I want to go to my OS next Friday armed with a ton of info. After two nerve surgeries in my foot, my OS was not at all surprised when I fell and badly sprained my ankle. The MRI showed tears in a few of the ligaments that connect the talus to the other bones (calcaneus, fibula, tibia), so my OS sent me off to PT with fingers crossed and "no promises" that there would be no surgery. However, I am tired of this ankle constantly collapsing. It hurts, and I am terrified to walk, to fall. My PT thinks we've tried enough conservatively, so is sending me back with a recommendation for stabilization of the ankle. I really like to hear patient stories, so please tell me yours--what kind of procedure you had, what symptoms you had before the surgery--and for how long--and how long the recovery takes, and the specifics. Thanks for sharing your stories; I am a control freak and need infomation so I can plan!
The following user gives a hug of support to KarynLR: tinkerbell1018 (06-18-2011)
I had an unstable ankle for 10 years before I finally went ahead with the surgery. The typical surgery they start with is the Brostrum, which is where they just tighten up the ligaments that are there.
My doctor was concerned that I would stretch that repair out, though, because I have elastic tissues (I can bend my fingers pretty far backwards). So my surgeon decided to do an extra step to the surgery which used a tendon to create a new ligament. The specific procedure he used was the Evans, but another common and similar one is the Chrisman-Snook. These procedures are done in addition to the Brostom.
The basic principle behind the tendon part of the surgery is they take the tendon of the peroneus brevis muscle, split it longitudinally, cut the end of one half up in the leg where it attaches to the muscle (leaving it attached down in the foot where it attaches at the base of the little toe way down in the middle of the foot). Then they drill a hole through the fibula (ankle bone), thread the tendon through, and sew it back on itself. This basically creates a new tendon going from the base of the fifth metatarsal to the fibula. The procedures vary based on where the holes are drilled. I think the Chrisman-Snook has a hole in the fibula and a hole in the calcaneus for the tendon to go through.
While the surgeon was in there doing all that stuff, he also did an arthroscopy (actually, he did the scope first). He looked for any funky stuff in the joint, like loose bodies, rough cartilage, bone spurs, etc. I'd have to check the report, but I think mostly he just shaved off a bunch of extra bone I had growing around the joint.
The surgery itself was easy, because they do general anesthesia. Not so deep that they have to intubate (put in a breathing tube), but deeper than you go for getting your wisdom teeth out. But you've had surgery before, so you're familiar with all that stuff. You'll definitely want to spend the night in the hospital with IV pain meds. I found it to be quite a painful surgery. I was taking my happy pills for at least 2 weeks. Although I must note that I'm a bit of a wimp.
They sent me home in this huge surgical bandage for a week, then a cast for a week, then I got my stitches out (which hurt a lot!!!), then a cast for 4 weeks. So the first 6 weeks I was on crutches NWB. Then I went in and got the boot, was allowed to start walking as tolerated, and started PT. I lost the crutches in 3 days and did PT for about 6 weeks. Then I was pretty much good as new. I don't remember how long I was in the boot, but after that it was on to the shoe.
During recovery, I pretty much had to keep it elevated all the time for the first 4-6 weeks. I couldn't drive for a month, not because of the foot, but because it hurt to let it hang down when I sat to drive. I had to be driven around while I sat with my foot up on the dash. In classes, I sat with my foot up on the table or desk. In stores, I drove the little cart around with my foot up in the basket. If I let it hang down, it would turn this dark purple color. So even after the major pain went away, I still had to elevate for the swelling.
I had the surgery 2 years ago. My ankle is totally stable now. Very tight. I actually have hardly any inversion at all now. Much less than my other foot. I stepped off of a stair wrong about 3 weeks ago and I did sprain it, but I didn't damage the repair. I managed to sprain some ligament that was up in front of the repair. But that's pretty much healed up now, too. I no longer have that unstable worried feeling that I'm going to fall over whenever I do anything. I definitely am glad that I had the surgery, even though it was painful and the recovery seemed to take forever while it was happening (although now it doesn't seem like that long).
