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pilko · 06-16-2012, 09:14 AM

Folks, reaching out there in the hope someone else has gone through this and found a way to deal with it (hopefully better than me)

I'm a little over three weeks post OP and having real problems with my ankle throbbing.

Its particularly bad in the evening as I try and lay in bed.

I have three incisions, the two from the Arthroscopy and one 7cm (2.75 inches) where a bone fragment was removed.

I'm going to make an unscheduled appointment with my surgeon as I've already had my initial post op consult where I've gone from the really heavy post op bandage to just using a tublar bandage.

I find at night I can make do if I take the heavy pain killers, but I really would like to wean off them.

I suffer from severe sleep apneau and the heavy pain killers make dealing with CPAP all that bit harder. Not to mention that it really knocks you around.

I find during the day I have other things around me to keep my mind busy but at night the pain consumes me.

I'm taking regular pain killers, I'm keeping my foot elevated as much as I can and I'm icing every few hours.

I'm also doing my Physio (Physical Therapist) prescribed exercises.

When I mentioned this throbbing to my Doctor today he said it was possible that I could have this for up to six months post surgery.

Surely this isn't the case?

I'm off work still and this is holding me back. I'm remaining largely positive, but this pain is one thing that I'm struggling to push past.

Hope someone is able to help

Thank you,

Ian.

Hollywood48 · 06-16-2012, 09:44 PM

Hi! Welcome to the boards, but sorry you're having so much pain and need the boards! I totally get where you are coming from. You're still not that far out from surgery so I would expect that you would still have a good amount of pain especially if the bone was involved. What all did they fix with the athroscopy? Just debride scar tissue or did they fix anything? That would tell me more about your pain. Not to make you totally down, but I had my 2nd ankle reconstruction in Feb. Open repair, nearly 4" incision and I had 3 torn ligaments repaired, 1 torn tendon, and a bone drilled and broken to deepen the groove so the tendons won't pop out anymore. Now, it's my 2nd but there was more work done this time. After 6 weeks in a cast and 8 on crutches and nearly 3 months of PT, I went at the end of May for my last regular post-op visit with my OS and I asked the same question: How long is it going to hurt and swell? He told me the same thing your doctor said-probably 6 more months. He said usually it's about 9 months from my type of surgery before patients are swelling and pain free. Now to his credit, he did tell me that the recovery would be worse for me because of the bone stuff so I'm wondering if it's the same for you? I, too, still have to take pain meds at night. Not every night now, but I did for a long time. I still take pain meds 3-4 nights/week. It just depends on how busy my day is and how much it hurts. But on my last day of regular PT (I will start the maintenance program now), my ankle was the size of a grapefruit which is the same size it was on my first day of PT and that was 2 days after my cast came off!! Talk about depressing! The PT confirmed I'd be sore and swollen for a while. I'm allowed to do whatever I want as long as working out, sports, and running are in the brace. Problem is the ankle bears so much weight and so much of the body's functions. You don't do anything without it being heavily involved you know? What I can tell you is that it DOES get better. It did after my first surgery and it will for me with this surgery. It's just going to take longer. So it will get better for you too and hopefully it won't be the whole 6 months for either one of us! All I can tell you to do is to keep elevating and icing. The pain meds are there to help you. I know you don't want to take them, I don't either, but there's times where they are needed and now is one of them. I know it's harder with your CPAP though. My husband has that, but hasn't had any issues with pain meds with it so I'm not sure what to tell you. What pain meds are you on? That might tell me. Other things you can try is a TENS unit (trans electrical stimulation unit). I have one of these and wore it after my first surgery when I was back to work full time in the SICU (I'm an RN). I wore it on my scrub pants like a pager (right next to my pager actually) and ran the wires down the inside of my pants and attached the pads to my ankle and foot (can work up to 4 pads at once) and turned it on mildly. It disrupts the nerves so you don't feel pain. It doesn't HURT the nerves or cause any nerve damage/issues/etc. Physical Therapist use it all the time. That might help with your pain, but it is not recommended to sleep in at all! I also wonder if an ice machine would work for you where you can do continuous ice from the time you get home till you go to bed so that it's good and cold when you go to sleep. There's also something new called a cooling wrap. It's like an ACE wrap, but it's cooling and compression. It self cools and is reusable. I just got one to wrap on my ankle for an overseas flight coming up so not sure how well it works, but just throwing it out there. When your doctor told you it might be another 6 months, did he have any ideas on how to control the pain other than pain meds? My doctor basically handed me another Rx for pain meds. If it is bone pain you are having, it's REALLY painful and can be for a while. Not to mention how long it takes soft tissue to heal! And you will definitely know when it is bone pain vs soft tissue pain vs nerve pain (if you have any-with my surgery, they have to move the rural nerve out of the way so I have sensory disruption in my 4th and 5th toes and on top of my foot under those toes and all along the lateral side that takes 6 months to come back. But when it "wakes" up, it starts firing and that is driving me crazy! I didn't have the firing at my first surgery! Ok, sorry so winded, but I just feel for you because I'm going through the same thing and wanted to throw out any ideas I could! Let me know what you think, what your doc said and what pain meds you're on and any other questions you have!

