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LadderMan 07-11-2012 12:55 PM

Talus crush injury, 19 years later
 
Hello All,
Well, it's been 19 years since I crushed the Talus in my right ankle. The bone splintered to the point there was nothing solid enough to work with, so I went through the cast and heal, cast and heal route.
About a year after the accident, I had a Subtalar Arthrodesis, followed up by casts, non-weight bearing, crutches, etc. Cadaver bone was used as grafting material.
About a year after that, I had the fixture removed. The fixture was put in through the anterior of the Talus, as opposed to the posterior of the Calcaneus. Why? I don't know. I was having a lot of pain at that site and there was a "popping" sensation, so I assumed the fixture was causing a problem.
Another year passed and an x-ray and CT scan showed a non-union. That brought on the third surgery; another Subtalar Arthrodesis. Again, the fixture was placed through the anterior of the Talus.
It's been a little over ten years since I've had a doctor look at it. My original doctor moved his practice out of state, and after all of the "wonderful" experiences I've had with this situation, I haven't been beating down the door to another doctor to keep up on it.
I've had to adjust to my new limits after the accident, but I still feel the want to go out and do things. Uneven ground is almost a no-no. Extended periods of time on my feet comes back to haunt me. I'm not able to jog anymore, obviously from the lack of movement in the joint, and I can tell when the weather is going to change. (would have never believed that was possible...)
Anyway, that brings me to the present situation. I walk my dogs outside in the yard several times a day. We have our set path, which takes us about 350' or so. The yard has the usual lumps and bumps and tufts of grass that you wouldn't know were there if you hadn't injured your ankle like this.
Two weeks ago, I was just starting across the yard when I felt something I describe as crushing a boiled egg in your hand. You squeeze until you feel the egg shell pop, then give way in your fist. I doubt it actually made any sound, but I could hear it go up my spine and into my ears. There was a sharp stab in the ankle joint at the same time. I've felt that to much smaller degrees in the past, so I wasn't extremely worried.
A couple days later, I cooked dinner. I had to hurry back and forth from the kitchen to the bbq grille outside. After about an hour, my whole right leg felt like it was on fire all the way up to the knee. Again, I've had this feeling before, just not quite as severe.
I finally gave in and went to my wife's doctor and he did an x-ray. He did an x-ray and sent me for a CT scan.
His exact words after viewing the Ct scan were "That looks like s---!", so I guess there's a problem. There is another non-union. At least he was honest. lol!?
He said he didn't know why the fixture was put in from the anterior, because he would have done it differently, but I don't think that has anything to do with the situation. He pointed out the arthritis that's built up in the front and back of the joint, and the path where the first fixture is still visible in the CT scan.
He recommended another fusion, but going the route of an external fixator instead of another internal. I'm not sure if that's due to the two having already been tried or not.
I googled those things and don't know that I can deal with another round of this and having something on the outside of my body that I have to deal with. Besides the physical pain of recuperation from surgery, the mental turmoil is equally rough. I actually became conscious during the second surgery while the doctor was removing the fixture.
With the constant pain (in varying degrees), the non-articulation from the fusion, the loss of physical activities I used to enjoy, the details we have to deal with after fusions, etc, I'd almost opt for an amputation at this point. It seems BK amputees get to do all the things I used to do and still want to do but can't.
The CT scan shows the gap between the calcaneus and the talus. You can see the path the original fixture took through the talus and the calcaneus. You can see the existing fixture, and there are what appear to be hollow pockets at the top of the talus and what looks like a hollow tunnel going down from the top of the talus to the center just above the calcaneus. I'm not a doctor, but it doesn't look right to me.

I guess I can laugh a little because I now have a pretty sweet belly button on top of my foot! :)

Zerk 07-11-2012 08:31 PM

Re: Talus crush injury, 19 years later
 
I am curious to hear about how things go. Hopefully it all goes well.

janewhite1 07-12-2012 07:54 PM

Re: Talus crush injury, 19 years later
 
Hmm. I wonder if there is enough bone to put in a replacement? Clearly the attempt to fuse the talus and calcaneus didn't work.

Find a really good board-certified foot and ankle surgeon who has done a lot of ankle replacements. They don't like to replace ankles in people under age 60, but your case sounds bad enough to do it.