My only regret is that my scar is ugly. It's about 5 inches long, starting up in my leg, going behing my ankle bone, and into the foot. I also have two little dots from the scope in the front of my ankle, but those pretty much went away. The long scar ended up spreading and stuff, though, so it's kind of ugly. The surgeon said that if I ever have surgery again that they should use special stitches to close so that it doesn't happen, so apparently it's just a personal tendency towards scarring. So if you have had any problems with scarring with your past surgeries, that's something to think about.
Let me know if you have any questions. Good luck with your appointment.
The Following User Says Thank You to kehorner For This Useful Post: Flaubert (09-18-2011)
Oh kehorner, thank you so much! This is the kind of response I was hoping for! This sounds about as detailed as my surgeries prior--in terms of time in casts, and recovery, and I spent the night in the hospital for both of those. IV pain meds for the second one; a great option that I would certainly use again.
Why did you wait 10 years to get the surgery? My surgeon is very conservative, and told me that we would probably know in 6 to 9 months if healing of the ligaments will occur, but I'm feeling the instability now, which causes my "team" (PTs and a podiatrist whom I "consult", but do not let cut) to think it won't heal miraculously in a few months. I am starting PA school in the fall, and Zingas (my surgeon) recoveries tend to run long, and I have a bit of concern regarding being "ready" in time for the start of my program. So, I am hoping he and I will be able to come up with some sort of "compromise" timeline. I would like to operate as soon as my semester is over, but we'll see.
Also, thanks for sorting out the procedure names for me--it was helpful! Basically, you had a Brostrom with an Evans procedure? I do not like to do a lot of Internet searching, as I think you can go through a bunch of crap, but that's where the podiatrist helps--he's hooked me up with a medical library, and has some time to call me back (unlike my OS) and discuss what I've found. The podiatrist's opinion is that my OS would do a Crissman Snook, because the "tightening of the ligament does not provide as much stability as rerouting the tendon", and that kind of surprises me. Do you know the healing time differences between a Brostrom and a Crissman Snook? When he was telling me about the holes in the bone I thought it was just the coolest idea! So smart! It just makes me think of ribbons and a hole punch for greeting cards
Did your surgeon do the scope separately before you had the Brostrum, or were they on the same day? Also, did you have stress views of your ankle pre-operatively? Apparently, they can numb you up, resprain the ankle, x ray it with force on the ankle, and then can measure the distance in the black space, and somehow can make a determination if the ligament is slack by how the bones are positioned in the x ray. If the measurements are okay, there may be some issues in the joint, so only arthoscopy might be needed. Personally, I'd just rather do the big fix. My PT, when I first came back in said to me, "Is there anything else you'd like Dr. Zingas to do if he's going in anyways? Take out more nerve? Release more plantar fascia?" He was really serious about that, and we are going to seriously discuss that before they "release" me.
One of the best things Dr. Zingas believes is that if you're going to do foot surgery, you're going to do it right--you'll stay off the foot, you'll be in a cast, you will use crutches. If you aren't going to give the foot time to heal, why do the surgery? He has drilled that into my head, and I believe it now--so while long recoveries are daunting, I know he is making sure we have the best outcome possible, and I respect his opinion. I would (and am) wary of surgeons and podiatrists who let people walk out after surgery or let them walk on the heel or whatever. People see me in a cast for weeks on end and say, "I would tell that doc to shove it!" but they have no idea what it's like to have been with a bad podiatrist, and to now have an amazing surgeon--if he says wear a cast, I am in that cast!
I have no idea how you did college with that ankle repair. I think you're my new foot goddess--that is just amazing! I am a baby and won't even attempt my campus with crutches!
Thanks for all the help--I look forward to the responses!
I had a Brostrum repair about 2 1/2 years ago. My surgery was outpatient, so I was home in my own bed that night. I was in a NWB cast for 4 weeks, then moved to the "boot" for about six weeks and started walking as tolerated (very slowly). I went back to work at six weeks, an office job, but elevated while sitting at my desk. Pain was tolerable for me, took the pills for about the first week. I had been doing great until this summer when I may have done something freaky to it, but I don't see my Dr. until next week.
