I've had a painful "popping" on the outside of my ankle every time I put weight on it as of late. I haven't injured it since my freshman year (2003- although I probably sprained it a dozen times between 2001 and then between volleyball and rugby) and it's been a little sore after using it, although nothing major. Lately though its gotten to the point where not only does it hurt when I'm using it, but for days afterward, to the point where I don't want to get off my bed.

I finally broke down and went to see my PCP who referred me to an orthopedic doctor. I ended up meeting with him a month ago, and he put me in a boot and ordered a MRI (which they couldn't fit me in until last week:mad: ). I just went back to see him this morning to get the results, and he said he found that the ligament on the outside of my ankle was loose, and it was allowing the tendon to shift across the bone. He also said there was a bone fragment in the joint and a cyst (which he said was probably nothing:) )on the bone, which were most likely not the reason why I'm in pain. He then said I should undergo PT for 8 weeks then come back to see him.

I was wondering will PT even work to tighten up the ligament, especially since I don't remember doing anything lately that will have caused this:confused:. From what I read (and the thought that the bone fragment isn't going to just go away) I'm not it sounds like I'm just delaying the inevatable, and am going to go back in September and find I have to go for surgery anyhow. What's worse, practice starts up for me the first week of Sepember, so I'm going to miss the first two weeks of the season stuck in this boot (which didn't really help this last month), but if I go in and find that I do have to go for surgery sometime after that, I'd be doubtful for the spring season starting in March. Knowing this is my senior year, and probably the last year I'll get to play, I could try and push it off until next summer, although I'ts almost unbearable now, and I can't imagine it getting any better. I was just wondering would I be better to push the doctor for surgery now, with the hope of being back for the spring, or roll the dice with the PT.

Sorry about being so long winded, I'm just a bit worked up about this, cause barring all the sprains I've never really had a major injury.
-Molly

Bone fragment in the joint - where did that come from, and I assume eventually it will have to come out or it could possibly do more damage to the joint. PT may help the tendon issue, but I can't help to think something else is going on. Is the OS you saw and Foot and Ankle Specialist? If he is not, or even if he is, I'd see anothe Foot and Ankle OS and get a second opinion, besure to take your MRI with you.

Good luck!
-eko

RugbyGirl:

PT cannot fix loose ligaments. What PT can do is improve your balance and prioperception the strength of the muscles. For many people that sprain their ankles repeatedly their issue it ankle strength and prioperception. So, the usual course of treatment is to be conservative and try PT. Doesn't sound like it will work in your case. Also, I wonder why he put you in a boot. From all that I have read, there is now no evidence that immobilization will work for an ankle sprain. Damaged ligaments don't scar back down with immobilization.

I had a similar situation to you. I had a real bad sprain in college but then contintued to sprain it 10 or 15 times a year thereafter. It didn't hurt all that much afterwards, so I just ignored it. Then playing flag football it twisted up inside the ankle and I was in pretty good pain from there on out. The MRI showed bone spurs and loose fragments in the joint. I also had a tear of the peroneal tendon and badly scarred ligaments. My OS said "lets try PT for 6 - 8 weeks." My PT said "there is nothing I can do for you." My OS said, well, you can have surgery but I'd suggest that you just wear an ankle brace most all of the time." I thought that was crap. I then went to an OS that specialized in foot and ankle surgery. He said "of course PT won't work - let's fix this." So I had two surgeries - an arthroscopic one that cleaned up the joint and then one about 2 months later to repair the ligaments and remove some of the tibia that had grown up due to repeated trauma (this sounds like your "cyst"?).

My advice, get a few more opinions.

Molly,
I think your gut response is correct, and you should seek another opinion, preferably from a foot/ankle specialist. If you don't have access to one, try to get an ortho specializing in sports injuries. They will be much more knowledgeable, and will work to get you up faster...
Rest, immobilization, and pt have helped with minor issues, and I don't know why they do this. Just my opinion, but if you are loose enough to have had numerous sprains/strains, you are beyond pt. The bone chip or pieces, too, is something I'd question, makes it sound like you have had a more significant injury at some point, (when you thought you had a sprain), and worked your way through it.
I wish you luck, and hope you will post back and let us know how things go. Kim

Well, I went for a second opinion, and after doing PT found I have to go for surgery... This second doctor (foot & ankle specialist) looked at the MRI and said that the ligaments looked fine, but one of the two tendons on the side of my ankle is damaged. Despite pretty much expecting this, I still was taken back by it and didn't fully comprehend what the procedure is going to be (I'm starting my list of questions now).

