Ankle OCD/Ligament - Denovo NT and Brostrom Procedures
I read a lot of posts on these boards prior to surgery, so I feel it's only right to give back. I'm not an expert like many on these boards, so I apologize if I don't use all the correct terms or am missing some info. So here's my story:
36 year old, active male. Originally hurt left ankle when I was 24 and in the Navy. Playing volleyball, came down hard on it, knew right away it was badly sprained. Never followed through with treatment or therapy, and just got used to living with an unstable ankle. Frequent, but minor sprains over the years.
Last winter, decided to participate in a Tough Mudder. To prepare, I completed the Insanity workouts, which helped me get in great shape and drop some pounds. During the workouts, I rolled my ankle once, but recovered quickly. In May 2012, I completed the Tough Mudder event. One mile in and I slipped on a rock running downhill. Major sprain, ankle swelled immediately, and I thought my day was done. But I was determined to finish and went another 11 miles on it.
Got X-rays and MRI afterwards. MRI showed OCD (grade 2+) but intact ligament. I asked to push surgery until the end of the summer. Doc said ok. At that time, I was scheduled for just MF. Summer went and surgery approached. Won't bore you with the details, but had to switch surgeons after having surgery postponed several times. New doc decided that Denovo NT would be much better, and to deal with the ligament at the same time. I agreed.
Had surgery on October 19th. No problems with actual procedure, and sent home in a half cast and wrap. Given one percocet before leaving the hospital, which made me feel high. That night I had little to no pain. Next two days were ok. I only took tylenol and never filled my percocet prescription. Kept the leg up and iced often. By day 3, I was off all pain medicine and starting to get around on crutches more. Even got back to driving and work. Saw doctor that Wednesday. He just unwrapped it, looked at it, and wrapped it again. I had no pain at this point.
Back at doctor the following Wednesday (10 days post op). Got stitches out, told to keep it elevated when I could. That night, I slipped on a wet leaf and put my bad leg down momentarily. Don't think I put much weight on it, and never got any pain. Prayed nothing bad happened, but didn't worry about it. Next day I went to work and when i got home, put my leg up. Out of nowhere, my calf started hurting. Went to bed and slept fine, but as soon as I got out of bed, the calf started to hurt. Called the doctor that morning.
He said it was probably nothing, but sent me for an ultrasound. Turns out, I had a clot in my calf. Not super emergent, but put me on Lovenox (blood thinner) right away. For 5 days, I injected myself in the stomach, 4 shots per day. Fun stuff, but not really bad. Yesterday morning was my last round of shots and now I'm on Coumadin, once daily pill. On Monday, saw the doc and he put me in a large boot. Still can't move the ankle or put weight on it. Also had to give blood to test INR (to do with blood thinner levels). I mentioned the slip the day prior because I wonder if it somehow contributed to the clot. My doctor and the radiologist said who knows.
I remain very active (as much as you can on crutches) and probably do more than I should. My good leg is getting very strong as I hop around and do deep knee bends to pick up things. Tomorrow is 3 weeks post op. No pain at all, in either the ankle or calf.
I'll be on the Coumadin for awhile and need to give blood on Monday again. I see the doctor on November 19th (1 month post op) and will start moving the ankle. 2 weeks after that, I'll put weight on it for the first time.
I will add that in the boot, I can move my foot and leg around somewhat. I catch myself doing it, and try not to. But it feels great and I have no pain at all. Look forward to getting this boot off and moving the ankle.
Last edited by mattttt25; 11-13-2012 at 02:41 PM.
The Following User Says Thank You to mattttt25 For This Useful Post: LabGimp (11-11-2012)
Re: Ankle OCD/Ligament - Denovo NT and Brostrom Procedures
Just keeping this current.... spoke to doctor last week. Blood work came back, INR was low but in the therapeutic range. Taking 5mg Coumadin daily, should raise it up. Gave blood again yesterday (Monday), should hear from doctor by tomorrow and see if my dosage needs to change.
No pain in ankle or calf. Good news for the surgery and blood clot. In 6 short days, I visit the doctor and start range of motion exercises.
Re: Ankle OCD/Ligament - Denovo NT and Brostrom Procedures
Wow! I was put on Lovenox shots from day one out of the hospital and eventually on both lovenox and coumadin then to just coumadin. I never had a clot but the doctor wanted to prevent it from happening. The place where I went was a Coumadin clinic. They did the weekly blood draws with a finger ***** and I got my INR results within a minute or two. If you're going to be on it long, you might look into an Anti-Coagulation clinic. Was nice to do that and have instant results. My doc prefers to have them monitor the INR levels.