"Every good has a better and every bad a worse."
I was in middle school when I had the original injury, and at that age I terrified of getting blood drawn, so surgery wasn't an option that I was willing to consider. It took me some time to get older and wiser and realize what I should do.
Absolutely do NOT try to have the surgery during a semester. Wait until summer break (or possibly Christmas break if you get like a month off). I was really dumb and did mine over spring break (not even at the beginning, but on Wednesday!). I was very behind for the rest of the semester and it was a struggle to just keep up. I would recommend doing it over the summer if you can.
Yes, when they do the Evans or Chrisman-Snook, the also do the Brostrom. So I had a Brostrom repair with an Evans. They did the scope at the same time of the surgery, just immediately before making the big incision. So I guess they knocked me out, scoped the joint, then sliced it open and did the big repairs.
I did have stress x-rays taken a long time ago, closer to the time of the original injury. They didn't numb me up for it or anything. Basically the doctor just put on some lead gloves and gently pulled my ankle as far as it would go. But they don't actually reinjure the ankle or damage any ligaments when they do it. I think some doctors do the numbing so that you don't tense up your muscles and limit the range of motion.
As for doing my campus with crutches, I was pretty much a baby too. I got the handicap permit, and there happened to be a handicap lot right behind the anthropology building. Disability resources at that university was great... they scheduled a golf cart to come pick me up from that building and drive me to my other class across campus and back. I could also call them up for other random rides when I needed them. Plus, my mom flew out and stayed with me for a month. So she did all the cooking, cleaning, cat care, shopping, and driving.
I had a grade 3 sprain in 1990. I continued to twist/sprain my ankle 10 - 15 times year thereafter. June 12, 04 I was playing flag football and twisted it strange. It wasn't an inversion sprain. I had no idea what I did, but right away I knew it was different than a sprain. It was very painful to walk on. A few weeks later I got in to see an OS sports medicine specialist. He sent me to PT. Didn't help. Did an MRI - saw there were bone spurs and floating stuff and that my ankle ligaments were scarred and there was a lot of scar tissue. I also had a pretty decent sized bone growth (exostosis) due to the repeated trauma. In August that sports doc did an orthroscopic procedure - debridement - to remove bone spurs and clean out floating stuff. He recommended ankle ligament reconstruction next. I got a second opinion from a OS that specialized in ankles and feet. He agreed, but I liked him better so I used him for the second surgery. BTW, the first OS didn't do the ligament surgery at the same time because he said they had different recoveries.
In November 04 I had the modified brostrom, repair of torn peroneal tendon and a bunch of tibia sawed off (the exostosis growth). Cast for 6 weeks, NWB for 3 of them. Then aircast for 6 weeks. Running again at 12 weeks.
I am very glad I had the surgery. I don't twist my ankle anymore. I don't think I realized how *** up my ankle was until it was fixed. I had lived with it so loose for so long that I didn't realize how it affected my life. That being said, my injured ankle will never be like my other one. Its still bigger. It hurts first thing in the morning and if I sit more than 10 minutes or so. Sometimes it throbs in the middle of the night for no reason. Sometimes pain shoots up from my ankle into my shin for no apparent reason.
A word of caution though if you are active. My OS and PT told me I could run and to gradually increase mileage and run thru the pain. I did. I limped a bit, but not a lot, when I ran. I would limp somewhat for a day or two afterwards, but it got to where I could run more and more. I did a few triathlons this summer. Mid-summer my hip started hurting so I rested it for a few weeks. Then I ran and did another tri. Then it hurt, then I rested, then ran, then did a tri. Anyway, I stopped running altogether after my last tri on labor day. I figured I'd rest it for a few months and all would be good. Well, its not good. I have been to see my OS 3 times, had an MRI and a cortisone shot in my hip. Have been referred to PT. Turns out I have an issue with my ilio-sacral joint in my hip that has caused IT Band and piriformis problems in my hip. This all is due to running with an "uneven gait" i.e. with a limp. I am looking at a few more months of PT and probably a few more months till I can run again.
