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Old 02-20-2011, 07:45 AM   #1
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Severe pain after Osteochondral Lesion repair

Hi all - wonder if anyone can offer any advice please. I'm a 39 year old male. I had a 10mm OCD of the talus repaired end of September 2010. They were going to fix it via keyhole but when they put the scopes in they could see there was too much damage and cartlidge "flapping about" so they opened me up and fixed it by cutting it away then drilling to promote new cartlidge growth etc. I was none weight bearing for 7 weeks.

I'm back walking now but the pain is far worse than it was pre surgery. Though it is a different pain, feels in a different part of my ankle.The surgeon states that from the xrays everything looks normal and the bone has healed etc. He is now saying it looks like I may have arthiritis in the ankle. This is the first time anyone has mentioned arthiritis though pre surgery they did an mri scan not an xray so I've nothing to compare the xray with.

I get a lot of pain when walking and it is all the time (pre surgery it used to come and go). If I have been off my feet (sat at a desk, in bed etc) for an hour+ then stand up the pain is really bad, almost agony, for the first couple of minutes, I can hardly put my foot on the floor without steadying myself. The pain is within the ankle not under the foot, so I don't think its plaintar f?? It hurts whenever I cycle, swim, walk....running is out of the question, I can hardly run across a road! I'm going back to my gp and going to contact the surgeon again as something isn't right. The surgeon did say it could take 6 months to heal properly so maybe the pain will go away in a couple more months?

Can the operation actually CAUSE arthiritis. I'm thinking if it's caused the cartlidge on the rest of the ankle to decline or become thinner that could explain the pain. The damage was on the left side or inside of the ankle, the pain actually seems to be more towards the right hand side or outside. The xray showed the "arthiritis" to be on the right side too.

Does all this sound normal for 4 months post op? Anyone elses' experiences sound similar to mine, or anyone got any advice please?

Many thanks for taking the time to read this!

 
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Old 02-20-2011, 09:42 AM   #2
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Re: Severe pain after Osteochondral Lesion repair

I had the same procedure, although it was done via scope and not open incision. After non-weight bearing for 5 weeks and another 5 weeks in the boot, I started attempting to walk normally. I received pain on the "other" side of my ankle when walking, but the OCD side felt fine. In theory this was determined to be scar tissue build up within the joint, due to being imobile for almost 10 weeks.

I found cortizone injections into the joint helped tremendously and maybe over time it will settle down some.

I had the same question as you regarding arthritis, and can the surgery itself cause arthritis. It's important to understand that the OCD itself is in fact arthritis. Typically it's post traumatic arthritis from an injury or repetative micro trauma vs the slow progressing wear and tear of osteoarthritis.

My guess is you've got some scar tissue built up, which may be causing synovitis (painful inflammation) within the joint. I think folks like us are pre-disposed to longer term arthritis but I doubt it would be advanced throughout your joint within 4 months of surgery unless you went into the surgery with a lot of arthritis or the surgeon caused damage in other areas of your joint prompting accelerated arthritis...

 
Old 02-20-2011, 10:35 AM   #3
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Re: Severe pain after Osteochondral Lesion repair

Hi - thanks for the reply. I was only in a cast for 2 weeks then I wore the aircast boot for the next 4 weeks so I could take it off during the day (and also whilst in bed) as the surgeon said it was important to keep the foot mobilised. As it was not properly mobilised I guess scar tissue will still form though.

With yourself how did they diagnose that it was scar tissue build up causing the post op pain? Was it via xray/mri scan etc?

How often do you have the injections and has your pain actually settled down?

I actually damaged my ankle snowboarding 5 years ago which caused the OCD in the first place.

Thanks once again.

 
Old 02-20-2011, 11:28 AM   #4
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Re: Severe pain after Osteochondral Lesion repair

You can't (or shouldn't) have more than 3 injections in a year as it may cause more harm than good. I've only had a couple since my surgery July 2009. Follow up MRI's showed that the OCD filled in and the pain area appeared to be scar tissue, although they can't know for sure until they go in.

I had a subsequent debridement scope to clean out the scar tissue (and of course check on the OCD repair) this past September. In the end, I'm really no better off by having the 2nd surgery, but the OCD was filled in and the surgeon did confirm I had a whole band of scar tissue on the front of my ankle joint (with some synovitis that he cleaned out). I was weight bearing right away with this procedure but the scar tissue still forms.

