I have my appointment with an Orthopedic Surgeon on Wed to see if

A.) The diagnoses and plan of action given by the Podiatrist I was referred to is correct and if surgery is the only course of action.

B.) If I am doing further damage by delaying surgery.

C.) If there are any pain treatments I could use while delaying it that would allow me to continue working.

I sell cars at a very busy dealership and am on my feet all day and moving a lot. I can't take anything for pain that would have normal pain killer side effects because I have to drive cars a lot during the day and can't really be popping Vicodin or the like while driving a $60,000 Mercedes or Porsche.

If I have the surgery, I will lose my job (at least temporarily, they would hire me back once I recover.) but I would also lose the 2 biggest selling months of the year and the period where I would earn about 35% of my yearly income.

We have tried cortisone, and immobilization. The podiatrist didn't feel there were physical therapy options that would work because the damage is too extensive. I have "chronic sprained/unstable ankle" and they are talking about using a tendon to reconstruct the ligaments that are pretty much ruined and have a ton of scar tissue.

Prolotherapy
Reconstructive Therapy
Sclerotherapy

I had some complications from plantar fascial release, resulting in nerve damage. I was shuffled around to a plethora of health professionals including physical therapists, neurologists, neurosurgeons, podiatrists, and orthopaedic surgeons. I really believe that there are many different approaches and schools of thought on treating foot problems, so none of the doctor's opinions were the same. Because of this, I didn't know which doctor/treatment to go with. I ended up with a wonderful orthopaedic foot and ankle surgeon because a) his treatment was fairly conservative, b) he was very informative and answered all my questions, c) he was confident that he had a good shot at fixing my problem, but he wasn't promising anything, and d) he had a busy but very nice practice and office staff. Because I didn't make the right decision about the PF release the first time, it was a little hard to trust myself to make this one... but make the decision that feels right to you--you can't go wrong with that!

Yeah, the problem is I am just not sure what the right thing is right now. I have a lot of pain, every day, but I am really frightened at how major this surgery sounds.

Even though they preface it with arthroscopic, the thought of a hole drilled into my ankle, and a tendon used to replace ligaments, it doesn't sound very "minor" or even arthroscopic.

Prolotherapy
Reconstructive Therapy
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What about them?

Surgery *is* major, and I *don't* think any doctor should recommend it right off the bat. I had no idea how major my fix was going to be... when the OS told me that it would include a hospital stay, I was freaking out! Major foot surgery is hard to commit to, because the recovery is so extensive--and limiting, but if it gets rid of your daily pain, it might be worth a shot. I started seeing my OS in September, but since I go to school everyday, driving there, I couldn't do the surgery until I was done for the year, in May. My OS was okay with that--the injury wouldn't get worse--but was concerned about the pain I was in until that time. He made me promise him numerous times that I'd let him know if I couldn't stand the pain anymore, and he'd work out something to do in the meantime while I waited for the major surgery. Are you going to have the OS do the surgery or the podiatrist? Also, does the OS specialize in foot and ankle disorders?

The OS is not a foot and ankle specialist, but he has done surgery on my shoulder and knee before and I know him to be very conservative.

I am not sure who would ultimately do the surgery yet, I'd prefer the OS just because I know him already and I know he is one of the best in the state. He teaches at The University frequently and has done a lot of lectures on arthroscopic surgery.

I know that I can't take the pain much longer.

I would try a foot and ankle specialist orthopedic surgeon, and definitely get all the opinions you need. There is a less traumatic ankle repair they can do, but if you are hypermobile to begin with I wouldn't recomend it, but otherwise it is a great procedure for most people. I have had both types done. I had the ligament recon with the tendon transfer in February and it worked great overall. Still have limited ROM but is much more stable.. it's amazing. I'm assuming you've tried ankle bracing? It was never too successful for me but always an option until later on.. The instability shouldn't really get any worse, mine was unstable for a long time before it was fixed for good. I would recommend getting it fixed though.. and get as many opinions as you want, lol. I have seen a total of 6 surgeons for my ankle with 2nd opinions and everything.. Good luck!

Yeah, I've tried ankle bracing. It does nothing for the pain. The biggest problem is the pain that I think is caused more by the debris in my ankle than the weak ligaments themselves.

The hypermobility isn't as much of a problem. Yes, I can roll my ankle while baerfoot on flat pavement, but it doesn't happen often and I usually catch it before it rolls to the point of a sprain.

I wonder if they could just clean up the debris and hold off on the ligament repair to see if that does enough. I don't know how much pain the weakened ligaments are causing.

If you don't think its the ligaments don't have the surgery. A scope would be much easier to recover from, and you would be walking pretty soon after if they were just cleaning it out. I personally wouldn't get the ligaments reconstructed unless the instability was actually bad. I would roll my ankle really easily.. going down the stairs, on the sidewalk.. anywhere. And a good PT program can strengthen the outside of the ankle and eliminate most of the little instability you have. I would demand a full course of PT before any surgery too.. it helps a lot.. I promise.

I don't know much about ankle surgeries, but I have to agree that the idea of just taking out the debris and not touching the ligaments sounds like a really good idea. Why go fixing something that may not be broken? You know what's causing the real pain, just fix that first and get PT if needed, then see if you need the more complicated surgery. That may solve your short term problems, and possibly also your long term problems as well. When in doubt, be conservative!

I'd also ask for a referral to an orthopaedic foot and ankle surgeon. From what I've seen with my OS, he's very clear about being limited to foot and and ankle surgery. Yes, he does practice general orthopaedics, but he (and every other doctor in his practice) would quickly hand you off to the doctor in the office who specializes in your injury area if it's not general stuff or their specialty. He removed a nerve from my foot, and when I asked him for some nerve pain relief, he asked me if I'd seen a neurologist because he really didn't know a lot of ways to help nerve pain besides what we'd already tried! My point is that specialists really are limited to their speciality. If you like your OS, which is good, ask him for the name of a good foot and ankle surgeon in your area. I think your OS can give you his opinion in a "what a physician would do" approach, but if you really want to know if your podiatrist recommended the right surgery, you have to ask a foot and ankle surgeon. I think it's good that your OS is conservative; he'll probably send you to another conservative surgeon, which I highly recommend.

I waited 10 years in between the initial injury and getting my ankle fixed. I got two opinions before having surgery, one who said that there could be long-term problems (arthritis) if I didn't fix it, and one who said that there wouldn't be any. But either way, waiting a few more months shouldn't have a huge impact on the long-term outcomes. I'm a wimp, so I would definitely just wait and have only one surgery. If you can stand the pain, it seems like the timing of the surgery is up to you. I tried physical therapy and immobilization soon after the injury, neither of which helped tremendously. Eventually my pain went away for the most part, after two or three years. I finally decided to have the surgery done because of the instability and recurrence of pain with activity. I had the ligaments fixed up with the tendon transfer and also some trimming of excess tissue. As far as I know, the tendon transfer isn't done arthroscopically. I know that there are a lot of nerves in the area to watch out for, and I'd be wary of any surgery in which they couldn't adequately protect those nerves. Even without any nerves being cut, I had numbness in my toes for 10 weeks or so because the nerves were damaged from swelling.