25 w/ Chronic Ankles - Scared and Need Help/Advice - Foot Problems Message Board

hordan54 · 06-01-2007, 02:42 AM

God that title sounds like a horrible personals ad

I'm 25 and an avid basketball player. My whole life I've struggled with ankle sprains -- probably rolled each over 20 times -- many mild sprains with a few hugely debilitating ones mixed in. Usually would get x-rays (all negative) and then just RICE and ease back into playing -- went on from about 8th grade til current (11-12 years) -- I played a LOT at a very high (stressful) level. The last couple of years my right ankle has been spraining more, even with a brace, and felt weak.

About six months ago I had a mild sprain of my right ankle while wearing a lace-up McDavid ankle brace -- not much swelling but slow healing, and when I went back to play after about a month had hot pain on my medial malleolus region when planting and cutting. Got MRI (at last), which revealed lots (detailed below) but my sports medicine doc just said to do ankle excercises and strengthen my legs. Was good for a few months then had another mild sprain -- finally got a referral to an orthopedist. He looks at my MRI and X-Ray (same one the sports med people looked at) and basically tells me my athletic life is over -- any basketball basically greatly increases my chances of ankle dislocation due to prior injury. Here's a summary of the MRI

Avulsion fracture involving the medial malleolus and superficial deltoid ligament. Osteophytes are present and growing from September to May (that's from the Radiology report). Longitudinal split tear involving the peroneus brevis tending estending from the lateral malleolus to the calcaneus where it reconstitutes. Thickening of both tibiofibular ligaments. Thickening of calcaneal fibular and posterior talofibular ligaments (the anterior talofibular is not even SEEN). Thickening of the superficial fibers of deltoid and spring ligaments.

That's the MRI. My doc told me my tibofibular ligaments are "GONE" (his words) and the only thing basically holding my tibia and fibula in place are the interossal membrane, muscle, and scar tissue. He suggested surgery on my own timetable with arthoscopic to clean out some of the bone spurs and torn ligament and perhaps surgery to suture together the torn ligaments that are salvageable.

I walk normal, without too much pain (nothing I haven't grown used to) and can even run short distances (I've never been a marathoner). I've not tried playing again since the last ankle injury (4 weeks ago). I guess I've got a few questions:

1. The diagnosis: are my ligaments (particularly tibiofibular) gone or just "thickened?" What does that mean, scar tissue?

2. The surgery: the available options are at my discretion, although anything more than arthoscopic increases recovery time, PT, et cetera. Should I get everything fixed at once? Wait and just do PT and enjoy my relatively healthy ankle as is now following a more conservative surgical course? How well do those repaired ligaments hold up before stretching? What's my recovery looking like those of you who've done this?

3. The philosophical choice: Even if I get some surgery (I'll probably at least opt for arthoscopic clean out) what do I do after? Do I retire from basketball and take up golf and biking and play it safe? Or continue to do what I love (taking all possible precautions -- altering my style of play) and deal with the consequences when they come? I'd feel HORRIBLE if I played it safe and gave up the sport i LOVE (my favorite activity in the world) and then blew out my ankle stepping in pot hole. I'm too young! But I guess this depends on......

4. The outlook: What's the worst that could happen? What if I dislocate it at a young age? What if the tibia and fibia start to separate and I need screws/pins? What would my life be like then (I don't know and there's people here who've been there)

5. Oh yeah the brace: Should I always be wearing a brace? Just during sports? Neoprene, wrapped, or hinged stirrup? Can I dislocate it with one of those on? No way right (right??)

Anyway, that's a bundle of questions and I'm sure too much information -- that's how you can tell how scared I am. I'm 25 years old and have no perspective and feel like lots of windows are closing on me with this news. Any help would be so much appreciated!

I'll probably repost once I talk to the surgical scheduler and find out what my options are.......

THANK YOU!!

_s****_ · 06-05-2007, 12:41 PM

The problem is that every time you roll your ankle you're doing more and more damage. A dislocation or fracture could really be devastating. I rolled my ankle several times before I'd had enough. I had my ligaments rebuilt. It lasted 8 years before I stepped on some uneven pavement and went tumbling down. Eventually I had it rebuilt again and so far so good. But the damage was done after the first injury. I've fought scar tissue and nerve problems since that time. I've had neuromas removed three times, the last being just last week. I've already got arthritis. A coworker fractured his talus several years ago. He never had it taken care of and now he is in deep trouble. He's developed avascular necrosis which is pretty bad on that particular bone.

If I had your ankles I'd get them tightened up and cleaned out at the very least. Chronic inflammation can destroy the joint.

jprinz99 · 06-06-2007, 03:37 AM

Good grief! I feel your pain as I have "been there, done that and have the Tshirt"

Dislocating an ankle is really, really bad news so wear the brace as much as you ccan stand it. I moved into a DonJoy Velocity and I think it is the best for preventing rolling, plus it gives better support. Remeber, less stain + less inflamation.

I would just go and get things fixed. Personally, I would rather have an extended down time with a longer rehab than face repeat ops. My OS (foot and ankle tauma/sports med doc) summed it up after he gave me my options. He said if I only opted for half the job then it would be semi-useless to get anything done. The analagy he gave was if I only wear the shorts but not the shirt, then I am still out of uniform. After all, the scar tissue is trying to hold stuff together. What do you think will happen if you clean it out?

Thickening is a fancy term for a torn lig that is being held together via scar tissue. Ligs that are repaired will always have some degree of scar tissue but function very well. They usually hold up but if you blow them out in a really bad injury then you are facing a "re routing" via one of several routes Evans, Chrisman-Snook, etc). You move from an anatomical to the mechanical repair.

Not trying to be a downer, just offering my 2 cents. Good luck and good healing no mater what you decide. If you have nagging concerns why not get a 2nd opinion from another foot and ankle guy? (I would totally discount what the first sports med guy said as he obviously was out of his league foot-wise)

Jane

Clar · 07-21-2008, 12:32 PM

Hi -- I'm 23 and facing similar issues. Well, not so similar... but I have sprained my ankle multiple times in the space of a single year. My peroneus brevis tendon is now severely degenerated, and there's degeneration elsewhere in the foot. The pain is terrible. I have been unable to walk for two months (since my most recent sprain).

My surgeon wants to wait and see if it the pain will clear up on its own. I have never had surgery, but I'm beginning to think it is my only option. Severe tendinosis does not just go away. I also have overpronated feet and a history of wobbly ankles.

So I'm curious--whatever happened to your ankle?

Clar · 07-21-2008, 12:34 PM

I meant to reply to your post--see below!