anterior aspect - the side is very thin, with irregular contours intra - articular, suggesting fibrosis or synovitis or synovitis. Breakage of the upper anterior ligament talo-fibular, identifying residual fibers in the lower aspect topography of this ligament (anatomic variant with attachment issue?) "

    I fell “clicks” too - just in right ankle - every time I below. I Never broken my ankle in my life.

    The fact is that I feel pain for over 06 years in the right ankle and only with that ankle arthrodesis is that these lesions appeared. Neither the normal MRI contrast took the lesions. The doctor who meets me here in Brazil said that although my ankle hasn’t "drawer" he'll have to do a surgery, clean and put some such metal anchors (I think it is).

    Dr, it hurts me a lot, I can not longer exercise - any jog 3 or 4 km unleashes a terrible pain and is hurting for weeks until more than a month. I've done acupuncture and physiotherapy. Just pass the pain in the coming days. I was running I liked to exercise but do not do anything. Believe me, it hurts even swim.

    My question is this: the exam is compatible with surgery? The results are satisfactory? The other day I was thinking of going to consult with orthopedic surgeons who treat football players as I think they face this - and more - every day. Anyway, if Mr can help me.


  4. Hello Doctor, I am a Taekwondo athlete and I used to train minimum 4 to 5 hours a day on my fighting, speed & power. unfortunately when i was in korea for my intensive 4 weeks training I tore my left ankle ligament, but didn't notice at that time of ankle twist happend. I was keep doing my training for about 4 months and all of sudden i noticed that I couldn't do the training. my ankle was hurting very badly. i have approached a specialist and I have been told that the one of my left ankle ligament partially tore. I am now up for the surgery (the surgery that my doctor suggested me is - sorry i don't no what is it called but i have the codes for the surgery, i am sure you will know them W8630 W7430). I understand that I will be on plaster for 3 weeks and physio for 3 weeks. please suggest me if I can still get back on my Taekwondo sport and go for compitations. Thanks, Murthy.

  5. Hello Murthy,

    Sorry for the delay, but this comment ended up in my was in my spam folder.

    If the correct diagnosis was made, and the surgery is to simply to repair the most commonly torn ankle ligament (the ATFL), then I would expect a full recovery and return to sport. The most commonly performed procedure is Brostrom Ankle Stabilization Surgery. This is a relatively simple surgery that tightens up and reinforces the AFTL.

    The only reason that you would unable to return to active sports and competition is if you had an undiagnosed talar dome lesion, lateral process fracture or more severe injury that was not address at the time of surgery.

    Recovery fast!

    Dr. Segler
    Doc On The Run
    Housecalls and Consultations for Athletes

  6. Dear doc..
    i am 17 years old and i sprained my ankle a year back (14 months to be exact).. it got aggravated over the past as i had played many matches and i did attend physio after brought down the swelling and pain.. a recent MRI( just a month old) showed i had a tear in my ATFL.the xray confirmed that it was not a major one (it seems the opening up between the ankles in the lateral was minimal or something)! I'm going back to my doctor now and i will consider getting a surgery done to return to active sports. I just wanted a 2nd opinion on this decision and also i only feel a little uncomfortable now and i have minimal pain but there is little swelling and no major worries after all :). Please guide me ( btw it is called brostrom surgery which i might be getting)

  7. Hello, Doctor
    I dislocated and fracture my right ankle, as a result my doctor performed surgery to repair, now I have a plate and six screws on the right side of my ankle, before my injury I was running about 25 miles a week and training for marathon, my doctors says I won't be running any time soon, as I should seek other activities and forget about running again, with physical therapy and understanding that everybody heals different, what is an reasonable time to slowly start running again??