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Old 05-03-2012, 12:05 PM   #1
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Chronic Ankle Instability x 2

I'm so glad I found this board and to hear I've got company in the "bad ankle business". I just turned 30 and have sprained my ankles (yes both) each at least 20-40 times. I know I was younger when my right ankle first became injured. At some point in my late teens or early 20's, my body decided "hey the right ankle is toast, let's work on the left now."

I don't know how many x-ray's I've had on my ankles over the years, countless. In 2009 I injured my left ankle more severely and finally had my first MRI.

Here's the "conclusion" of that:
1. Relatively high-grade, chronic anterior talofibular ligament sprain. Somewhat generalized chronic calcaneofibular ligament sprain.
2. Chronic deep fiber medial deltoid ligament sprain.
3. Approximate 6 x 4 mm osteochondral lesion involving the lateral talar dome. Minimal irregularity and flattening of the contour of the subchondral bone with minimal edema signal in this area. Thinned, irregular appearance of the articular cartilage in this area.
4. Mild tendinopathy of the peroneus brevis tendon traversing the distal fibular tip. Mild to moderate peroneal tenosynovitis.
5. Mild posterior tibialis tenosynovitis. Mild tenosynovitis of the flexor hallucis longus tendon through the foot.
6. Mild poorly defined marrow edema signal along the dorsum of the medial cuneiform, either a mild contusion or stress reaction. No fracture is seen.

I saw an orthopedic physician who specializes in feet and ankles. He really was no help at all. He gave me a elastic ankle brace and sent me on my way.
I had explained to him that both of my ankles have be very unstable for as long as I can remember. I cannot seem to step off a curb or walk on grass with out my ankle(one or the other) giving out. He stated I should try PT to strengthen the ankles. I had already tried this several times with no help. I would strengthen the muscles and the foundation was still weak. I'd sprain my ankle again and it would just hurt and swell more, because the muscles had been made stronger.

I have popping and clicking in both ankles. They are achy and I always feel they could "turn" at any minute. If I sit on my feet or try to sit cross-legged my ankle will pop out of joint. I get excruciating foot pain, especially when try simple exercising. I've had ultrasound on my feet for this with no improvement. I saw a podiatrist next and he ordered my some custom orthodics, which didn't seem to make any difference.

My right ankle doesn't even swell anymore when I twist it. There's nothing left to destroy. My left ankle is still painful with injury. I was playing frisbee with my family about 2-3 weeks ago and stepped to the side...not in any forceful way...and pop...I'm rolling around on the ground. I begin to cry, less from pain and more from frustration. I'm so sick of not being able to do simple things without falling. It's embarrassing and painful. My family and friends have be teasing me for years "did you "break" your ankle again".

My normal physician ordered an MRI of the left ankle, as she knows my chronic history.

Here's that conclusion:

1. More acute-appearing marked sprain and at least partial-thickness disruption of the anterior talofibular ligament. There are additional changes of more chronic-appearing sprain of the lateral ankle ligaments, including the calcaneofibular ligament with suspected tearing near its calcaneal attachment site.
2. Additional sprain of the peroneal retinacular structures with additional fibrosis overlying the lateral inferior margin of the distal fibula.
3. Residua of chronic-appearing medial ankle sprain.
4. Focal areas of full-thickness chondral loss and chondral delamination involving the lateral margin of the talar dome.
5. Moderate tibiotalar and posterior subtalar joint effusions.
6. Small amounts of fluid are present within the medial flexor tendon sheaths with more moderate fluid within the peroneal tendon sheaths. This may imply communication with the tibiotalar or posterior subtalar joint capsules, and is less likely to represent tenosynovitis.

I requested a referral to an ortho doc again, though someone different than last time.

I saw him on Tuesday. He felt both ankles and stated they seemed very unstable. He asked me if I'd ever had any stress x-rays. I had not, no one even had suggested it in the past. He performed these and stated "I don't think I've seen two more unstable ankles in my life. (Meaning one person to have both so unstable)". I'm now having the Bromstrom procedure on my left ankle(right ankle is next, maybe 6 months from now....we'll see how surgery # one goes). He said he would make the incision a little larger than normal so he can see into the joint more and determine if he needs to drill into the cartilladge to encourage new fibrous cartilladge to be formed.

I just hope this offers me more stability so I don't have to be so paranoid about hurting myself.

Wish me luck. Surgery is on 5/17.

