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Old 08-13-2009, 11:08 PM   #1
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Osteochondral Defect - Post Op Update

Just an update for anyone to compare notes and for newbies to hear one more insight : Had Microfracture surgery May 22 2009 to "repair" 5mmx8mm lesion in the talus. 6 Weeks NWB, then 6 weeks in boot. 6 week follow up xray shows the hole in talus appears to be filled very nicely. Dr. pleased with progress. After finally dropping crutches found the boot irritating...the foot position in the boot had a tendancy to send shocks of pain when stepping so, I left the boot at home more frequently since I sit most of the time at work. I tried PWB while rebuilding strength in the foot. Dr. didn't prescribe PT. Luckily, I can bike with little discomfort. Now August and biking hard an hour/day. Waking to morning joint stiffness and still occasional shocks of pain from the instep by heal upward. But almost no limp. Biking is quickly rebuilding leg strength but need more work on lower leg. Discovered hiking steep inclines produce zero pain but flat surfaces are not so good. I carefully jogged 25 yards today with little discomfort and only a couple shots of that pinched nerve-like pain. My prayer is to return to trail running...even if shorter distances. Eager to hear other updates...but hope that no replies suggest everyone is getting along too well to report in!

 
Old 08-14-2009, 06:34 AM   #2
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Re: Osteochondral Defect - Post Op Update

Tibors,
I had(have) 2 OCD spots. OATS on one, microfracture 3 times now on the other. I have to say that after the first 2 surgeries I was able to get back to running. I had tendon issues which prevented my complete recovery this time, but I bet you can get back to running. It takes time. Keep the positive attitude! I'm glad things are going well for you.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
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Old 08-14-2009, 06:37 PM   #3
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Re: Osteochondral Defect - Post Op Update

Kris, thank you for replying. I cannot fathom going through this 3X. I am sorry to hear. I'm reading mixed reports on the time before returning to running. Some never... but others as soon as 3 months or as long as 12 months. In your experience, how long did you wait? and did you wait until you were 100% pain free before running again? Did your return to running bring on the need for the additional microfractures? or worse...the OATS?

Tibor

 
Old 08-15-2009, 05:21 AM   #4
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Re: Osteochondral Defect - Post Op Update

Tibor,
My first dr. was very conservative with rehab. I had a modified Brostrom, peroneal subluxation repair and torn peroneal tendon repair, debridement of my ankle, synovectomy, and microfracture of 2 OCDs. Well, I was NWB for almost 12 weeks. I wasn't allowed to run until 5 mos post op.
My result was that I was pretty good for about a year and a half. I got back to everything I wanted to do. But I retore the peroneal tendon (no idea how) and stretched out the Brostrom, and eventually, the pain from the OCD's, especially the bigger one becaue unbearable. So I had surgery #2

Surgery #2 I had peroneal tendon repair, OATS on the bigger OCD, microfracture on the smaller, a complete reconstruction of my ligaments using some fibular sheath, and another Brostrom to reinforce the new ligaments, also had the peroneal tendon cleaned up, arthritis debridement, and general debridement all over the ankle. I had a different dr. and he told me I could run at 3 mos post-op. It still hurt quite a bit so I waited and at 4 mos post up I started to run. I was in pain yes, the pain never went away and thus the reason for surgery #3.

This time around I had microfracture of the smaller OCD, the OATS looked pretty good. My posterior tibial tendon was torn and my peroneal tendons and my posterior tibial tendon were all full of scar tissue and adhesions that made them stuck down an unable to move. I basically had a frozen ankle. (Yes, I was running on this and doing karate and it hurt, but I did it.). So now I am 2 1/2 weeks out of surgery 3. I'm NWB 6 weeks this time and a boot for 10. I started PT at 2 weeks because my dr. and I figured that the adhesions happened because I was 6 weeks in a cast which is normal protocol, but my body just makes extra scar tissue. I had a similar problem after shoulder surgery.

I read recently that it is suggested to wait 15 weeks before running after microfracture or OATS. That is more in line with what my first dr. said. So this time, I'm going to wait longer as my microfracture from surgery #2 looked in surgery #3 like it hadn't ever happened and it actually got bigger. Most of my pain was from my tendons though, so although the OCD got bigger, the pain didn't get worse than before.

I think that running didn't have anything to do with me needing OATS. My bigger OCD was already stage 4 and at least 1cm I think microfracture at that point isn't as successful. So I think running/not running for that one wouldn't have made a difference. Now, for the smaller one this time around, who knows. Maybe if I held off it wouldn't have grown. I have lots of arthritis by that one and so I have a feeling that is keeping it from healing.