What I have learned is "the shin bone is connected to the thigh bone, is connected to the hip bone is connected to the back bone, etc." If one thing gets out of balance then you are likely to have other problems. Be careful out there.
Hello! Kehorner pretty explained the whole procedure, but I thought I would share my story. I just had the Chrisman-Snook procedure, along with arthroscopy and debridment of my ankle joint, plus drilling of an osteochondral lesion on Weds. Jan. 11th. I am now 2 weeks post-op. My surgery was done as an outpatient under IV sedation. I was given versed and fentanyl, and was out in 30 seconds after they put it in my IV. After I was unconscious, they did a femoral nerve block, and bilateral popliteal nerve blocks so that I would feel absolutely nothing below my knee. The nerve blocks lasted approximately 24 hours before they started to wear off. So, the next morning is when I started to take my extended release oxycontin. My pain was pretty much under control, and I took my last pain meds Fri. Jan. 20th. I was in a plaster cast until my first post-op visit on Fri. Jan. 20th. My OS took the cast off and took out my staples (approximately 25 of them in 2 locations). There was very little bruising, but still a considerable amount of swelling, especially if the foot is not elevated. So, I still have to elevate it pretty much all day. I now have steri strips where the staples were, and I have 2 small holes from the arthrocopy that are stitched up, with everything covered by a dry dressing. I am now in an air cast boot walking with crutches, and non-weightbearing until 6 weeks post-op. After 6 weeks I can start putting weight on that foot and will be in the walking boot for another 6 weeks. But, if you ask me, it's all worth it. I had been having chronic instability issues with inversion sprains over the last year. I tried wearing a lace up ankle brace for the last year, and went through PT, all to no avail. And since I am a nurse, and on my feet all day long, my condition was only worsening. Finally, surgery was recommended, and I said yes. I am happy I did. This board is a great place for you to post. Everyone here is good about giving great advice and sharing their stories. I hope my story helps.
Thanks everyone for posting the stories--they really are helping. I haven't reinjured my ankle yet, but I am wearing the lace-up brace--supposedly, it is the most support you can get outside of reconstructing the ankle. Still though, I feel unstable. My PT has done a wonderful job of explaining the strength vs. stability issue--the muscles in the ankle must be strong to support the ligaments. As I just finished PT 8 weeks ago for recovery from the nerve surgeries, the PT clinic is pretty familiar with my feet and Mike, the PT in charge of my case says that he never really felt like ankle strength was a big problem for me, so we shouldn't expect that to increase the stability (by providing a good base for the ligaments). We are trying Anodyne to "create an environment of healing" but I think that he's trying to stretch with that. I had Anodyne before my second surgery, but clearly it didn't help because I ended up having surgery We were doing ultrasound, but it was just too painful and I would go home and not sleep through the night on the days I had ultrasound because of the pain--so we took that off the list.
As for the nerve surgeries, I had a podiatrist literally sever the lateral plantar nerve when he released my plantar fascia. We knew that there was nerve damage, but to what extent was unclear until the first operation with my orthopaedic surgeon. His words are that the nerve was "shredded". He did a neurolysis--cleaning off the scar tissue, amputating the lateral plantar nerve where there was good nerve, suturing it into the calcaneus, and then cleaning up scar tissue and removing the plantar fascia--the pod had just released it. That was a 6 week NWB in casts, and then 4 weeks in WB casts, then the boot and months of PT.
