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Old 05-10-2011, 07:56 AM   #1
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Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

Hello everyone,
I was diagnosed last week with functional instability of my left ankle and told that I need a brostrom repair to tighten the ligaments. I had an MRI performed yesterday and the results said I have a 2 torn ligaments in my ankle that the Brostrom procedure will correct, and some other small things. It seems like a pretty standard Brostrom repair.

I have a follow-up appointment on Monday with my orthopedic surgeon to set a date for the procedure and go over the MRI results.

He told me during the initial visit that he performs arthroscopic surgery first to check the ankle and perform debridement (clean out the scar tissue). Then he does the Brostrom procedure to tighten the ligaments. I know there are a lot of boards dealing with this surgery, but I have not seen anything dealing with my question:
My doctor told me that I will be in an aircast for 2 weeks following the procedure instead of a cast. Many of the other boards say that they were in a NWB cast for 4-6 weeks following the procedure, and then a PWB for 2 weeks after.
How are the recovery times so different for the same procedure? He also said I could return to work 5 days after the procedure.
Is returning to work 5 days after the procedure too soon?

Thank you so much for any help you can give!!! These boards are extremely helpful for nervous people like me about to get this operation.

 
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Old 05-10-2011, 08:35 AM   #2
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

Yes, there can be huge variations in recovery protocol based on the surgeon. My surgeon was one of the most liberal I've seen. I was in a cast for 2 weeks, then a boot for another 2 weeks, then an aircast for a few weeks. From the start, I was weight-bearing as tolerated. For the first week, I was pretty much NWB (other than setting the foot down on the ground). I ditched the crutches about 1.5 weeks after surgery.

I'm not sure about being in an aircast after surgery, if he's referring to one of those stirrup-style braces. With the amount of pain I was in post-surgery, I wouldn't have wanted to just be in an aircast. Plus, until you can actually walk on it, the crutches are a hazard (especially combined with pain meds), and the cast or boot provides extra protection in case you fall). Maybe he means the aircast brand boot? That would be reasonable, to be in a boot after surgery.

It's standard procedure for them to do the scope, then repair the ligaments. The scope lets them clean out any extra bone growth or inflammation that's occurred as a response to the injury, and also to make sure that there's no other damage that they didn't see on the MRI (it's basically a "while you're knocked out, why not?" sort of thing).

I had my surgery mid-December (maybe the 16th), and was back to work January 6. I probably could have gone back a little sooner, but I work at a college, so all the students were on break and there was no hurry. Plus, I had the surgery at my parents' house, and I live 2 hours away, so I had to make sure that I was able to drive that distance before I went back to work. You'll definitely want at least a week off. If you had the surgery on a Friday, then going back on the second Monday might be feasible, since you'd get some extra recovery days with the weekends. Going back so soon after surgery, you're not going to be able to be on your feet much, and you're going to want to spend most of your time with your foot propped up. It was about a month before I was spending a lot of time without my foot up on a chair.

 
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Old 05-10-2011, 09:02 AM   #3
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

Thank you so much for your reply!

My doctor seems to be on the liberal side as well. I will get more clarification on the post surgery aircast when I meet with him on Monday, May 16th.

Iíll also ask him if I should take more time off work. I am mostly in front of a computer at work, but it would be difficult to prop my foot up while typing (and it would look silly at meetings). 2 weeks off work sounds about right.

KeHorner, was your surgery limited to Brostrom or did they perform other procedures as well after the arthroscopy? It seems like a lot of individuals who underwent this surgery had OCD lesions that required microfracture repaired combined with the Brostrom procedure. The MRI did not show any OCD lesions, but I am not sure if that means that it will not show up when they have the ankle open (the MRI was blurred do to motion; I did not feel like I moved at all).

Not really related to the original post, but I thought I would throw it out there:
I have had multiple ankle sprains. Some were very bad, and some were relatively minor. I was told that if the ankle ligaments that will be shortened in the procedure have too much scar tissue from the numerous sprains, then the OS would not perform the Brostrom repair and would remove the ligament and replace it with a tendon (tendonesis repair). Has anyone been scheduled for a Brostrom repair, been anesthetized, and then had the Evans Procedure (tendonesis) performed because the ligaments that were going to be repaired were too damaged?