Will I run again? I really hope so. But I will try and wait until 15 weeks and maybe work up my run instead of just starting out at 4 miles. But, my PT said my running days could be over since I have some bone on bone action going on in my ankle. I don't want to go there yet, since running is my favorite thing to do, but it is in the back of my mind. My dr. and my PT all said that actually my karate (I'm an instructor) is less stressful on my ankle than running.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 08-15-2009, 09:33 PM   #5
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Re: Osteochondral Defect - Post Op Update

Hey Kris,

So glad to hear you have already started in PT!! Adhesions and scar tissue should be less this time around. My PT grumbled again about scar tissue this week (he is still ****** Dr. wouldn't let me start pt until 6 weeks out). Keep us posted.

Margaret

 
Old 08-16-2009, 04:48 AM   #6
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Re: Osteochondral Defect - Post Op Update

Hi Margaret!
I hope your scar tissue isn't as bad this time around. I was very excited to start PT and moving my ankle so early. I really hope it makes a difference, but right now it hasn't. My ankle still feels as frozen as before, not all my toes are "active participants" as my PT said and I can't get them all to work. Also, I'm having some nerve pain if I touch the skin and most of my foot, at least 50% in numb. I hope that this is all normal and I just wouldn't know because usually at 2.5 weeks out I'm still in a cast. So I can't really compare to before. At least that's the view I'm having now. My PT said that scar tissue starts forming from day 1 though.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 08-16-2009, 07:51 PM   #7
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Re: Osteochondral Defect - Post Op Update

Kris, I'm surprised you could run at all. That is actually encouraging, though I'll pray for your speedy recovery and a positive attitude. I'm just catching up again on this site, and saw that another runner finished a 100 miler two years after op. That is so amazing. Tonight, I jogged slowly again, 50 yards out and back with only dull aches, no stabbing pain. Oddly it is deep w/in the arch, like a plantar faciatis, that throbbed after, and continues to. Even just pressing on the bottom of the foot. I'm going to stick to biking for at least another 3-4 weeks before trying again. I too, worry about scar tissue, hope that biking keeps it down. Thanks again.

 
Old 08-17-2009, 03:21 AM   #8
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Re: Osteochondral Defect - Post Op Update

Tibors,
I ran, but ran with a limp. Honestly, running hurt less that walking did. My PT said it made sense to him because of how my stride was with running vs. the longer strides I took while walking. It was only at the very end before my last surgery where running got too painful. I was able to do a 3.5 hour endurance day for our karate school. It involved a lot of running and I did great, but at the same time, it may have been a bit much because it was after that day that I started to go downhill. I was about 7 mos post op then.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
Old 08-17-2009, 07:31 PM   #9
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Re: Osteochondral Defect - Post Op Update

Take a deep breath. While it seems this second (third for you) surgery is nothing compared to the OATS we went through, this was very invasive to the soft tissue. It will take awhile. Not what you want to hear but it was at least 4 weeks post op before my toes joined my foot and 6 weeks before my ankle had the tiniest bit of mobility. My OS told me this surgery was a big step backwards after the OATS and in hindsight, it is. I didn't believe anything could be as discouraging as the post-op OATS but I think the tendon/scar tissue/hardware removal is actually more discouraging. Healing is not visible on an x-ray like with OATS. We were thrilled to gain mobility and flexibility and now, rather than starting back at zero, we start at -5.

The recovery from this follow-up has been much harder physically and mentally for me. Take it easy, respect the boot and keep telling yourself 'fusion is not an option'.

Cheers,
Margaret

Last edited by Administrator; 04-12-2011 at 10:18 AM.

 
Old 08-18-2009, 04:28 AM   #10
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Re: Osteochondral Defect - Post Op Update

Thanks Margaret for the encouragement and reminders. You are right. To me I keep thinking this was a "not that big of a deal" surgery, but I still had a lot of tendon work on both sides, microfracture, and a torn PTT. So it still was. I have to say I'm having the hardest time respecting the boot this time around. My thoughts to myself are that since I need to be moving it anyway, why wear the boot? I do wear it when I'm in public, just not at all when I'm at home. With the OATS I knew I had a broken bone and had to be careful. This time I figure, I need to break up scar tissue so what's the point? Bad, I know, but I don't get the purpose of the boot.

Is your mobility more this time around? I don't know what -5 is. My PT just uses degrees like 20 degrees.
__________________
Brostrom x2, peroneal tendon repair x2, Peroneal subluxation, PTT tendon repair, microfracture x5, OATS, Distraction arthroplasty, ORIF talus & fibula, subtalar fusion, ankle replacement (failed)
RSD

 
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