I want to go to my OS next Friday armed with a ton of info. After two nerve surgeries in my foot, my OS was not at all surprised when I fell and badly sprained my ankle. The MRI showed tears in a few of the ligaments that connect the talus to the other bones (calcaneus, fibula, tibia), so my OS sent me off to PT with fingers crossed and "no promises" that there would be no surgery. However, I am tired of this ankle constantly collapsing. It hurts, and I am terrified to walk, to fall. My PT thinks we've tried enough conservatively, so is sending me back with a recommendation for stabilization of the ankle. I really like to hear patient stories, so please tell me yours--what kind of procedure you had, what symptoms you had before the surgery--and for how long--and how long the recovery takes, and the specifics. Thanks for sharing your stories; I am a control freak and need infomation so I can plan!
Thanks,
Karyn
The following user gives a hug of support to KarynLR: tinkerbell1018 (06-18-2011)
I had an unstable ankle for 10 years before I finally went ahead with the surgery. The typical surgery they start with is the Brostrum, which is where they just tighten up the ligaments that are there.
My doctor was concerned that I would stretch that repair out, though, because I have elastic tissues (I can bend my fingers pretty far backwards). So my surgeon decided to do an extra step to the surgery which used a tendon to create a new ligament. The specific procedure he used was the Evans, but another common and similar one is the Chrisman-Snook. These procedures are done in addition to the Brostom.
The basic principle behind the tendon part of the surgery is they take the tendon of the peroneus brevis muscle, split it longitudinally, cut the end of one half up in the leg where it attaches to the muscle (leaving it attached down in the foot where it attaches at the base of the little toe way down in the middle of the foot). Then they drill a hole through the fibula (ankle bone), thread the tendon through, and sew it back on itself. This basically creates a new tendon going from the base of the fifth metatarsal to the fibula. The procedures vary based on where the holes are drilled. I think the Chrisman-Snook has a hole in the fibula and a hole in the calcaneus for the tendon to go through.
While the surgeon was in there doing all that stuff, he also did an arthroscopy (actually, he did the scope first). He looked for any funky stuff in the joint, like loose bodies, rough cartilage, bone spurs, etc. I'd have to check the report, but I think mostly he just shaved off a bunch of extra bone I had growing around the joint.
The surgery itself was easy, because they do general anesthesia. Not so deep that they have to intubate (put in a breathing tube), but deeper than you go for getting your wisdom teeth out. But you've had surgery before, so you're familiar with all that stuff. You'll definitely want to spend the night in the hospital with IV pain meds. I found it to be quite a painful surgery. I was taking my happy pills for at least 2 weeks. Although I must note that I'm a bit of a wimp.
They sent me home in this huge surgical bandage for a week, then a cast for a week, then I got my stitches out (which hurt a lot!!!), then a cast for 4 weeks. So the first 6 weeks I was on crutches NWB. Then I went in and got the boot, was allowed to start walking as tolerated, and started PT. I lost the crutches in 3 days and did PT for about 6 weeks. Then I was pretty much good as new. I don't remember how long I was in the boot, but after that it was on to the shoe.
During recovery, I pretty much had to keep it elevated all the time for the first 4-6 weeks. I couldn't drive for a month, not because of the foot, but because it hurt to let it hang down when I sat to drive. I had to be driven around while I sat with my foot up on the dash. In classes, I sat with my foot up on the table or desk. In stores, I drove the little cart around with my foot up in the basket. If I let it hang down, it would turn this dark purple color. So even after the major pain went away, I still had to elevate for the swelling.
I had the surgery 2 years ago. My ankle is totally stable now. Very tight. I actually have hardly any inversion at all now. Much less than my other foot. I stepped off of a stair wrong about 3 weeks ago and I did sprain it, but I didn't damage the repair. I managed to sprain some ligament that was up in front of the repair. But that's pretty much healed up now, too. I no longer have that unstable worried feeling that I'm going to fall over whenever I do anything. I definitely am glad that I had the surgery, even though it was painful and the recovery seemed to take forever while it was happening (although now it doesn't seem like that long).
My only regret is that my scar is ugly. It's about 5 inches long, starting up in my leg, going behing my ankle bone, and into the foot. I also have two little dots from the scope in the front of my ankle, but those pretty much went away. The long scar ended up spreading and stuff, though, so it's kind of ugly. The surgeon said that if I ever have surgery again that they should use special stitches to close so that it doesn't happen, so apparently it's just a personal tendency towards scarring. So if you have had any problems with scarring with your past surgeries, that's something to think about.
Let me know if you have any questions. Good luck with your appointment.
The Following User Says Thank You to kehorner For This Useful Post: Flaubert (09-18-2011)
Oh kehorner, thank you so much! This is the kind of response I was hoping for! This sounds about as detailed as my surgeries prior--in terms of time in casts, and recovery, and I spent the night in the hospital for both of those. IV pain meds for the second one; a great option that I would certainly use again.
