I just hear all these horror stories and know mine is not that bad. The Dr. although said he would never push surgery on anyone and it was my decision, he did seem to be pretty positive that it needed to be done. So I guess the xray was pretty definite... I am just hopefull, doubtful but hopeful.... I apperciate the information.
I agree with DMBNJ. You don't want to look back and regret not having done it earlier. I, too, don't like to push surgery nor do I like it pushed on me. My doc was like yours. Confident that I needed surgery (now my history is different than yours as this is my 2nd surgery on this ankle), but he also stressed it was totally my choice and that he didn't think it would get any better but could get worse. He said I could wear a max support brace and take NSAIDs off and on and ice and not do surgery if I didn't want it. That would never have worked for me because it had gotten so bad it would give out at any given time by taking a step out of a standing position on a completely flat, smooth concrete floor! Never,ind gravel, uneven terrain, pothole or grassy areas with holes, etc. I wanted to do what I wanted to do without fear of my stupid ankle. I was told back I'm 2003 & 2004 by 2 different surgeons in 2 different states (I was a travel RN back then) that I needed another operation but I brushed it off and let it "heal" (loose term because it never did) and went about my way. Since my major 2004 injury (Jones fracture which is fracture of the 5th met, torn ligaments, what I think is the start of the longitudinal tear in my peroneal tendon, and torn cartilage), my husband has been asking me to go have the surgery done and I didn't. I finally got it checked in Nov and the MRI was a nightmare. Might not have had THAT much damage.
However, really just need to see what the MRI shows as that is the best way to see what's going on inside your ankle and go from there. I see the predicament you are in if you aren't having that much pain. Is it giving out on you a lot? Do you want to have to think about your ankle and look down lot see where you are going and where you are putting it or are you good with that?
The doctor was pretty confident in the surgery last time, I agreed to it if it would help and he said it would. I guess I am now at the point where I am wondering what if the MRI comes back and does not show any significant tears or anything would surgery still be warranted. I guess the doctor will let me know that. But I figured with the pain not being so bad, stairs and even ground are pretty bad. My ankle does roll some on even ground not so much on flat. The problem I do have and it is kinda odd, not really rolling but at times it kinda feels like my whole leg goes out (almost like I lose my balance) when I step on that foot. It is hard to explain on here. Almost like my foot and leg are not working together and I have to rebalance myself on that leg (which hurts at times as well). There is a good deal of popping and grinding when I rotate my foot, when I straighten it out the of my ankle hurts (towards the front of shin). I am just wondering what are the odds that the doctor looks at the MRI and sees nothing? How accurate is the reading on the stress xray? Does my OS pretty much already know and is just doing an MRI to see the true extent of the damage, such as possible tendon tear? With my knee they never said ligament tear until they saw the MRI, just alwasy said possible....
Sounds like you are having problems with proprioception. That's the leg giving out hard to describe balance thing you are talking about. A MAJOR component when talking about correctly rehabbing an ankle to prevent further issues. I had bad proprioception too which caused a lot of my injuries. The chances that nothing will be seen on MRI are rare with all that you are telling me, but it could happen. However, doctors usually base diagnosis on 2 things. Their physical exam (objective), subjective information (what you tell them), and the films. My first OS thought that my exam was a lot worse than what my MRI was telling him (just like yours). He got in there and both ligaments were completely ruptured. Sometimes things are poorly visualized on MRI and the PE (Physical Exam) will tell you more. Sometimes, the ligaments might not be completely torn, but are thin and wavy enough they need to be tightened because they are causing issues just like completely ruptured ones would. If they are tight, they aren't working properly which will cause weakness, further injuries, laxity, pain, etc.
What causes proprioception? Is it caused by damage or me over compensating for the injury and treading lightly. That is how I feel, that I am so careful with the ankle and baby it along that it is wobbly, but not so much lower part but the whole leg. I went through PT and that did not help. I ge the MRI tomorrow but I am not able to read them so I wont know for a few more days. Wish I did have at least a clue what I would be looking at but no.... Thanks again.
Proprioception isn't caused. LOSS of proprioception (which is what I was referring to) is caused by injuries. Proprioception is the body's ability to know where a limb is and what it's doing without having to actually look at it if that makes sense. It's what lets us walk without always looking down. However, when you have hurt your ankle and it's weak, you're always looking to see where you are putting it and make sure you don't step on a rock or uneven ground etc. If you are standing while putting on your pants, you are looking down to "balance it" like you can balance with your eyes. Am I making sense?