LadderMan 07-12-2012 09:57 PM

Re: Talus crush injury, 19 years later
 
I've been steam rolling through internet blogs, forums and medical information sites the past week. I found one last night that kind of made me think harder than before.
I read about avascular necrosis and saw some examples, and it appears from my CT scan that there is a high probability that I have that happening now. The original fracture included a dislocation of the foot. It looked like what Kathy Bates did to James Caan in the movie Misery. The actual fracture was kind of in the middle of the Talus body, underneath the Tibia, and the foot turned in and laid on its side, similar to the appearance of club foot. The bone was splintered and looked like tooth picks, so there wasn't any way to secure it with pins or screws and plates at the time, so the doctor reset it and I went from cast to cast until it became "solid", then had the first fusion.
Now, I can see what appear to be hollow bubbles scattered through the top of the body of the Talus, and what looks like an hourglass, or a tornado vortex that starts where the splintered area was and goes almost straight down to the subtalar joint. Halfway down, it begins to expand again, like a second vortex turned upside down, hence the hourglass description. That area has really dark outlines and middle, resembling what the xrays showed for avascular necrosis. (wish I could post a picture of that CT scan frame.)
I've read that some people have had upwards of 30 or more operations on their foot/feet, and I sure don't see me going through all of that. With the pain and what's left of the talus, I'm seriously thinking about bringing up amputation with my doctor. I know it swaps one set of problems for another set, but there are more pluses to that than there are for repeatedly fusions and a prosthesis would give me more chances to get back to being active like I used to be, rather than confined as I have been. I figure, I've given 19 years to this, so I've done my time by now, if the option is there.
I can't believe I waited so long to look for a support site like healthboards. There is so much information out there, and so many more people than I could have imagined. I am not alone, which is WEIRD! lol I feel bad for anyone and everyone who wound up here like I did, but I am grateful for all of you.

janewhite1 07-12-2012 10:07 PM

Re: Talus crush injury, 19 years later
 
Generally, if you are able to walk even somewhat they don't want to amputate, as amputation opens the door to a lot of other problems, such as phantom limb. The guys with bionic legs who run and win races are the very very lucky few, most amputees are not that well off.

Look into the ankle replacement first. It really could be an option, and it's usually a lot more functional than an amputation.

And I'm glad you found us! This site has been very useful to me through all kinds of difficulties.

LadderMan 07-23-2012 08:42 PM

Re: Talus crush injury, 19 years later
 
Update:
Had an appt today with a board certified foot/ankle specialist. It's been 13 years since my last check up. The subtalar arthrodesis is a failed/non-union. At present, I need the existing screw removed and a third subtalar arthrodesis, talonavicular joint fusion, and calcaneocuboid joint fusion. The most recent CT scan shows probable osteonecrosis of the talus crown.

The doctor said he'd have to scope the area once he began the surgery to know what needed to be done, though he was having a second radiologist read the CT scan prior to the surgery. I have a cd copy of the CT scan, but as a layman I don't know what I'm really looking at. I can see what appears to be a dark/shadow area that resembles a tornado vortex with the wide upper area covering the talar dome and the slender body of the shadow area extending all the way down to the subtalar joint. There are several (5 or more) "hollow bubbles" randomly appearing throughout the talus, which I asked they pay attention to along with the "vortex" because I'd rather know in advance what they feel they might need to do, rather than while I'm under anesthesia on the operating table.

The doctor said I need to get a bone stimulator asap, prior to the surgery. I assume it will begin a healing of the talar dome that I have questions about and where I see that shadow area that extends to the subtalar joint. Anyone with experience with those, let me know how your experience went.

I'm still a bit lost and confused with part of the explanation, but from what I do understand, if there is a problem with the talar dome, an ankle fusion may be necessary. If that is the case, after scoping the area, he will stop and speak to my wife and let her know the situation. (**** I hate being sedated during those decisions, but what can you do?)

Anyone with similar combination of surgeries, please let me know your experiences and what I might expect for post-op recuperation. I am surprised to be told that I might be able to actually walk on an exterior fixation the day after this surgery. Maybe the doctor was trying to make me feel optimistic. I'd be surprised and happy to be able to walk with this amount of work being done and walking the next day.

ayerb 07-25-2012 07:00 AM

Re: Talus crush injury, 19 years later
 
Wow, that sounds awful. By your "name," I think you fell off a ladder in the original accident. I have a similar talus-calcaneus fracture, with 4 screws both both the posterior calcaneus and from the medial side through the talus. Stiffness, difficulty walking on uneven ground but nothing as bad as your. Fall was 7 months ago. Good luck. ayerb

shoe68 08-14-2012 03:47 PM

Re: Talus crush injury, 19 years later
 
I have avascular necrosis of the talus bone and before I settle on fusion my doctor wanted me to try an external fixator. I'm having that surgery in 2 days and I'm hopeful that it will work. I'm 43 and have been inactive for 2 years since my accident. My first surgery was in March 2011 to repair the ligaments and tendons that I shredded and walked on without seeking medical attention for 8 months. About 10 months after the surgery I started having little episodes of pain, nothing horrendous, but now 8 months later, I'm walking in a boot, and in horrible pain. I told my doctor a few months ago that I didn't mean to be crass but I was ready for amputation. He said that just told him where I was at with everything. If this doesn't work, it's going to be devastating. I'll post in a few days if you'd like to know how it went. Or, if you've already had it done, tell me how yours went.