loki2012 · 06-18-2012, 02:32 AM

What type of problem did you have that you needed surgery? I have similar ankle issue and will be having surgery at some point hopfully in the future.

pilko · 06-19-2012, 06:36 AM

Thank you for the welcome to the boards.

I probably should have come here months ago, but I guess it's not until things really get bad you turn in all directions for help.

The clinical diagnosis for my situation:-

"Lateral process of the talus fracture (snowboarders ankle) debridement of osteochondral defect and removal of impinging lateral talus fragment.
I also had chronic synovisits caused by the previous so that was cleaned out in my "grease and oil change"

History:-

I'm an obese male, however I have lost 26kg (57 pounds) in the past 7 months.

I'm very flat footed and while doing an Aqua Exercise class I inverted my foot which was initially thought to have caused multiple severe ligament sprains. We think
that while during one of these classes in the pool I landed with such force that I fractured my Talus.

Sought Physio (Physical Therapy) treatment and got some basics exercises to do and it didn't get much better.

Visited local GP and had referral for X-Ray "if it didn't get better"

Got X-Ray done and that's when the first part of the diagnosis was in (although they missed the fracture)

Things were getting worse, pain was incredible and I was starting to take too many days off work.

I ended out seeing a specialist and got the MRI. OCD and Chronic Synovitis was diagnosed yet, fracture still missed.

I had a steroid injection into the ankle in the hope that swelling would reduce and it incapacitated me further. (made things worse)

Surgeon could not explain why I was in so much pain and said my only option was surgery if it didn't get better.

I suggested a Moon Boot (pneumatic walker) which I wore for 4 weeks with little improvement.

Surgeon said that exploration surgery was next step. (This was after a E.D. / E.R. visit one weekend) I was just in too much pain.

I was not about to consent to surgery when there wasn't a clear diagnosis.

I visited a local specialist sports medicine clinic where I visited a sports doctor where he asked "has anyone told you, you've fractured your ankle?"
surprised I said "no"

Anyway I dropped the previous surgeon and saw a new surgeon about 3 weeks later.

He confirmed the fracture and the surgical path.

My understanding is they've gone in via arthroscope and removed the synovisits and scare tissue flushed it out and then done a open incision to remove the impinging bone fragment.

Surgeon tells me that swelling and bruising is always worse when they do this. Sadly something I can attest to.

I think this is where the bulk of my pain is coming from.

The part of the ankle joint involved is avascular, there is some debate about if I have ligament damage (will wait for follow up appointment with surgeon) if there
is, I'm told this can take quite some time to heal and that could be part of it.

The fact they've got stuck in and removed part of bone (fragment) (I'm unsure if they shaved any parts while I was under) could well contribute to it.

Sorry to read about the pain you've gone through, while I can relate on some fronts, you really have been through quite a few battles.

I don't wish to sound rude or nasty, but I'm forever thankful that was I'm experiencing while it has taken nearly 6 months to get to this point, I should make a full recovery over the next few months.

I do take some comfort in the fact knowing that when it comes to stuffing up a weight bearing part of my body, while I've needed surgery I've really got off lightly!

I'm going to see my GP tomorrow and chat about my pain meds. The main ones are still opiate based, which worry me as I don't want to become addicted.

My GP tells me that as long as I'm in pain and I take the recommended dosage I should be fine. It's if I just take them when not in pain that's a problem.