Last edited by Slillymom; 05-18-2012 at 02:11 PM.

 
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Old 05-03-2012, 01:15 PM   #2
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Re: Chronic Ankle Instability x 2

Hey, sorry you've had such a long and arduous ankle war.

Brostrum usually has good outcomes for people with chronic instability. The "chondral loss on the talar dome" is basically osteoarthritis, though, and it may be there to stay. However, ending the sprains and instability should at least slow the loss of cartilage.

You'll be in a cast or other immobilizer and on crutches for a while after the surgery. The crutches may be very hard on your right leg, so consider either a wheelchair or a device called a knee walker for going outside. Also, you'll have to keep your foot elevated most of the time for the first few weeks after surgery, as swelling will make it painful.

Make sure that you can get from bed to couch, kitchen and bathroom on crutches. It might help to remove clutter and rugs from your path. Ice packs are vital. If the cast gets in the way of icing, put one behind your knee.

 
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Old 05-04-2012, 02:14 AM   #3
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Re: Chronic Ankle Instability x 2

I'm so sorry you are going through this. I completely understand! I just had my 2nd ankle reconstruction (Brostrom) from chronic instability due multiple ankle sprains. This 2nd surgery also included repair of my torn retinaculum, my torn peroneal tendon, and deepening of the fibular groove (where they break and depress the bone) for peroneal tendon subluxation. Definitely read the sticky at the to for tips for coping with being NWB. Also check out threads by me, JOYFUL, PZNATTI, DMBNJ, MRSHEIDI as well all just had similar surgeries in Jan, Feb and March. Do you know if you will be in a cast or boot after surgery and how long on crutches? Do you have a knee walker or cast protector or know how yo will get food/meals why you are confined to bed/couch? There's a laundry list of stuff to do to get prepared so just let me know if you are interested! Welcome to the boards! We are all here to help you get through this!
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Old 05-06-2012, 11:14 PM   #4
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Re: Chronic Ankle Instability x 2

I was told I would be but in a NWB cast one week after surgery for 3 weeks, so 4 weeks NWB. Then 3-4 weeks in a walking cast. I really do need to study up on all the extras I will need to do day to day things. My husband is great and will be helpful, but I will have to figure out how to shower without getting my cast wet. I'm going to try and head back to work after 2 weeks. I'm an LPN in a clinic. I do sit often and can put my feet up. If this doesn't work, I guess I'll have to take 4 weeks off until I am weight bearing. Thanks for your suggestions. I'm hoping the surgery and recovery go well for me so I can have the same surgery on the right ankle when the time comes.

 
Old 05-06-2012, 11:20 PM   #5
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Re: Chronic Ankle Instability x 2

Hollywood, what are your biggest recommendations for tools that will make taking care of myself a little easier? My husband works with his father about 2 miles from our home and can come help me if needed. I just want to be prepared. Maybe I'm optimistic about how much I will be able to do for myself. I know the first day or two I will definitely be out of commission. Hopefully being a little bit younger will help some.

 
Old 05-07-2012, 02:42 AM   #6
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Re: Chronic Ankle Instability x 2