I was still in considerable pain from the nerve after that surgery, and it was determined that I probably developed a stump neuroma, which happens when the nerve regrows with nothing to attach to--it keeps sending out nerve ends, hoping to find its other nerve end, but it will never connect to anything--it is just painful! I had another tarsal tunnel release, but this time, my same OS also had his hand surgeon assist, because the hand surgeon was more familiar with microsurgery--this time, the tibial nerve was severed, completely destroying the plantar lateral branch which was causing the pain, and buried in the bottom of my leg somewhere. That was 5 weeks of NWB casts and 3 of WB casts, then the boot and more PT. This surgery was very successful, and I am so happy I did it--the pain is much more refined, less present. Unfortunately both surgeries weakened my ankle, which caused my to fall and tear the ligaments. It's a vicious cycle!
I guess my next question for the ankle people is how much should I push for this surgery? I just do not feel stable on my feet. I refuse to walk without the lace up brace, but if I wear the lace up brace, I cannot wear an orthotic, which is necessary to support all the previous work done in my foot. I am 22 and I am turning into my grandma--the other night a group of friends were going downtown, and it was kind of slushy and snowy, and I didn't go because I was worried about falling. Between that and the last night I couldn't sleep, I decided I had had it. My surgeon had wanted to see me back in March, but when I called my PT aunt in tears, she told me to make an appointment sooner and make a decision about the surgery. I just don't feel I can adequately be a busy PA student next fall if I don't have this ankle stabilized, and I don't really have a ton of time to make decisions and heal. I haven't re-injured my ankle yet, but I know it is only a matter of time. kehorner, I just don't feel comfortable on this ankle for 10 days let alone 10 weeks!
I don't want to come off like a crazy person, but I want to be firm too.
Thanks for all the advice! I appreciate everyone's stories
It sounds as if you are leaning toward the option of surgery, since you have not received adequate results from conservative treatment. Like you, I did everything you did with going conservative. At some point, you do have to make a decision. At the point you are right now is when I made my decision. I am glad I did. My ankle feels great so far, and I can already tell that is feels much more stabilized than it had been. Just know that you have to make that decision yourself. Please let us know what you decide. We are all with you.
From your initial post, it sounds like you were at high risk for an ankle sprain to begin with. Having one sprain increases your risk for another one. So you've got two factors against you there, even if you were to heal up from this sprain eventually. You didn't mention how long it's been since the sprain. However, even if your doctor wants to wait a few more months, you could put off the surgery until May and still be good to go for August. You could even put it off longer, because really you only need to worry about the time on crutches. Since that's generally no more than 8 weeks, you could have the surgery in the middle of June and be off crutches by August, although you'd probably still be in a boot.
I think the doctor's reason for hesitation would be that there are risks with surgery, and they don't want to do surgery if there's a possibility that the ankle could still heal on its own.
You could always move the appointment up to discuss the possibilities of surgery and timelines. That might make you feel better to at least know something (say, perhaps, you wait two more months, and if it's no better then he will do the surgery), rather than just waiting with no resolution.
Thanks for your response regarding the nerve surgery. Do you really mean that the posterior tibial nerve was severed? Or was the lateral plantar nerve transected where it branches from the tibial nerve? I ask because the posterior tibial nerve is both a sensory and motor nerve. Do you have permanent numbness on the outside bottom of your foot? Would you mind sharing who your doctors are and where? Even the first podiatrist so that we could avoid him. Sounds like he should have been sued.
I think the fact that you are young should help in your recovery if you do choose to move forward with surgery. I wish you the best of luck!!!!
Making the decision to have surgery to a difficult one. I wore a brace for six months before I decided I had enough of this and had surgery (my Dr. said most patients usually go a year, and I told him I was not most patients). Anyway, even though recovery was long and tedious I was glad I did it in the end. What ever you decision may be, we all wish you well and are here to support you. -eko
"Every good has a better and every bad a worse."