 
Old 05-10-2011, 11:16 AM   #4
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

They didn't find anything exciting when they did my scope. Just some inflammatory tissue that they removed.

I had the Evans done on my other ankle about 6 years ago. Definitely a longer recovery time (and a lot more pain). For that one, I was NWB in a cast for 8 weeks, then in a boot for maybe another month. I think there was so much more pain because they drilled through bone and also messed around with the tendons. I did go back to classes (grad student) about 4 days after surgery, but I was sitting in classes with my foot up on the desk (and yes, it looked ridiculous, but it had to be up that high for the pain and swelling). I couldn't drive for about a month because it hurt to let my foot hang down in a seated position for the 20 minute drive to school. In terms of outcome, though, I have no complaints. The ankle is totally solid. I'm actually happier with the Evans ankle than I am with the Brostrom ankle, just because it feels more solid. I fell down the stairs a few years after the surgery and resprained my ankle, and was sure that I'd damaged the repair. It all checked out fine, the pain was gone in a few days, and I was good as new. I'm sure that if I did that with my Brostrom ankle that I would have snapped the repair. But it's a harder, more painful surgery with a much longer recovery, so the Brostrom is the way to go if there's enough left to repair.

 
Old 05-10-2011, 05:53 PM   #5
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

I had a brostrom and scope in November. I was in a splint for about 7 days, and then had my stitches removed and went directly into a boot. I had to wear the boot 24/7 until the 4 week mark. I started weight bearing at about week 3, and had completely ditched the crutches at week 4. I have a very active job and am on my feet all day long. I am lucky if I am able to sit down for 20 minutes for lunch. I took off 8 weeks.

For me, there is no way I could have returned to work after 5 days. I remember somewhere around day 8 or 9 I was having pretty substantial pain still. It took me about 2 weeks to get off the pain meds. After that, I didn't really have much pain at all. It seems as though I am in the minority, and that people are off pain meds in 3-4 days post-op. I also had a screw removed from a previous surgery, but doubt that caused any real increase in pain. My ankle feels as stable as the other ankle which is such a wonderful feeling. It's nice to not feel like you are going to fall over everytime you walk across the grass.

 
Old 05-11-2011, 09:13 AM   #6
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

Thanks for your response!
You're post surgery recovery sounds a lot like what my doctor described. I am wondering if the walking boot helped you in any way. Do you believe a cast after the splint would have been any different?
Glad you're surgery was a success!!! In the end, that's what we are all striving for.
Thanks again for your input. It helps me out a lot, and I am sure it will help many others.

 
Old 05-11-2011, 02:33 PM   #7
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

I am not really sure about any difference, but the boot is very challenging to sleep with. It is so heavy and awkward. I had 2 big body pillows and would manage to get at least some sleep at night time. I am a stomach sleeper so I had to find a way to go at least semi-close to that. It is not too bad when I think back on it now, being that it was only 4 weeks in some sort of boot or a cast. There are people who spend much more time than that in a cast.

A cast is more restrictive than the boot. My doctor told me that I would be stiff once I began physical therapy, but it wouldn't be as bad if I was wearing a cast. You can only tighten the straps on a boot so much.

 
Old 05-18-2011, 07:24 AM   #8
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

poppyg1 ~ when you wrote "It's nice to not feel like you are going to fall over everytime you walk across the grass" I knew I have to message you. Next week I am scheduled for Brostrom with lateral ligament reconstruction and Talus OCD, scope. My history is major instability with multiple grade 3 sprains. The last 18 months have had several sprains in which no mri was done, but xray said no breaks. Just 3 weeks ago, mri done revealing 3 torn ligaments, cartiledge and OCD damage. I am SO scared to do surgery so I'm here trying to get some encouragement. I'm told 1 week with soft cast after surgery, then 4-6 weeks hard cast, then walking boot for possibly another 4 weeks. Please tell me this is going to work and I'll be able to play with my kids outside in the yard? Thank you all for your support.