Why did you wait 10 years to get the surgery? My surgeon is very conservative, and told me that we would probably know in 6 to 9 months if healing of the ligaments will occur, but I'm feeling the instability now, which causes my "team" (PTs and a podiatrist whom I "consult", but do not let cut) to think it won't heal miraculously in a few months. I am starting PA school in the fall, and Zingas (my surgeon) recoveries tend to run long, and I have a bit of concern regarding being "ready" in time for the start of my program. So, I am hoping he and I will be able to come up with some sort of "compromise" timeline. I would like to operate as soon as my semester is over, but we'll see.
Also, thanks for sorting out the procedure names for me--it was helpful! Basically, you had a Brostrom with an Evans procedure? I do not like to do a lot of Internet searching, as I think you can go through a bunch of crap, but that's where the podiatrist helps--he's hooked me up with a medical library, and has some time to call me back (unlike my OS) and discuss what I've found. The podiatrist's opinion is that my OS would do a Crissman Snook, because the "tightening of the ligament does not provide as much stability as rerouting the tendon", and that kind of surprises me. Do you know the healing time differences between a Brostrom and a Crissman Snook? When he was telling me about the holes in the bone I thought it was just the coolest idea! So smart! It just makes me think of ribbons and a hole punch for greeting cards
Did your surgeon do the scope separately before you had the Brostrum, or were they on the same day? Also, did you have stress views of your ankle pre-operatively? Apparently, they can numb you up, resprain the ankle, x ray it with force on the ankle, and then can measure the distance in the black space, and somehow can make a determination if the ligament is slack by how the bones are positioned in the x ray. If the measurements are okay, there may be some issues in the joint, so only arthoscopy might be needed. Personally, I'd just rather do the big fix. My PT, when I first came back in said to me, "Is there anything else you'd like Dr. Zingas to do if he's going in anyways? Take out more nerve? Release more plantar fascia?" He was really serious about that, and we are going to seriously discuss that before they "release" me.
One of the best things Dr. Zingas believes is that if you're going to do foot surgery, you're going to do it right--you'll stay off the foot, you'll be in a cast, you will use crutches. If you aren't going to give the foot time to heal, why do the surgery? He has drilled that into my head, and I believe it now--so while long recoveries are daunting, I know he is making sure we have the best outcome possible, and I respect his opinion. I would (and am) wary of surgeons and podiatrists who let people walk out after surgery or let them walk on the heel or whatever. People see me in a cast for weeks on end and say, "I would tell that doc to shove it!" but they have no idea what it's like to have been with a bad podiatrist, and to now have an amazing surgeon--if he says wear a cast, I am in that cast!
I have no idea how you did college with that ankle repair. I think you're my new foot goddess--that is just amazing! I am a baby and won't even attempt my campus with crutches!
Thanks for all the help--I look forward to the responses!
I had a Brostrum repair about 2 1/2 years ago. My surgery was outpatient, so I was home in my own bed that night. I was in a NWB cast for 4 weeks, then moved to the "boot" for about six weeks and started walking as tolerated (very slowly). I went back to work at six weeks, an office job, but elevated while sitting at my desk. Pain was tolerable for me, took the pills for about the first week. I had been doing great until this summer when I may have done something freaky to it, but I don't see my Dr. until next week.
-eko
__________________
"Every good has a better and every bad a worse."
I was in middle school when I had the original injury, and at that age I terrified of getting blood drawn, so surgery wasn't an option that I was willing to consider. It took me some time to get older and wiser and realize what I should do.
Absolutely do NOT try to have the surgery during a semester. Wait until summer break (or possibly Christmas break if you get like a month off). I was really dumb and did mine over spring break (not even at the beginning, but on Wednesday!). I was very behind for the rest of the semester and it was a struggle to just keep up. I would recommend doing it over the summer if you can.
Yes, when they do the Evans or Chrisman-Snook, the also do the Brostrom. So I had a Brostrom repair with an Evans. They did the scope at the same time of the surgery, just immediately before making the big incision. So I guess they knocked me out, scoped the joint, then sliced it open and did the big repairs.
I did have stress x-rays taken a long time ago, closer to the time of the original injury. They didn't numb me up for it or anything. Basically the doctor just put on some lead gloves and gently pulled my ankle as far as it would go. But they don't actually reinjure the ankle or damage any ligaments when they do it. I think some doctors do the numbing so that you don't tense up your muscles and limit the range of motion.
As for doing my campus with crutches, I was pretty much a baby too. I got the handicap permit, and there happened to be a handicap lot right behind the anthropology building. Disability resources at that university was great... they scheduled a golf cart to come pick me up from that building and drive me to my other class across campus and back. I could also call them up for other random rides when I needed them. Plus, my mom flew out and stayed with me for a month. So she did all the cooking, cleaning, cat care, shopping, and driving.
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