See, before my surgery if I was in the closet putting pants on, I could stand on my right leg (uninjured foot) all day long and not wobble the slightest bit. I could be a flamingo with that leg if I wanted! The left leg (injured foot) not so much. I can't so much as stand on it 2 seconds before I'm wobbling all over the place or hopping to get my balance back or whatever. This is attributed to no PT after my first surgery where they help to regain proprioception. It is a major KEY component to rehabbing an ankle injury and so you won't be back in the same position. I didn't know that back then so when he said I didn't need PT I was like cool! Yeah, NOT cool! I'm finding that out now with my foot/ankle OS. I'm SO glad for PT this time!
As far as MRIs, yeah just wait for the doctor! You won't have a clue as to what you are seeing! Even I have issues with ankle/foot MRIs because there are so many tiny bones and ligaments, nerves, etc. Brain and spine MRIs are the only thing I have experience with.
I had the MRI it went fine. It will be read on Monday and I see doctor on Tuesday. The MRI technician was surprised that the first xray showed nothing and the second one the radiologist said there was a definite change. The 3 OS doctors also said there was nothing. What the change is calcification. My latest OS also stated there was some loose bodies but that could be fixed orthoscopically, if he was not doing the reconstruction. I of course will keep everyone up to date.
Glad the MR went well. I didn't know,you had discrepancies in the different OS opinions. Be really interesting to see what the MR shows. Yes some things like loose bodies (floating cartilage, etc) or scar tissues can be excised arthroscopically vs open incision. Let us know after your appt on Tues!
I will post update after Tuesday.... The first Xray was reviewed by emergency room and showed nothing. The next one was 2 monthes later reviewed by radiologist who said there was a difference. The next one was reviewed by an OS who literally saw me for 10 minutes said there was no break and it would take time to heal. Did not touch my ankle or anyhting. I was in there for 10 minutes (8 of which he talked about my job). So I decided to ask my knee OS. He looked at Xray and said there was no break but was not an ankle specialist. He said if the ankle was still looking bad after knee surgery he would send me to his specialist. The ankle spcialist looked at Xray mentioned the loose stuff and calcium, but also said no break. He took the stress Xray and that is when he recomended surgery to repair the ligaments.
Well went to the OS today for MRI results. The OS came in and re-examined my ankle as if I wsa seeing him for the first time. It was odd, he had me doing various things and looking at it. I was happy, because I figured that there was nothing on the MRI and he was just checking things out. Well I was wrong, The MRI results were 4 pages long. The doctor said there was a lot wrong. He gave me the brief, low down and dirty version of what needs to be fixed at this point. The ligaments are completely torn, there is significant cartlidge damage and debris and my tendons have had some serious strain posibly torn. He said the MRI does not show the tendons to good, but they looked to be intact for the most part. He was however worried about the tendons as he said that is a rough surgery, and some of my pain and movements is showing that damage. Because I am waiting until July for surgery he decided to put me in a hard walking cast to help the tendons heal if they can. I go back in 5 weeks to check on the tendons. He said he would look at them and possibly "scrape" them when he is in there working on everything else. Thanks for the info everyone.
I'm so sorry! As soon as you said he was checking your ankle out like it was the first time, I knew your MRI wasn't good. My MRI wasn't good either but the report said it was basically fine (which is why the MRI always needs to be read by your OS). My OS (after going through the MRI with me pic by pic and showing me all the tears) did the same thing yours did. Re-examined my ankle in depth. I hope you don't have tendon damage, but I won't be surprised if you do. All my ligaments were torn along with the retinaculum and one of the peroneal tendons and both tendons were popping out of place so he had to deepen the groove they sit in by drilling and breaking the bone. None of it pleasant. Good move by your to put you in a hard walking cast to give the tendons a rest and hopefully they heal up. How much pain are you in? Did he discuss anything regarding the surgery with you like how long NWB, etc?
I have not had a lot of pain. Here recently I started to have a new pain on the inside of my ankle (the outside was the what hurt before). I told him like it was wrapping around my ankle. When I noticed it I touched it and it was tender, however the pain was not excruciating and it has been recent (since my last visit). He said it showed on the MRI but they are had to see the extent of tendon damage, but when he felt it, it felt like was good but he wont know for sure until he sees in there through surgery. My pain overall has not been to bad, some days is worse but overall okay. I was able to walk pretty good on it, no noticeable limp most of the time, did give out a bit, but even that was not to painful. Hurts when it happens but goes away pretty good, swelling is still there, looks like I have a minor sprain all the time, at times feels like that. I am very concious of it so that maybe why I do not hurt, I baby that leg alot.