I'm going through a "weaning" process now which while hard is largely working, but I've "afforded" myself the permission that if I need to step up the pain killers I do.

I'm keeping the empty packets as a reminder of what I've gone through. Not entirely sure it's helpful as there are quite a few packets, but at least it allows me to
understand that this has impacted on me hugely over the past few months.

I've been using a really cool iceing system called BodyIce, it was developed by an Olympic Gold Medal Aerial Skier who injured herself many times.

It works really well, the only downside is having to use real ice. I've worked out how to generate enough ice at home and I'm lucky that I have access to a ice machine at work.

I have tried using commercial ice packs and I find using real ice so much better.

Thank you for replying and sharing part of your pain/surgery journey.

Hopefully the above has answered most of your questions.

I'm not familiar in using online forums and still trying to work out how much to share

loki2012 ,

Hopefully the above answers some questions too.

janewhite1 · 06-19-2012, 09:34 AM

Hey, Pilko, it sounds like you've really been through the wars with this. I also spent months trying to get a diagnosis (In my case, turned out it was just a lot of synovitis), but I did eventually recover fully.

When you have surgery that affects bone, expect significant pain for about a month. That's just the way it is. Keeping your foot elevated on pillows at night might help some. Don't be afraid of the painkillers, people getting addicted from legitimate use is far less common than the media would have you believe it is. Most of the folks who abuse pain pills started using them for fun, not for surgery.

Hollywood48 · 06-20-2012, 12:59 AM

You have definitely been on a frustrating wild goose chase! I just hope you are on the tail end of it. I hope you don't have ligament damage, but if you do, hopefully it will scar down and there won't be any instability so you won't need surgery. Please do ue your pain meds! Your doctor is right. When you are in pain and are using them as prescribed, you won't get addicted! We tell patients that all the time! Hang in there and keep us up to date!

pilko · 07-14-2012, 04:25 AM

I just wanted to re-visit this thread with an update and also post some thanks, it's been long over-due. I've been slack positing, got caught up with return to work.

Firstly Hollywood48, thank you for the suggestion of using TENS, I initially had a break through with pain management after one session, totally amazed my physical therapist.

As suggested by a few people I had already been elevating the foot at night with mixed success.

I'm now roughly 2 months post op and the throbbing is still really bad. I've had to ease up what I'm doing (yes ok, I admit I probably was doing too much too soon)

Plus I've been more sensible when it comes to pain management. I know my body and when it's in pain I'm taking appropriate pain relief.

Met with my surgeon this past week and he suspects that the swelling (which I assume is synovitis) is quite high. He also says I'm not progressed as well as he'd expect, but given my history that's not surprising.

Apparently they cut/flushed out all the synovitis and scar tissue and new scar tissue is forming.

To aid the reduction in swelling I'm having a cortisone / steriod injection in just under a week.

Prior to surgery I had one and despite popular reports for me it made things much worse, I hope the same isn't true this time around.

I've been off crutches and a walking stick now, if I can't weight bear then I'll be back on crutches while it settles down.

If that happens, so be it, just hope that isn't the case.

I'm going to start another thread on the injection.

Thanks again to those who took the time to reply, thank you very much.

joyful123 · 07-14-2012, 11:17 AM

Hi. Sorry - I've been off the boards for awhile. I had surgery on 2/22/12 for torn ligaments, and debribement. I fell off a porch delivering pizza and tore the ligaments off of my ankle. Anyway, I still struggle with pain and throbbing at night - if I do too much, etc. Sadly I had to go back to work for Dominos about two weeks ago and it has not been a pleasant experience with my ankle. The swelling is back with a vengeance and the pain has increased. I'm still taking pain pills, but thankfully they do keep it in check. Hang in there and just take it slow. My doctor also commented that I'm taking an awful long time to heal but that each of us heals differently. And to top it all off I was diagnosed with fibromyalgia a week ago - so that has also thrown a wrench into the healing process. Hang in there and just don't rush it. I know and understand the frustration and being so sick of being in pain. It will get better.......and hopefully the shot will help this time instead of making it worse!

pilko · 07-17-2012, 02:23 AM

Joyful123, thanks for your words and it too sounds like you've gone through your own wars.

Will be interesting to see what happens, I will post an update after Friday (day the injection occurs)

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