Glad things are going better for you now and you're on the mend. Take it easy and don't overdo it.
Last Friday was 4 weeks post op and yesterday was one month per the calendar. Saw doctor and had CAM boot removed. He said the ankle looks good and that the swelling was normal. Directed me to start therapy, and to see him in 2 weeks to start weight bearing. Surprised with how much motion I already have, thought it wouldn't move after being immobilized for 4 weeks.
Saw therapist later in the day. Mostly eval, and was given range of motion exercises. Set up visits starting next week, will be going 3 times a week.
Took a LONG shower yesterday and enjoyed being able to wash my foot and ankle. Did my exercises and kept it elevated. Enjoyed the feeling of getting into bed without the boot.
Feels good this morning and no real pain. Still doing my motions. But I did notice that the ankle and foot are reddish. Still swollen (not terribly, but noticeable). And when I touch the bottom of my foot, it feels somewhat tingly, like pins and needles. Anyone else experience this? Just want to make sure this is normal and not a symptom from the blood clot. Have a call into my surgeon and also seeing the therapist again later today.
I had that feeling in my foot too Matt. Sometimes almost feels like little electric shocks in it. I think it is in the nerves. Just work on rubbing the bottom of your foot and it starts to de-sensitize itself. I was in a cast for 16 weeks and the bottom of my foot was going crazy! Sign of a blood clot would be more like sharp pain in your calf and your calf would be hot. I am not a doctor though.
Thanks. Talking it through with a coworker, he said the same thing. I've been walking, running, jumping for 35 years and now no weight on my foot for 4 weeks. Makes sense that the bottom of my foot would need to get used to pressure again.
I always described it as either feeling like the electric shock or sometimes felt like someone took a thick rubber band and snapped the bottom of my foot.
Had surgery at Anne Arundel Medical Center in Annapolis, MD.
Good therapy session yesterday, doing great with range of motion exercises.
What I'm experiencing right now- no pain. Minor swelling of ankle and foot. Minor pins and needles when pressing bottom of foot. Foot and ankle are reddish in color when compared to my other leg. Leg is also colder than the other. Spoke to doctor and said I shouldn't be concerned. Anyone else have these symptoms and agree?
Yep! The bottom of my foot got really red. I was alarmed at first too. As for it being cold, mine doesn't get cold too often. Mine is usually warm. I wouldn't be alarmed by it being cold unless the color changes to blue, you lose feeling, or numbness.
Friday was 5 weeks post op. My recent concerns have seemed to go away- foot is occasionally colder than the other, but not always. The reddish color goes away if I do my exercises, which I've been doing often. And the tingling on the bottom of my feet is almost gone. Swelling seems to be getting better. If I elevate for awhile, my foot appears to be the same as the other. Ankle is still swollen, but I'm told that will persist for quite some time.
No pain, which is the most important thing I guess. Still doing range of motion exercises often, pretty simple when you're just sitting around.
I visit the doctor this Thursday and start weight bearing. Can't wait to ditch these crutches.
Tomorrow is 6 weeks post op. Saw my surgeon today, who said everything looked good and that I could begin weight bearing. So I ditched the crutches, but I'm back in the boot. I guess I was expecting to put on sneakers and walk out of the office, but still not complaining. I see him again in exactly two weeks, and if everything goes well, I'll come out of the boot.
I went immediately to therapy after the doctor visit. Went through all the massage, ultrasound therapy, range of motion, and then added some light resistance work. No pain, everything went well.
I've probably spent a total of one hour walking today, and it's now a bit sore. I'm sure that is expected. And still can't complain considering it's the first pain I've had since a few days after surgery. I plan to take it easy, but not to be afraid to walk around when needed. Do my range of motion exercises at home, 3 days of therapy per week. I'll be very interested in how things go moving forward, because now we're dealing with the OCD and Denovo graft. Fingers crossed that it worked.
I know it's one day since I last posted, but quick update. I was a little sore yesterday after being on the foot for the first time in 6 weeks. But I elevated and rested. Woke up this morning with no pain. Boot went on and I'm here at work, walking around with no problem. Very happy with my progression. I have therapy tomorrow and was told to bring my other sneaker. Guess I'll be doing some light walking without the boot.