We did discuss some surgery stuff. not much because he wants to see how I respond to the cast and my tendon issues. but for now he said he could use a ligament from a cadiver or from me. He talked about the pros and cons for each, and said he has no preference. He also talked about the clean up of the other stuff, cartlidge and all, how usually that is done orthoscopically but since he will be in there he is going to fix all that as well. I would be 6 weeks NWB and then 6 weeks in a walking boot. Said all this changes if there is significant damage to tendon as that is a bit more intensive. I got back to see him May 29 to get cast off and schedule surgery. That visit he said he would get inot a lot more details about what he plans to do, how the surgery will work, and I will decide if I want my ligament or a doner....
Oh how I wish that read this back when you first sprained your ankle. Your story is very much like mine.
YOU NEED TO GET THE ANKLE FIXED. THat is the bottom line. Learn from my mistake and get off the ankle now.
Here is a very short version of what happened to me:
I, like you, sprained my ankle in 2006. 3rd degree sprain. ER said just stay off of it until it doesn't hurt. FIrst OS said it was "just a sprain, haven't you ever sprained an ankle before?" And gave me no instructions.
I was a competitive athlete in Karate and was in the midst of getting ready for a huge National tournament. ANd it was "Just a sprain" so I kept practicing.
I did see a foot/ankle specialist who told me I needed to be off of it. I didn't listen, after all, it was "just a sprain" and I had a tournament to get ready for.
Had an MRI. Had 1st surgery. Brostrom repair (ligaments) peroneal tendon repair, peroneal tendon subluxation repair, micrtofracture on 2 OCD's (cartilage damage).
Went back to karate. Ran. Competed. All of which I should have been careful about. in 2008 I had to have another surgery. Another Brostrom repair, another peroneal tendon repair, OATS on one OCD, microfracture the other.
Tried to run. Went back to karate.
In 2009 had another surgery. Posterior tibial tendon repair, peroneal tendon cleaning out, microfracture on OCD's.
Never got back to running.
In 2010 I had ankle distraction arthroplasty and microfracture of OCD's. Stem cells were put into the ankle joint to promote healing.
In 2011 I had an ankle replacement, subtalar fusion, ORIF on my talus fracture and ORIF on a fibula fracture. WHy the fractures? Because my bones were so brittle, probably from the RSD I got after the distraction arthroplasty.
ANd yes, in 2012 I need another surgery, more bone cutting because my foot is now not straight and I can not walk.
I'm 43 and permanently disabled.
Do I want to scare you? In a way, yes. I did not take my ankle sprain as serious as I should have. I thought that once I had the tendons and ligaments fixed then I could do everything I coudl before. Your MRI shows cartilage damage. Did your dr mention osteochondral defect? That is what ultimately led to the demise of my ankle. THat is serious stuff. I did not listen when my dr. told me to no longer run. And I went from 2006-2011 from being at the top of my game physically to needing a wheel chair if I go somewhere that requires walking more than 100 yards at a time.
So PLEASE, make sure your dr. is a foot/ankle specialist. You need to get the ligaments fixed because a lose ankle just makes the bones clunk together and damage them more and the cartilage more. Someone once told me that the talus is a VIP bone. That little bone can cause so much grief. You need to protect it and make sure your ankle is very stable. If it means wearing a boot until your surgery, then do that. Any more rolls to the ankle will damage it much more than you can imagine.
I'm angry with your docs, actually, for letting you go this long and walk on it this long without really getting and MRI and a good look at your ankle.
The first doc who looked at mine didn't even touch it either. So when I read that about you, I had to respond.
I hope your surgery is a success and listen to your docs instructions very carefully. This is a very serious injury. Way more serious than if you had broken your tibia.
The Following User Says Thank You to K_Lana For This Useful Post: bridaman51 (04-25-2012)
Thank You... I will get it fixed and take care of it. I am not a runner or anything, am active as I coach but I do not do running or any sports. My current OS has been on top of things he has been very through and I like it. I was not going to let it rest when the other doctors just sent me off on my way, I knew something was not right. I have had many sprains and nothing like this, the look, the feel, the swelling.
I am also very similar with OCD as that has been the demise of my right knee. I am 34 and have had 6 surgeries on it since I was 18. I have had 3 on it the last 5 years. My knee is shot and the only way to fix it now is TKR which at 34 is not cosidered an option so I have to be carefule on it. The OS did not mention that specifically, but like I said the report was 4 pages long. He said he would get more into the surgery and other issues at our next appointment. He was really worried about the tendons this time around espcially with where my pain was, so he wanted to get those taken care of, and get it supported and rested.
I am sorry to hear all your problems. But if there is any cosilation I will learn from your expierence and make sure I do exactly as the doctor says and be very cautious.