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Old 04-01-2011, 11:01 AM   #1
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Did I ruin my ankle microfracture?

I am a 39 year old mother of 2 young children (ages 8 and 5) who loved running. Last May (2010), I sprained my ankle during a race. The next week, I remember stomping my ankle and having a stabbing pain for about one week. It hurt to drive or walk on but I did it anyway. After a summer of rehab and no running, I had an MRI and learned that I had a 6 mm cup shaped osteochondral lesion on my medial talar dome below the medial malleous. After research and much thought / planning, I had ankle microfracture perfomed January 10, 2010. After the procedure I was informed the damage had progressed since the MRI and my orthopaedic surgeon needed to remove quite a bit of damaged cartilage.

Any way, I was making good progress 6 weeks non-weight bearing, slowly transitioning to full weight bearing at the 9 week mark. At 10 weeks, I started doing ALOT more and even put on a shoe to go to a gymnastics meet. At the meet, after going up and down some ramps with the shoe on, I had that same feeling as before the microfracture (pain in the center of joint when walking). My ankle didn't swell right away and I even felt better that night. Two days later however, I started to feel worse. Pain on the inside of the foot under the tibia but not on my OCD site. Does anyone out have any ideas? My physical therapist, orthopaedic surgeon, and his Physicians assistant all believe that the microfracture is still good and that I just aggravated other tissues in the joint (causing swelling, causing the irritation in the joint). Does anybody have any thoughts? I am really upset with myself for overdoing it so soon in the game. I just felt good so I returned to my life before MFX. I am really upset, I hate the idea of waiting then potentially having to do this again. Has anybody had a similar experience with MFX (pain when returning to shoe / normal activities after NWB period)? Did your MFX work in the end?

 
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Old 04-01-2011, 01:37 PM   #2
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Re: Did I ruin my ankle microfracture?

My ankle microfracture was Jan 10 2011.

 
Old 04-01-2011, 02:54 PM   #3
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Re: Did I ruin my ankle microfracture?

From how you are discribing it, it sounds like it could be impingment pain. Where tissue gets pinched between the bones in the ankle. I had this on top of my OCD and a cortizone shot and rest seemed to fix it. If nothing else meantion the posssibilty of this to you doctor to see what he thinks.

 
Old 04-01-2011, 05:33 PM   #4
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Re: Did I ruin my ankle microfracture?

I hate coming onto posts and being all negative, So I am not trying to be like that just telling what happened. I had my microfractrure done in early June 06I did all the theropy like I should have. Then started having bad bad pains. Went to doc for follow up in Sept. was suposed to be one of my last ones. I told her of the issues. she did not want to check it and was pretty confident all was fine. I however was not convinced. Ended up waiting till december to get a MRI after lots of complaint calls to her. definitly bad results and was very mad at myself for not pushing her in september. If the problem goes on, insist on a full evaluation. If you think there is an issue, there probibly is. Listen to your instincts. Best wishes to you

 
Old 04-01-2011, 09:19 PM   #5
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Wink Re: Did I ruin my ankle microfracture?

Ketaylor1980,

I'll definitely bring up ankle impingement up to my surgeon. In your case, how were they able to diagnose it? I asked for an injection to relieve my pain and the PA and surgeon wouldn't do it since my surgery is only 11 weeks old. They said it could interfere with cartilage adaption. When did you have your injections? How long of a rest period was needed until you felt relief?

I am very grateful for the advice.
Suzanne

 
Old 04-01-2011, 09:39 PM   #6
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Re: Did I ruin my ankle microfracture?

Thanks for the advice. It seems like most surgeons want to wait it out to see if the surgery worked. I asked my surgeon if there would be a follow-up MRI. He said he normally does not do them as standard follow-up but does them if a patient is still experiencing issues. He told me MRI's much earlier than 6 months can be misleading. He didn't say he wouldn't do it however. We definitely need to be our advocates since we know what we are experiencing. What kind of aches and pains were you experiencing from Sept-Dec when you had your MFX? Where was your defect? Did you go do another MFX? Did you finally get ankle problems resolved?

Thanks again!!
Suzanne

 
Old 04-02-2011, 07:02 AM   #7
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Re: Did I ruin my ankle microfracture?

When I had my microfracture (posterior medial talus dome) in July 2009, I ended up having issues on the anterior lateral aspect of my ankle (i.e. not near the OCD) when I began walking out of the boot at 11 weeks. My surgeon wouldn't do anything because it was too soon. I finally had a cortizone shot (in the office) at about 18 weeks. It helped a bit and then about 6 months out I had another shot under flurascope, which helped tremendously. They usually last a couple months but my surgeon believes that the scar tissue that forms in the joint, after the joint is debrided, is not the same tissue as the original capsule and synovial lining, so it will take some time for this new material to form and shape so it doesn't continue impinging.