Hi! So just some tips. First, expect to be on crutches longer than you are told. I say this because different doctors have different protocols, but almost all of us were on crutches longer than we were told. The standard seems to be 6 wks. I was a 6 weeker, but it's not like the day the cast comes off and the boot (walking cast) goes on, you can toss the crutches. The ankle/foot/leg are way too weak and way too painful. You have to wean off. It took me 2 weeks to completely ditch them both. I went with one crutch for a while. Your calf will atrophy too. Mine was half the size of the other! Quads are weak too. Not trying to scare you, it's all normal. Just want to be real with you. So if you were told 4 wks, then think 5-6 depending on how your pain is. That's great you can sit down at work and prop up, but if you can take the time, do. Your foot will have a hard time being down even in the car. It was my left ankle and I was given the ok to drive as long as I wasn't on pain meds, but I couldn't keep my foot down that long for a long time. It gets taxing on your whole body (the surgery and the crutches). Do you have a knee scooter? If not, get one! So helpful! Make sure it's a steerable one with brakes and you can put a basket and cupholder on it. That worked well on mine! I'm an RN and granted I was working SICU so I was always on my feet, but after my first surgery 11 years ago, my doctor had me in the boot and off crutches by week 3-4 and I was back in the unit working full time by week 5. Big mistake and I had some complications from it. This time, crutches 6 wks (8 by the time I was off them), I'm in the boot and brace now (trying to work out of the boot) and it's week 11. PT is definitely something you will need and it can be painful. I'm just now in the most painful part of the whole 11 weeks so far! But this has by far been a much betternexperience the 2nd time around!! That's good your husband is close and can help. You will need him especially the first 2-3 wks, but really the whole time you're NWB. If you have kids, figure out how everything will be done for them. Same with pets. Figure out food. If you have friends or work or church that wants to bring you meals, tell them THANK YOU and let them help! That was a lifesaver for me. I had meals delivered every other night for 5 wks and it helped me for obvious reasons and helped my husband who works long hours not worry about me or what I was eating and he had food when he came home from a long day. Plus, company was great!! You can also make meals ahead of time and freeze them. Individual portions are great for when you are by yourself. Keep easy things in the fridge. Canned sodas, bottled water, yogurt, etc. Things you can throw in a bag and crutch from the kitchen to the couch to eat. Get paper plates and plastic forks/knives/spoons. Much easier to throw away and have less dishes to wash because you won't be able to and less work on him. Stock up on household items,for 6 wks so you wont have to worry about running out and less stress on your husband and you wont have to go shopping while you are learning to walk again (things like toilet paper, paper towels, napkins, plastic silverware, laundry detergent, fabric softener, garbage bags, pet food, etc). Have the couch and your bed "set up" meaning trash cans at both. If you can have two of these, have a charger for your phone, computer, iPad/iPod/kindle/nook, whatever it is you have at both your bed and couch. Have a cooler with drinks stocked if that's easier for you. Have ice packs (the big gel kind that come with a felt sleeve and have a Velcro strap to go around your cast. Got mine at Wal-Mart). Have remote controls close. Stock up on books if you read either in print version or e-reader, save up your tv programs on your DVR, queue up Netflix or Hulu if you have them. Rent movies. Have enough pillows to prop your foot up. I had 4 on the couch and 2 extra in my bed. Think about how you will sleep. I slept in the bed with my husband, but on top of the covers he was using and I got a separate comforter to cover up with because our covers are too heavy for me to elevate my foot on 2 pillows and get them over all that! Get nightlights for in the middle of the night in case you go to the bathroom. I got motion sensored so they weren't on all the time. Remove anything in your way that could trip you or make you slide (rugs that aren't heavy). Some people like a grabber to get things out of reach. I had everything in reach so didn't need one. Get a shower chair for the shower and a handheld shower head if you can. Cast protector is a must and I bought the one recommended to me from ppl on here and it was AMAZING!! My doctor even asked for the name of it because he couldn't believe I had showered EVERY day since surgery and a month later, my cast still had not gotten wet AT ALL! It's called Seal Tight. Just look it and order it. AWESOME! Also, I found cast sleeperz (yep with a "z") online. It is a fleece covering that comes in several patterns that you put on over your cast like a sock. Keeps your cast from tearing up your sheets or scratching your other leg and works well as a sock! Also awesome and my doctor asked for the name of it! Get s chair or vanity stool to sit on in the bathroom for when you are getting ready to go somewhere. Keep your pjs and lounge clothes in easy spots to reach. Biggest words of advice: take pain meds on time, every time, around the clock. I'm sure as a nurse you know this, but be the patient this time and not a nurse like we nursed tend to do. Take the meds q4h (or whatever the order is) ATC and set your alarm in the middle of the night to take the meds. Do NOT get behind the pain. Keep it elevated and iced. Ice the cast and you can put ice behind your knee. Follow all doctor's orders closely! This is all I can think of now, but I'm sure I will think of more, but if you have any questions so far, let me know!!
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-Modified Brostrom (failed)- 8/15/01"]

 
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Old 05-07-2012, 11:43 AM   #7
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Re: Chronic Ankle Instability x 2

I ordered some cast sleeperz(thanks for the recommendation) and a wedge for my bed to elevate my feet. I asked for a prescription for the shower chair and knee walker. I hope my insurance will cover them. If they don't they are still a necessity. I'm feeling a little nervous, but I know that I can take each day at a time after the surgery. Somethings I may come to desire after I've been home a few days. I plan on stocking up on a few things though. Thanks for all your recommendations. I'm a little nervous because I have a giant schnauzer that just turned one...needless to say he's a puppy. I will have to leave him in his kennel during the day, I think, at least at first, so he doesn't cause me any pain. I truly hope my pain is managed enough that I don't have to take more than 4 weeks off of work. Another nurse at the clinic will be filling in for me while I'm gone because her provider just went on maternity leave. She may be able to help me for the first week or two that I go back. Your advice has been phenomenal and much appreciated! I'm going to read and re-read it several times. I do enjoy reading and have many unread novels on my shelves. I can't let my brain completely turn to mush by watching TV ALL the time...lol.