He said something about one of them being strong enough to serve the purpose of both, so he was going to clean out the bone fragment, and remove part of the damaged tendon, and stitch the ends to the existing one:confused:. Is this something that's commonly done? He showed me where he's going to have to cut and it looks like it's pretty major, going along the side of my foot and up behind my anklebone (he said he couldn't promise, but he'd try and avoid the tattoo on my ankle)

He at least gave me the option to wait until winter break to have it done, so I'm looking at early/mid December. He did say with some extensive PT, I might be able to be up and running in three months :) (which If I go in December will have me healthy enough for the spring season, although puts a damper on the holidays). I was just wondering if anyone had any insight into what I can expect in terms of recovery time (I go totally crazy if I'm not doing something, so I can't imagine sitting around and doing nothging for weeks at a time)

Mol

Unfortunately welcome to the world of tendon repair, there is a bunch of us who have been there and done it. Did your doc use any words like Brostrom Repair, Chrisman-Snook (sp?), or anything like that?

Typically NWB for six weeks, moving through PWB to FWB. Full recovery is a function of your ability to heal, skill of the surgeon, and PT. Since your are an athlete, you might be in good shape in three months, possibly wearing a brace for support. Sounds like you have got a good surgeon.

Best wishes -eko

No he didn't use any procedure name, and after hearing that he wanted to do surgery I was kinda in shock to the point of not even thinking to ask. He only mentioned the removal of part of the tendon and stitching it at both ends. (It was about this point that it seemed to be getting hard to breathe and wasn't thinking clearly) He did say six weeks in a cast and then PT. The only thing I thought to ask was when I'd be able to return to running again which is where I got the three months.

Asuming I can run after those three months I'll be able to get back into playing shape in two or three weeks (maybe sooner if the New England winter cooperates and I'm allowed to ride my bike while doing PT). My biggest concern is that if he has me on crutches the whole 6 weeks, that not only will my ankle be on the mend, but my right leg will be weak as well.

At least on a positive note, he said assuming I could tolerate it, I could ditch the boot and do whatever the pain would allow me to do, and I was actually able to practice yesterday with limited pain after taking one of the ibuprophen 800's, although its a bit swollen and sore this morning (the half mile walk to class this morning is going to be a bit rough)

Hi Molly,

Hopefully I can give you some info that might help you out. I am now 6 weeks post-op from my second ligament reconstruction. During this surgery, my ortho took the peroneus brevis tendon and used it as a graft to reconstruct the ligaments, and used screws to hold it to the bones. So, as you said, your foot can function normally without one of the ligaments. I was walking in my cast by 4 weeks post-op. At around 5 weeks, I got the cast off, and was put into a boot, and started PT. I am in really aggressive PT right now. I still have pain, but it seems to be less and less every day.

Before I had the surgery, my ortho told me that the last person he did this procedure on was up and hiking three months later. I feel that with the progress I have made, and will make in PT, I'll definitely be back running and cycling in 3 months. I am very athletic (I'm 20) and will be back moving around by mid-November no matter what!

Anyways, just wanted to let you know that if all goes according to plan, and you have no setbacks after the surgery, and work really hard in PT, then you should be back to athletic activity in no time. If you go into it with a mindset that you're gonna get back on the bike, or run as soon as possible, then you'll do it. If you have any more questions, feel free to ask!

Take Care,

Megan

Thanks, I couldn't imagine having to go through a second surgery. I'm having enough trouble dealing with finding I have to go for one, (I spent the entire summer pretty much bouncing off the walls being pretty much limited when it came to physical activity) nevermind two.

I have no doubt that I'll be able to do it assuming the weather cooperates. My biggest concern is that I try and get on the bike too soon and injure it again (this is where having a high pain tolerance isnt' a good thing) and end up having to start at at the beginning again. I'm not too worried about getting back in shape, being only 22 and all, although I'm not sure what kind of excercise, if any I'll be able to do after the surgery and before I start PT. I've been spending a lot of time biking and swimming this summer (my bf's family has a pool), but the pool's not going to be an option for obvious reasons, and I'm guessing that riding a bike isn't going to be allowed (not to mention difficult with a cast on anyhow)

My other worry is that winter up here can be really messy (Snow by Thanksgiving is a definite possiblilty; not to mention those one or two storms a winter that dump one to two feet at a time), and despite all the undesired practice, am not all that good on crutches. Figure in a little snow or ice and I'm sure I'll be an accident waiting to happen. (On a good note I'll be home for Christmas break, so I wont' have my friends there to make fun of me and take pictures when I wipe out) Even after I'm into PT and able to go running, I don't do well on treadmills when I'm healthy, nevermind recovering, and theres times when the streets are so narrow with snowbanks that it's not safe to run for weeks at a time.

You sound like a carbon copy of myself...could be a good thing, could be a bad thing...LOL I ended up having to have another surgery because I wiped out on my bike back in June and blew out the first reconstruction. Not fun I must say. I have a super-high pain tolerance also, but this second surgery has been way more painful than the first. PT is not fun...can we say pain and torture? But I know in the long run, the work I have put into it will pay off.