I had a clean out (debridement) in Sep 2010 and sure enough, there was lots of bulbuous and banding scar tissue on the front of the joint, along with some synovitis. My OCD was fully filled in, yet a little softer than the surrounding orig cartilage, which is probably to be expected since it's not the same material. It is supposed to harden more over time.

I would probably push for an injection sometime after 4-5 months. Also, if you get the injection, be very careful with activity in the first couple days as it can temporarily soften the OCD and make it susceptible to injury. I usually take a full week off from anything after an injection. Outside of this, I would push for a follow up MRI at around 6 months, which is when I had my first follow up MRI done.

-Bob

 
Old 04-02-2011, 04:59 PM   #8
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Re: Did I ruin my ankle microfracture?

Hi again. So the doc did not want to do the mri on me either. that is why she waited till december when I had issues in Sept. Turns out 3 large pieces had broke off and one was getting smashed by a nerve. I could only describe the pain like a lighning bolt. It made me drop stuff if I had something in my hands. I worked those 3 months like that too. Ended up with an OATS. But by a different doc. The first let me get the mri in dec about the 14th but could not see me again till late Jan. In the meantime I went to another Doc, Defrino out of Palos Park. He was shocked by what he found. Wanted to do surgery next day. I am a bit on the unusual side which is why I don't always like to post. I don't want to scare or be negative. But if you think there is something Insist on that mri.

 
Old 04-05-2011, 01:35 AM   #9
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Re: Did I ruin my ankle microfracture?

My Dr told me to walk as normal after 4 weeks of microfracture surgery. I thought it was risky but did so and had a similar incident. That was 8 months ago and now its worse than the day before surgery. I think I would have made a full recovery had I waited.

 
Old 04-06-2011, 03:05 AM   #10
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Re: Did I ruin my ankle microfracture?

OCDed,
I am sorry to hear that you have been experiencing difficulties when your surgery was last summer. I can't say if you put weight on it too soon but did you get a follow-up MRI? What does the doctor say now? He can't deny the pain you are having. Did you find a new doctor?

I really didn't start putting my full weight on until 8.5 -9 weeks. My doctor is concerned about the pain I am experiencing and I am getting an MRI done tomorrow (April 7th). My orthopaedic surgeon admits he doesn't know what the problem is and wants to see what's going on with me. I will keep posting once I get the results.

Take care.
Suzanne

 
Old 04-06-2011, 05:45 AM   #11
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Re: Did I ruin my ankle microfracture?

Quote:
Originally Posted by suzamom View Post
Ketaylor1980,

I'll definitely bring up ankle impingement up to my surgeon. In your case, how were they able to diagnose it? I asked for an injection to relieve my pain and the PA and surgeon wouldn't do it since my surgery is only 11 weeks old. They said it could interfere with cartilage adaption. When did you have your injections? How long of a rest period was needed until you felt relief?

I am very grateful for the advice.
Suzanne
It was diagnosed while looking at my MRI for my OCD. A little of the MRI and a lot of hands on trying to get me to hurt in all the areas of my foot that he could possibly do. Turns out that on top of my lesion I have unstable ankles and because of that some tissue gets inflamed and pinched between bones in the back of the ankle. I had a cortisone shot the same day for the impingement. Honestly that just made things worse for a day or so. But with that and being put into a walking boot that pain stopped and left me only with the OCD pain. That was done early Feb and my surgery was on March 18th. I'm not sure what your doctor is taking about with no shot 11 weeks out.

Last edited by ketaylor1980; 04-06-2011 at 05:51 AM. Reason: more info

 
Old 05-12-2011, 02:50 AM   #12
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Re: Did I ruin my ankle microfracture?

So I have been meaning to post since I started this thread. Since it's been a while, I'll refresh....
As of today May 12th, I am 17 weeks post ankle microfracture surgery....

When I started walking out of the boot, I started having pain at the back of the ankle underneath the tibia where the posterior tibialis tendon runs. I went to the othopaedic surgeon. Since the pain was not located where I had the microfracture done, the doctor sent me to have the MRI. The MRI indicated that all the tendons and ligaments where fine. (OCD still there but I guess this is common after only 3 months when I had the MRI done.) His explanation for me was that it is likely that I am landing on the nerve due to weaknesses in my ankle. As he prescribed, I wore an orthotic in my gymshoes for the next three weeks to take pressure off that area. I slowly felt much better. Improvement in the nerve pain each day.

Then, I did something stupid...
on a Sunday, Mother's Day 2011, I climbed a fence with my son to get to a park he wanted to go to. Thinking I would just hop down on my good foot, I climbed ~ 4 foot chain-link fence. Crouched down at the top of the fence with both feet on the top bar. I dropped down my good strong foot and did land on the good foot first but then my other leg with the "surgery foot" fell. I intended to hold the "surgery foot" off the ground but to balance myself, I accidently let it fall down and bumped it on the ground. On impact, I didn't feel anything and thought, "Oh no. Bad move. Then, Oh good, I didn't feel anything. I didn't hurt it." I walked to the park and then walked the long way home without any pain.