LadderMan 08-14-2012 07:04 PM

Re: Talus crush injury, 19 years later
 
If you look at my avatar, you can see a dark funnel looking shadow with a wide top, narrowing as it goes through the talus and extending to the subtalar joint. That's the big concern I have.
I went back to the doctor for a two week check after he did a steroid injection into the talonavicular joint and the calcaneocuboid joint. that seemed to give me almost a day with little to no pain, then came back to what is "normal" pain for me.
I asked him about that shadow area and from his response, he didn't even look at the CT well enough to see it, and the second opinion he wanted didn't mention it either. I'm not very impressed with that response, since I specifically asked him and his nurse to look at that. I didn't know what questions to ask my first doctor, so I'm asking a number of questions now.
I can relate to the amputation frame of mind. We're all different and respond to treatment in different ways. It does get old. Personally, I see fewer problems with an amputation than I see with repeated surgeries because fusions often cause the other joints to fail, which means more surgeries/treatments for them.
This doctor did say that my first doctor asked him to take over a number of his "problem patients", ones with problems he just couldn't resolve. Shortly after that, the first doctor moved to another state. Kind of reinforces the idea that the first doctor wasn't as good as he should have been, so he cut his losses and moved to a place where his past wouldn't follow. (workers comp' doctor... I think that says a lot.)
Good luck with your surgery. Hope it goes well. Post an update and let me know how you're doing. :)

LadderMan 08-14-2012 07:15 PM

Re: Talus crush injury, 19 years later
 
If you look at my avatar, you can see a dark funnel looking shadow with a wide top, narrowing as it goes through the talus and extending to the subtalar joint. That's the big concern I have.
I went back to the doctor for a two week check after he did a steroid injection into the talonavicular joint and the calcaneocuboid joint. that seemed to give me almost a day with little to no pain, then came back to what is "normal" pain for me.
I asked him about that shadow area and from his response, he didn't even look at the CT well enough to see it, and the second opinion he wanted didn't mention it either. I'm not very impressed with that response, since I specifically asked him and his nurse to look at that. I didn't know what questions to ask my first doctor, so I'm asking a number of questions now.
I can relate to the amputation frame of mind. We're all different and respond to treatment in different ways. It does get old. Personally, I see fewer problems with an amputation than I see with repeated surgeries because fusions often cause the other joints to fail, which means more surgeries/treatments for them.
This doctor did say that my first doctor asked him to take over a number of his "problem patients", ones with problems he just couldn't resolve. Shortly after that, the first doctor moved to another state. Kind of reinforces the idea that the first doctor wasn't as good as he should have been, so he cut his losses and moved to a place where his past wouldn't follow. (workers comp' doctor... I think that says a lot.)
Good luck with your surgery. Hope it goes well. Post an update and let me know how you're doing. :)

shoe68 08-22-2012 07:14 PM

Re: Talus crush injury, 19 years later
 
Surgery went well, and obviously as with any surgery there is some pain afterward. I would suggest to anyone that has this done that you get the pain meds filled immediately after leaving the hospital/surgery center and start them when you get home. I made the mistake of having my husband take me home and then he went to pick up the kids and get the scrips filled and by the time he returned a couple hours later, I was beyond miserable. My first followup was yesterday and the doc told me that I should be able to walk on it, but right now there is no way that I could do that. I can feel every wire and it's not only a weird sensation, but also a little painful. I used a walker the first few days which was better than the crutches I used after my first ankle surgery. I've encountered a slight roadblock in that my leg and foot swelled so much that by the 4th day I was in the ER in excrutiating pain. I went to my ortho doc the next day and he put me on an antibiotic, an anti-inflammatory, and gave me some additional pain killers for "break through" pain. He may have to redo the frame and adjust the top ring. After taking the first day and a half of the new meds, my foot and toes are starting to look normal again. So after 1 week, I wouldn't say that I'm regretting it, especially if I'm able to walk again. It's going to be a long haul but I just have to keep reminding myself that it could lead to better things.

Stupid feet 10-13-2012 11:00 AM

Re: Talus crush injury, 19 years later
 
Just had my 2nd surgery to try and fix mine. Had one of the best docs in the world do this surgery after the last guy really screwed it up. New doc took out all of the old bone and hard wear and put in new bone and actually implanted a bone stimulator. He says there's a 80% success rate for what he did. Not a cure, but I should be able to be more active and have a lot less pain. I've been in pain management for about a year now and that helps a lot. Just had surgery 3 days ago so I don't really know outcome yet but doc was thrilled with how it went :)

shoe68 10-15-2012 02:42 PM

Re: Talus crush injury, 19 years later
 
2nd surgery to fix your ankle? Or 2nd surgery for an external fixator? I had mine removed last Thursday after 8 weeks with it on. He scoped it and said he thought it looked really good. I have a follow up on Wednesday and hopefully I'll be able to start putting some weight on it and driving again. The original surgery was on Aug 16, I had a 2nd one on Aug 24th to adjust the frame down and put in new pins. I had a horrible infection Labor Day weekend and was admitted to the hospital and put on IV antibiotics. Good luck with everything and I hope it all works out for you.

Stupid feet 10-15-2012 02:54 PM

Re: Talus crush injury, 19 years later
 
2nd surgery to try and fix the ankle. I made a mistake the first time and went to a local foot & ankle specialist and he did nothing but mess it up worse. I had a stimulator that I just strapped on my foot. This time, the new surgeon implanted some kind of stimulator and also took out the hardware and bone that 1st guy put in. Sounds like you have had it rough,
Sorry to hear that. Please let me know how you progress. Is your injury in both ankles or one?


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