Thanks again for all the help! I needed the kind words today; though I pretty much knew that PT was going to be over, it's always a little sad when they release you and aren't recommending more therapy because it just isn't helping. I just want some answers, some timeline. Thanks kehorner for pointing out some possible surgical timelines. My surgeon is very conservative, and he'll come in the cast room, look at you foot after you've been 4 weeks NWB, and tell the ortho tech to put you in another NWB cast for 3 more weeks. When you question as to why you'll be 7 weeks NWB instead of the 4 you'd discussed pre-operatively, he'll shrug and say, "it's just not ready yet". I've come to loathe but respect this, and just expect extended recoveries with him.
creative--you bring up a good point about the tibial nerve, but I am pretty sure we amputated a small part of the tibial nerve. Remember, the PLN was damaged to begin with, so we amputated the damaged part, leaving PLN to be drilled into my calcaneus. That end developed a stump neuroma, so we had to amputate part of the tibial nerve--that's what the hand surgeon did who assisted. Yes, I do have numbness in the lateral bottom sole of my foot, but it isn't as bad as I expected. We did a couple of nerve blocks to make sure I could "deal with the numbness" before we cut anything, and frankly, my foot was REALLY numb when we did those--I was a little concerned going into the OR, but the pain had to go. Fortunately, my numbness is NOTHING like the nerve blocks. My OS was worried about me like he worries about diabetics--stepping on nails, having a pebble in my shoe--but really, I ended up having a lot more feeling than we thought, which was good.
Fortunately, my first podiatrist no longer has a license. He embezzeled $700 grand from insurance companies, and the state took away his right to practice when he was convicted. There is a lawsuit going that started after the first OS surgery, because we didn't know exactly what we were dealing with until he went in. Currently, my case has a signed affadavit of merit and has been filed, however, it's been difficult to find the DPM and serve him the papers. My lawyer says this is likely because he may very well be in prison right now. I approach this from a need to know basis, because it's just so depressing. A lot of people think I get daily or weekly updates from my lawyer, but I don't need to nor do I want to--it's depressing to have to dwell on the fact that you picked a ****** podiatrist and are still suffering from it.
My orthopaedic surgeon is in Detroit, MI and works with St. Clair Orthopaedics and Sports Medicine, Christopher Zingas. He's just wonderful and has been so helpful. If you look him up online, you will find a lot about PF and shock wave therapy as he was the FDA's chief investigator on that study. He's conservative, creative, and cares about the patient. I just adore him. I hear a lot of "I don't even want to think about where you'd be if you didn't find him" when I go to PT, to get MRIs, when I am in the hospital for his surgeries. I don't either, frankly, it scares me! I found him when I was looking for a neurosurgeon. After I was sent to PT that didn't work from the guy who caused the injury, I was told to "find a neurosurgeon". I called my dermatologist, with whom I am very close, crying, to ask for a recommendation. "Start with Chris," he said, "he'll take really excellent care of you.". And he did! To walk into someone's office after 4 months and to have a physician say he knew what was wrong and how to fix it, instead of asking me if I could "live with the pain" was just so amazing... I never went back to the DPM and no one will ever cut this foot except him. I'm sure many of you know what it's like to find a doctor like this!
eko--that ankle brace is my big issue. I wear that because it is the only thing that makes me feel better walking, but I cannot fit my orthotics in the shoe with that, and I'd rather not fall. However, with no arch left in the right foot, the PF pain and nerve pain are slowly creeping back, so I need to get back to some support in my shoe as soon as I can. There was a lot of work done on that and now, without support, it's all going to hell! My doc originally said in November that it was fine because the ankle brace is for "temporary" situations, but how long is temporary? I was thinking in terms of weeks... but until this ankle gets fixed, it will be a daily part of my life.
Thanks again for all the help ladies! I know that a lot of my uneasiness is because of the uncertainty--hopefully by next Friday I will have a decision down and be able to live my life until the day of surgery or whatever the next step is.
I could really relate to your story. I too picked a ****** pod for my first surgery. He outright lied to me about the likelihood of success etc. How do these guys sleep at night!
I'm so glad to hear that the numbness is much better than you anticipated. I've read that over time, other nerves in the area may pitch in and help. Because you are so young, it's probably even more likely in your case.
That was brilliant of your doctor to ask a the hand surgeon to assist. For many doctors, their ego would get in the way.
Keep us updated on your progress. You found the right doctor and that is the hardest part.