 
Old 05-07-2012, 11:48 PM   #8
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Re: Chronic Ankle Instability x 2

Yay! Glad you got the sleeperz! What pattern did you get? I have the different shades of pink and brown dots or bubbles. So cute! Did you get the Seal Tight? The sleeperz and the Seal Tight were my top 2 most useful and favorite things! I'm sure you noticed the other products when you ordered your sleeperz like the slickerz, etc if you are going to be in the boot for a while, etc. Oh! Check out cast cozy online too. I did order this and used it a few times too. Might be good for you if you have go back to work in a cast. It's a toe cover basically. Comes in black or royal blue and it's fleece material. Covers your toes and there's a strap that velcroes around your heel to keep it on. Great product! It was still cool out when I first got my cast and so I wore it to keep my toes warm or whenever I didn't want the sticking out. Perfect for work, church, if you can't paint your toenails (LOL! As soon as my post-op splint came off and my doc put my first cast on, he said to me "you can paint your toenails now!" I was like great! I will pronto and I did! LOL! The important things you know!!), cold weather, etc. Just check it out so you can make the decision for yourself. Yep, sounds like the puppy needs to be in his kennel until you both get used to your situation. Since he's big,he can cause you pain, but more so after the cast comes off. There's not much that can get through that cast to hurt your ankle thankfully. I fell on my foot, my 3 dogs jumped on it accidentally and it was all good. BUT...my 3 dogs are Maltese and weigh 3.5, 6.5, and 7.9 lbs! LOL! My dogs were great though. They were overly concerned and protective of me. They wanted to be fully attached even more than normal to me and my boy dog always laid on the couch with his head and 1 paw on the thigh of my casted leg! So cute! If I winced or was in pain, he'd whine a little and my girls would be right there staring at me. Animals are so smart! That's great you have someone covering for you. If your job is pretty relaxed, it may work out for you. Order the cast cozy and ask for permission (get an MD note if you need it) to be able to keep your foot propped up and iced throughout the day. Is this your left or right ankle? If its your right, is your husband driving you to work? I know some people drive with their left foot and so easy for me to say because it was my left foot (although I didn't drive much due to the pain of my foot being down), but just keep in mind that in many stars it's illegal to drive with the left foot and if you get in an accident and they see a cast or boot on your right foot, not good. Not only could you be faulted, but in this sue happy world we live in now, you could be sued too! Yikes! As far as your pain, really if you follow all instructions and stay ahead of/on top of the pain (q4h ATC x3-4 days) your pain should be managed well. Do you know what you will be on for pain afterwards? Does your doc do nerve blocks? A lot of people on here got them and LOVED them because they had no pain for 12-24 hours after surgery. But a lot of people didn't know when to start their oral pain meds and then the block wore off and they experienced a huge surge in pain. I personally didn't have one with either of my ankle surgeries just because I've also worked as neuro ICU and outpatient RN and seen what can happen and for me, it's not worth it. It's completely a personal choice, no right or wrong and I'm def the odd ball on this. My pain was managed well after both surgeries with this latest one being the best. The first time I had fentanyl in the OR and Percocet before I left hospital and then 1-2 Percocet q4h PRN. Then on the 3rd or 4th day, he gave me an Rx for lorcet plus and I switched to that and was on it for several weeks off and on. This time I was given morphine in the OR (I stopped breathing off fentanyl the first time!!) and then 2 Percocet when I left the hospital and then 2 Percocet q4h ATC. Did that for the first 3 days and then it would be q6-10 hours to twice a day. Then off briefly until PT started back up. Doc asked me if I needed more pain meds and I asked how painful PT would be (I didn't have PT after the first surgery!) and my doctor replied with "yeah I will just write you another Rx for pain meds!" Grreeattt!!! True to his word, oh goodness! Oh and take pain meds about an hour before your post op Appts that will involve cast changes, suture removal, positional,x-rays, boot placement, etc. Will help big time, but means you will need someone to drive you!