Unfortunately I think it's something I will just need to contend with going forward. I currently use a home ultrasound, massage, heat, ice, stretching and trying to keep mobile. I'll also get the occasional joint injection. I'm hoping over time it becomes less of an issue. I'm still able to go to the gym, etc. Some days are better than others. When my joint is warmed up and I'm exercising, I really don't have pain...it's later when I've been off my feet that it gets stiff and I can get front ankle pain when I go to walk, etc. The pain is usually between 0-2, so not really debilitating. It sounds like yours may be a bit more intense.

It was interesting when I was at the gym yesterday, I ran into one of the PT's from the therapy place I used to go to (not my PT but another one I recognized). She ended up telling me males between the ages of 40-60 form a lot of post surgical scar tissue for whatever reason. I had never heard this before but I'm in my 40's so fit that case study.

 
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Old 02-20-2011, 11:51 AM   #5
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Re: Severe pain after Osteochondral Lesion repair

I think I'll see if the pain recedes over the next month or 2 then request an MRI scan to see if they can see any scar tissue.

There seems to be 2 different symptoms with mine - the real bad pain is when I've been off my feet for a period of time, then putting my foot on the floor is intensly painful, then after a couple of dozen precarious steps that pain goes away. That's like a searing pain in the whole of my ankle. Then there's the pain on the other side of the ankle to the OCD that's always there when walking (or even just moving my foot around - if I point my ankle out and my toes up to about 10 o'clock). That's more of an ache and not THAT bad (about a 2).

I'm also getting some bespoke orthotics made to correct my gait as I do (and always have) walk on the outside of my foot - the outsides of my shoe heels always wear out quickly. I find that if I walk more on the inside of my heel the pain is a lot less.

 
Old 02-20-2011, 12:52 PM   #6
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Re: Severe pain after Osteochondral Lesion repair

This almost sounds like it could be peroneal tendonitis?? Not sure where the searing pain goes, but worth mentioning. From what I've read, it goes away with rest, but hurts when you first move the joint. Similar to what happens with plantar fascitis but along the outside of your ankle and up the side of your leg some.

 
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Old 02-21-2011, 10:04 AM   #7
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Re: Severe pain after Osteochondral Lesion repair

TC,

As a fellow OCD'er I thought my story might help ...

I too had microfracture done on my 7x9x5 deep OCD back in August of 07 and ended up having OATS done in October 08 because the pains after the microfracture were worse than before.

Since 08, I've had 1 surgery because of the arthritis (and scar tissue that formed) and have another planned next month due to the arthritis that developed in another joint which they are calling post traumatic arthritis or degenerative joint disease. Never had any sign of it before when the OCD was diagnosed and now it seems to be chewing up my ankle joint AND my subtalar joint (which is what I am getting fused next month). I have also developed bone spurs now which I never had before either.

The more I read about it seems that arthritis in the ankle only forms after an injury or trauma and that the normal wear and tear arthritis that affects hips and knees doesn't happen in the ankle.

From what I've learned from my drs at Hospital for Special Surgery seems to be that once this starts it really can't be stopped. I am 43, so too young for a replacement and right now the subtalar pain is worsening so I am willing to fuse that joint (which I learned won't prohibit me from a replacement in 15 years). Fusing the whole ankle wouldn't allow for a replacement down the road.

I hope some of this information is helpful I think in my next left I am going to come back as an ankle OS .. I feel like I know WAY more about ankles now than I ever thought I would need to

Good luck!
Kim

 
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Old 02-22-2011, 08:39 PM   #8
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Re: Severe pain after Osteochondral Lesion repair

Hi all! I had OATS 5/21/09 & had issues w/stiff ankle/scar tissue after surgery. I also developed arthritis in my foot (tarsal/metatarsal joints). After surgery I was told to rub scars w/unscented lotion to help lessen scar tissue. My OS said Arthritis of ankle was a side effect of OATS surgery. My foot doc. gave me prescription Voltaren Gel (arthritis cream) & that helped. Don't know what you're doing at home, but Stretching ankle & any PT exercises should be done as much as you can. Invest in good, orthopaedic shoes/inserts which help. I like Clarks, Mephisto, Ecco, & Earth Shoes, & Asics for gym shoes. Good Luck
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