Maybe three hours later, I started to feel a little some sensation in the microfracture area. It didn't really hurt. No swelling. I felt uneasy and upset about the whole incident on Sunday night and Monday (kept icing the foot and trying to do less).

Then on Tuesday, I felt like the pain was increasing. Now it's Thursday and I still feel like it hurts at the microfracture site. I am scheduled to see the orthopaedic surgeon today to get fitted for custom orthotics so I'll have him evaluate me.

Can one single fall/ heavier imapct load permanately damage the microfracture when I am 17 weeks past surgery? Has this happened to anyone else? (Strong fall or jump). ANYadvice/thoughts from others who have had ankle microfracture would be greatly appreciated. I am really upset at the moment.

- Suzanne

 
Old 05-12-2011, 04:51 AM   #13
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Re: Did I ruin my ankle microfracture?

Hi Suzanne,
I was just reading through this thread. I had microfracture for my OCD in 2009. Mine was small (4mm x3mm). I also had a small tear in my PTT. That ankle OS was a cowboy and had me weight bear as tolerated immediately after the drilling. So, I was bearing weight the day after surgery. It hurt like _ _ _ _ so I did end up using my crutches but I was still putting weight on it and at 42 days after the surgery I was walking. At 3 or 4 weeks in PT, I was doing the agility ladder, slide board, mild jump squats...etc.

I am now recovering from my 2nd ankle surgery. I am with another ankle surgeon who is very conservative and complete. My OCD has completely filled in. There was some overlying scar tissue on top of the filled in scar tissue. My OS removed the excess scar tissue. I was also missing my anterior recess (capsule) due to a TON of scar tissue that had squashed it down with the scar tissue adhering to the talus. OS said that would cause significant pain. He also made an incision to remove an ossicle that was stuck in my medial deltoid ligaments. I was in a cast for 8 days and NWB. I just got my cast off on Tuesday and was told to only work on plantar/dorsiflexion ROM and NOT to focus on weight bearing although I CAN weight bear as tolerated. He told me NOT to push the weight bearing at this stage in the recovery. I get my stitches out on May 26th and will know more after that.

SO...my point is that I was doing a lot of activity immediately after my first drilling and my OCD lesion was fine (thank god). I don't know how big your lesion was/is....but it seems like you are a long way out and your fall on Mothers day may have just aggrivated your ankle. (I still had pain ALWAYS after my first drilling....could be because I was doing too much and more scar tissue formed or something...not sure...but the OCD was fine). I think you will always have pain with the OCD, it's part of the deal. However, if you are really concerned about it I would ask for some other tests to be sure. That is what I did as the pain in my ankle was progressively getting worse and I was afraid that my OCD had not healed. My current OS was concerned as well...given my first post op protocol with the cowboy OS. An MRI arthrogram is a possibility. (They stick a needle into your joint to get the dye in there). I had that done B4 this surgery and it was right on with what he found in the joint. It's PAINFUL though.

I hope your appointment goes well today!!

Julie

 
Old 05-12-2011, 07:06 AM   #14
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Re: Did I ruin my ankle microfracture?

Julie (let me walk),
Thank you for your reply. I sincerely hope you have a speedy recovery from your 2nd surgery. I feel for you that you have been dealing with ankle issues for so long. Hopefully with the stitches out in two weeks, you'll be on your feet for the summer.

I don't actually know how large my lesion was. From what I understand, the first MRI indicated 6mm dia X 2mm depth. After the surgery, the surgeon's physician assistant told me the lesion was much larger and that they had to "cut-away" alot of damaged squishy tissue. I think I will ask them if they remember or could look up the approximate size when I see them today. I had imagined it was less than or just around 1 cm2 (10 mm X 10 mm).

Thanks again. Everything I have read says that care should be taken until 6 months and I'm only 4 months. I keep imagining in my head that I squashed this tissue as if squashing a piece of fruit and that I've done some kind of irrepairable damage to the material. Sounds like you had a much smaller defect but it makes me feel better that you were actually jumping in less than 2 months and actually came out okay. I am shocked at how many post-operative issues you experienced. Do you think it was because of a rushed recovery?

I wish you the best of luck. I'll keep you posted.
Suzanne

 
Old 05-12-2011, 12:31 PM   #15
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Re: Did I ruin my ankle microfracture?

I had medial MFX in June 2007, and distinctly remember the terror of thinking I had damaged the repair several times for the first year. (i.e. one time I suddenly reached down to grab my dog's collar to keep him from escaping out the side door, bracing against my bad foot, and ended up with that electrical, stunning, take-your-breath-away, seeing-stars pain. I seriously thought I had ruined the fix. It was fine within a few days.) It takes time! Seriously, you need to take it easy for the first year. Two years (almost to the day) later, I ran a 100 mile race. So, yes, there is life after MFX, and there's running too!

 
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