See! Told you I'd think of more! When is your surgery again? You need to update us on here as soon as you are able so we can keep up with you we how you are doing!! What color cast are you getting?? May I recommend the purple! It's beautiful-a royal,purple and keeps its shine unlike some other colors. I didn't get tired of it either!
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-Modified Brostrom (failed)- 8/15/01"]

 
Old 05-08-2012, 08:05 AM   #9
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Thumbs up Re: Chronic Ankle Instability x 2

Hi have surgery on May 17. Unfortunately my "puppy" is 80 pounds. Hopefully he won't get to rambunctious. We also have two other dogs but they're smaller and older so they're calmer. As much as I prepare, I feel I'll still forget many things after the surgery. At least my hubby is willing to run errands for me if I need things. I've printed off the nonweightbearing list to help me prepare. I have grocery shopping to do tonight and will get a few things then. I normally go to Walmart so I can multitask. Thanks again for all the recommendations.

 
Old 05-09-2012, 12:51 AM   #10
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Re: Chronic Ankle Instability x 2

Oh yeah, there's always something you forget. I did too, but I felt very prepared with what I had done off my list, the sticky thread (tips for coping with NWB), and recs from others on here! Having your husband willing to help is HUGE! My husband became a rock star and I couldn't have done it (still can't do it) without him. I also went/go to Wal-Mart for multitasking AND I have found it to have the best and lowest prices! Please let us know how your surgery goes and we are here for you afterwards to answer all your questions after because you will have a bunch!!
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Old 05-14-2012, 09:39 PM   #11
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Re: Chronic Ankle Instability x 2

I am getting more and more anxious about surgery. I haven't done near the house cleaning I felt like I should do before my surgery. I'm nervous that I'm being very unrealistic about returning to work after only 2 weeks. I've been having a lot of pain along the underside of my ankle down the outside of my foot. This seemed to have started, or at least became more noticeable, after I had my stress x-rays. I'm not sure if I just have tendonitis or if something else is going on. My MRI showed that my tendons were "normal", but noted some tenosynavitis. This was prior to my stress x-rays. I'm still having pain in the foot and ankle, after spraining my ankle over a month ago. This is rare for me to have problems last this long. I hope that my Doc looks around in the ankle for damage that wasn't seen on the MRI. I'd like to only go through this surgery and NWB once for this foot. I'm just so unsure of what I should expect.

 
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Old 05-14-2012, 11:29 PM   #12
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Re: Chronic Ankle Instability x 2

Well, you are only a few days away, so being nervous is normal.

If you can get around the house on crutches without clutter tripping you up, then the place is clean enough for now. Don't stress about it. If all else fails, hire professional cleaners. I've done that a couple times when I wasn't well enough to clean and couldn't live with the mess any longer.

Right before my ankle surgery, I also had pain under the malleolus and along the bottom of my foot. Turned out my peroneal MUSCLES had spasmed due to limping for so long. I massaged them out, rolling up and down my fibula with a ballpoint pen!

 
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Old 05-15-2012, 12:29 AM   #13
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Re: Chronic Ankle Instability x 2

Definitely understandable to be nervous right now. I agree with janewhite1. Hire professional cleaners if it gets too much for you. I did that as well because I can't stand mess and I couldn't do it and my husband didn't have time after working and then taking care of me and our animals. If you are having pain not in an area he is supposed to look at, then make sure you tell him about it before surgery or on day of surgery because to explore anything else, it wil have to be on your signed consent. I also had the peroneal muscle issues that Jane described. Mine are so knotted that they massage them and roll them (like rolling out dough) with something called The Stick! One of mine is a trigger point knot that radiates pain down into my ankle. Doctor said these knots mostly likely occurred with my many ankle sprains.
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-Modified Brostrom (failed)- 8/15/01"]

 
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Old 05-15-2012, 08:28 PM   #14
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Unhappy Re: Chronic Ankle Instability x 2

I'm planning on mentioning the new pain prior to my surgery. Hopefully I'll have some answers after surgery. Thanks for all the support!

 
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Old 05-15-2012, 11:55 PM   #15
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Re: Chronic Ankle Instability x 2

You will do great!!! Can't wait to see you on the "other side"!
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-Modified Brostrom (failed)- 8/15/01"]

 
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