 
Old 05-18-2011, 04:37 PM   #9
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

I can't really comment on the OCD thing as I haven't had that done... yet. Doctor called to let me know it might be a possibility based on my MRI.

Anyways, about the brostrom. My doctor told me that this is one of the best procedures he does for people. He said it has a very high success rate, and people are generally very pleased with the results. I think you will feel a great difference in your instability once you are able to get walking around. I am sure you will do great!!! Maybe someone else will be able to chime in on the OCD process.

 
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Old 06-03-2011, 08:41 AM   #10
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

Ankle guy-hope your surgery went well. I had a brostrom repair last year. My surgeon did not put me in a cast or boot. I had a "surgery shoe" (basically a sandal type shoe with velcro straps across the top) to use when walking. I was told to weight bear weight as soon as possible. The philosophy behind not casting and bearing weight following surgery was to help with range of motion. My surgeon believes that immobilizing the foot can have a negative impact on range of motion.

 
Old 06-03-2011, 09:48 AM   #11
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

Otis ~ No cast and weight bearing as soon as possible? Oh my goodness, that's the first I've read of that treatment anywhere online. Please tell me how you are doing? I'm very curious as my surgeons approach is much more conservative. Thanks!

 
Old 06-03-2011, 10:40 AM   #12
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

I hadn't heard of it either. When researching the Brostrom procedure, I too found that most everyone was put into a cast and NWB. I really liked my surgeon and trusted him.
Aside from the Brostrom, I also had my peroneal tendon repaired. I wasn't able to bear much weight for a 2-3 after weeks after surgery. I had my surgery almost a year ago. Honestly, my ankle still aches and swells some days. I started running and cycling, but if I do too much, it is sore the next day and sometimes for the next few days. The plus is that my ankle is very stable.
The best advice I can give, is to follow through with PT. Do all your exercises. It will make a big difference. It's hard, but well worth all the effort.
Good luck!

 
Old 06-03-2011, 10:46 AM   #13
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

I'm really looking forward to having a stable ankle. The instability and the constant pain in my ankle is what I am looking forward to ending! You say you still have pain and swelling? Is there a reason for that, or do you think it might have something to do with your recovery? I do move my toes around and sometimes can move my ankle a little in my cast, I hope that's ok. My 2 week follow up with doctor is next week. I will keep you posted! :0)

 
Old 06-03-2011, 12:10 PM   #14
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

I went to the doctor to review my MRI and find out what procedures (besides Brostrom) needed to be performed.
I was hoping it was going to be a basic arthroscopy followed by the Brostrom repair. I found out that I need to have scar tissue and bone chips removed during the arthroscopy. Then the Brostrom procedure, and possibly fixing an OCD on my talus. The doctor was not sure this had to be repaired from the MRI.
I also need to have something done to my peroneal tendons. The MRI report said 'peroneal tendon synovitis' and my tendons make a popping noise when I move my ankle up and down.
Does anyone know what type of peroneal tendon repair I may be having? I do not believe they are torn. They seem to be stretched so they are popping out of the groove behind my ankle bone and causing a "popping" noise.
Thanks for any help you can provide. I'm having the procedure performed in mid-July.

 
Old 07-09-2011, 07:01 PM   #15
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Re: Cast vs aircast following Brostrom repair. Doctor says no cast after surgery

Quote:
Originally Posted by sealz View Post
Otis ~ No cast and weight bearing as soon as possible? Oh my goodness, that's the first I've read of that treatment anywhere online. Please tell me how you are doing? I'm very curious as my surgeons approach is much more conservative. Thanks!
I had a Brostrom repair on 6/9 as well as a Hallux Rigidus repair. I am 4 wks post op- went to the doctor yesterday. I had my third cast put on and will be in this cast for 3 more weeks. I am still on crutches as he just allowed weight bearing yesterday. He told me I can give up the crutches in the house but does not want me walking outside without them. At that point, they will put me in a boot. I do not know how long I will be in a boot. It sounds like I am progressing slower than the rest of you.

 
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