Wow Matt! You've done amazingly well! I'm sorry about the blood clot but happy it was small. I worry about that too... I'm not on anything to prevent them. Good luck with PT and keep updating please!
__________________ Peroneal brevis debridement; peroneal longus transfer to brevis: tenosynovectomy, 11/20/12
Saw my surgeon this morning. He said everything looked great and that I had progressed very well. Little to no swelling, good range of motion, no pain. He noticed some clicking while moving my foot, but it didn't seem to be coming from the area of the ligament repair or OCD. He wasn't too concerned, and neither am I.
He took me out of the boot! Very excited. Actually said I'm pretty much released to do anything in terms of therapy except running. So I can walk, ride a stationary bike, even elliptical machine. I see him again in 4 weeks, and if everything is still good, he said I could start running.
My plan is to take it slow. I plan to focus on regaining my normal walk. I'll continue therapy 3 days a week. Once I gauge my progression and if no pain develops, I plan on riding a stationary bike and walking each day for the next few weeks. I'll then add the elliptical.
Really won't know much until after I start running again, but so far, I am very pleased with the results. The surgeon and I chatted about the Denovo procedure today, and he said he has probably done his last MF and OATS, focusing strictly on Denovo. He has seen nothing but success with it.
Side note, still on Coumadin for another 6 weeks, just the normal protocol after having a clot. My INR got a little high last week, but we lowered my dosage and should be fine. Never had any other symptoms, except for the initial calf pain, which went away in a day. I'll finish the cycle and hopefully forget about clots and INR.
Great account, love to hear when things go so smoothly. I considered using local ortho practice here in Annapolis, but ended up where you probably started in Baltimore. :-)
Might shock you, but I started with a well respected OS in Annapolis. He intended to perform MF and not touch the ligament. Ended up with a Podiatrist in Annapolis who suggested and eventually performed Brostrom and Denovo at the same time, solving all my issues.
I obviously don't buy the OS vs Podiatrist arguments. Find a good doctor, period.
I think my entire family has had procedures at our local OS "shop" -- feet, knees, hips, wrists, shoulders, you get the drift. I chose a guy in Baltimore because the Annapolis dr was inclined to fuse my heel, and I think I am too young for that.
Sounds like you had an excellent outcome -- congratulations and I wish you many many years of pain-free feet!!!
Been awhile, time for an update. Last Friday was 13 weeks post-op. I saw my surgeon last Monday for my 12 week check-up. He basically released me- I'm allowed to run, jump, and return to all normal activities. He recommended me wearing a brace while doing anything other than straight pavement running. I'll follow his guidelines and wear a brace as needed for the first year. I do return and see him at the 6 month mark for one final check-up.
So how have I been doing? Pretty damn good. I continued therapy 3 times a week, which I think has been a key to my success. Never missed an appointment. Therapy progressively got harder and more challenging. Funny, at first I enjoyed it with the massages and stim therapy. Now I fear it with all the work they put me through. But it has definitely helped. My range of motion is excellent (better than normal) and I can do almost everything with no pain. I work out on my own at home each morning as well, doing elliptical work and cardio/weight workouts. I have done some light running at therapy, but nothing long. I plan to start running twice a week, very short distances, just to get that into my recovery. Slow and steady, but constantly trying to push myself. I will go to therapy for two more weeks (my insurance coverage then runs out) and then I'm on my own.
I do have a little pain at times. When i wake up each morning, I can't just jump out of bed or the ankle is stiff and sore. I usually move it around, so some circles and my first few steps are slow. But as soon as I start moving, everything is fine. Happens if I'm sitting for more than an hour as well. Doctor and therapists say it's normal.
I also had two "flair ups", with my ankle swelling up. Happened after a busy weekend of being on my feet all day, workouts each morning, etc. But both episodes cleared quickly and swelling resided. Again, doctor said it was normal and that I'd have flair ups as I increase my activity. Said to manage it with ice as needed.
No longer on Coumadin, recently finished that treatment. Happy to have one less pill to take.
Overall, everything is great and I look forward to continued my recovery. I could say I'm done since I can do everything needed to live a normal life. But I want to get back into sports and cross training, so I have a ways to go. The gains going forward will be slow, but I understand that and accept it.
Probably won't check in much after this post, but I do get emails when someone responds, so if anyone has any questions, I'll be sure to respond. Thanks for following along and best of luck to everyone.