Actually, this morning my physical therapist gave me the go-ahead to start riding a stationary bike. I don't have one at home, so I guess I can go to the gym sometime. When I asked about riding on the road, he told me to ask him again in two weeks. He is afraid I might crash again...and with my luck, I probably would. He also told me at least 2 more weeks in the boot, which will put me at almost 9 weeks post-op. After the surgery, when you get the cast off, swimming will be the best thing you can do for the foot. When I re-injured myself back in June, I was training for a triathalon, so this ankle thing has been a huge bummer!

I wish swimming would be an option, but the pool is outdoors and is already closed for the season....

I actually just got a message from the clinic, they scheduled me for Dec. 6th. (I swear they have a way of wording things to make people uptight- I have that knot in my stomach again... ) Apparently it's not outpatient, they said they'd have to keep me for observation for 23 hours. I know the doctor said I'd be in a cast for 6 weeks, is that something that he'll wait to do until he takes the stitches out (when do they usually take them out)?
Do the doctors give you the option to use a local anesthesia, or do they make you sleep through the whole thing? (some twisted part of me wants to watch the procedure, cause I've heard the stories from a couple of my teammates who have had injuries where they were allowed to stay awake during surgery)

I know I probably will feel awful the first couple days getting out of bed will be the last thing on my mind, but how soon is too soon to be up and almost functional? (I am really bad when it comes to sitting and doing nothing, and will probably be stir crazy as soon as I'm aware enough to realize I'm bored) My bf's company Christmas party is only a week and a half later (the following Friday), and they were doing a harbor cruise. I know he was really looking forward to going (as was I), but I don't want to ruin his time if I'm going to be in too much pain (i.e. miserable to be around), but if I'm feeling up to it, is a week and a half too soon to go out like that... Thinking about it now, the whole winter thing is going to be a royal pain in the butt, considering it gets so cold up here that I usually wear jeans all winter, which is making me think I probably won't be leaving the house in anything but sweatpants for those 6 weeks...

Sorry for being so longwinded, but this is all new to me, and the not knowing is getting me all freaked out......

Mol

December 6th...what a great date...thats my b-day! When I had the last surgery, I was kept for 23hr observation. At first my doc said outpatient, but after the surgery, he decided to keep me overnight for pain control. I was glad I stayed, getting dilaudid pca was great! My first surgery was outpatient, and I did fine being at home, but with the second one, so much work was done, and I was in alot more pain.

Stitches usually come out at the first post-op visit, around 10 days post-op...at least that's what I have always had done. After the surgery, you have the huge surgical splint, then when you go back that's taken off, stitches come out, and the hard fiberglass cast gets put on.

I asked my doc about different anesthesia options for my second surgery, and he said that it could be done using a spinal with some sedative, but he recommended that I go with the general. The general they use isn't so heavy that they have to intubate you, but heavy enough that you are totally out. I wouldn't have minded being awake, but he strongly recommended the general because it was a long procedure (4 hours), and there was alot of tedious work to be done.

I'd say the first 2-3 days are the worst. If you stay on top of taking your pain meds..take them before you hurt...then you should be pretty comfortable and functional. I was up on my crutches in the hospital the day after surgery. At home, I didn't spend much time in bed. I laid on the couch or in the recliner with my foot propped up. I was able to get in the shower the day after the surgery. By 4 days post-op, I was able to get out of the house and go to the store (with my mom), and rode in a hover-round thing. I was driving 7 days after surgery (the left foot was operated on).

I can't stand sitting either...I have to be up and moving 24/7 like you. By the second week, you should be moving around pretty well with the crutches with minimal pain. You just have to make sure you keep the foot elevated as much as possible. Putting the foot down for any length of time will cause swelling and pain. I am sure you'll do well, considering you said you have a high pain tolerance. I guess I would just do whatever you feel comfortable with, just don't rush getting back to your normal activities. You want that repair to heal strong so you don't have to deal with more problems in the future!

Thats such a coincidence....

Yeah, I'm pretty much looking at it like its going to be really incovnenient, especially for the first week or two, but it's only for a few months. I'm just going to try get in as good of shape as possible so that when I am able to start up again, I don't have quite as far to go. I was thinking on going down to the local YMCA (I believe they have a pool) and signing up so that when I get out of the cast I can start swimming right away (and with luck walking in the pool, I'm sure the buoyancy will help reduce the amount of weight I have on it too)

In the meantime, I'm just enjoying things as much as possible until then. I went to my team's game this morning and didn't intend to play until the second team game, but I was asked to come in at halftime of the first side game despite only having practiced the last two days. It wasn't too painful (thanks to the industrial strength ibuprofen), although I'm really sore now. Being I did all my teams kicking before all this, I was told once I went in that I would be resuming that duty. I luckily only had to do it twice, but that really hurt (The whole left ankle thing is good in terms of driving, but unfortunately I'm a lefty). I'm probably going to be wishing I hadn't as of tomorrow, but maybe the ice I have on it now will help....