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  • Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruction

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    Old 06-05-2015, 06:03 AM   #1
    samhills10
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    Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruction

    Hi all

    I am just writing with the hope of getting some more help/assurance re the Gould brostrum (or as my letter has now pointed out Arthroscopic debridement and lateral ankle reconstruction - unsure if this is the same of different?) procedure which I am due to have in just over 2 weeks on the 22nd June.

    I have been very unsure for a while now as to whether or not to go ahead with it but have decided to take the plunge, however I still have my doubts!

    I injured my ankle initially around 5 years ago (ruptured ATFL showed up in MRI scan) and almost had the surgery back then, only to decide not to go ahead with it. Since then I have rolled over and sprained it on multiple occasions, and have felt it become increasingly weak to the point where I have very little confidence in its strength. When playing football I now wear lace up supports, which are strong enough to prevent the rolling, but obviously doesnt deal with the root cause and there is a still a feeeling of achiness and limited movement. When not wearing my ankle supports I would say its at least a 50/50 chance I'm going to roll over on my ankle every time.

    I can still run and go about my everyday life virtually without any issues (feel twinges but nothing major unless recently sprained) and the views of the consultants varied from the cautious 'maybe only have it if you're playing high level sport' ( which I'm not but just play football weekly for my local team), to saying yes I go for it as its clearly getting weaker and weaker and becoming more of a frustration.

    I guess alongside asking for advice as to what to expect post op, I am also seeking assurance that by going ahead I am making the right decision (bearing in mind surgery is considered last resort and rehab process is lengthy).

    For me I guess I could continue playing football and sport and 'get by', but am hoping that in time with the surgery I will be better off.

    Hope you can help!

    Thanks!

     
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    Old 06-05-2015, 03:29 PM   #2
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    They are the same procedures.

    I had both plus Peroneal tendon repair last June 13. So I don't know the Brostrom recovery exactly but I can tell you that having ankle stability back after 5 years is great. I am still healing and learning to walk on rough surfaces without a brace so I'm still wobbly at times (I had to wear my brace 2.5 months longer outside because of how bad the winter was) but mostly I have learned that I can turn my ankle now and not fall or have pain; it just acts like it is normal. I am very, very glad I did the procedure. (I had extra instability from the torn tendons so there's that but any instability is bad instability). The problem with continually having your ankle give out over time is that eventually you can damage other things and that bumps the repair up to a more involved surgery/recovery.

    It's not that bad as things go. I had a 5 day nerve block but was done with it on day 3 and starting to come off pain meds by day 5. I won't go into all the details about recovery because it was longer from the tendon repair but it's a few weeks compared to the rest of your life and then you do PT and come out much stronger. I can do squats now standing on 1 leg on my wobble board. Since I had to have a hefty brace to walk for years leading up to that it's really amazing to do that.

    I was told I could delay this as long as I wanted. Then I tore everything again when I didn't wear my brace outside for a minute and surgery became necessary. I think I probably would have needed surgery at that point peroneals or not. I went to PT and my AFTL ruptured during therapy. It was torn before but just ruptured with this nasty pop. That ended PT and pretty much everything else until surgery. I delayed long enough that some of the strength won't come back which is too bad although I'm fine without that. My calves are probably uneven but who is looking?

    I would have delayed longer given the choice but I wasn't and I'm glad I did it. Which doesn't help you decide probably but that's my experience.
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    Old 06-06-2015, 10:31 AM   #3
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    I would make certain that you are using a Board Certified, MD type foot and ankle surgeon and not a podiatrist. Whenever possible, seek out high skilled surgeons who work on top athletes. If you want more assurance, I would research your diagnosis and ask yourself if your symptoms match that diagnosis. Next, research the procedures you'll be having and ask yourself if it fits the diagnosis and addresses the issues you are having.

    Forums like this can be invaluable. If everything "adds up", then you are probably on the right track. I would get copies of your records from your surgeon and take them to your family doctor and run everything by him/her and ask if the proposed treatment sounds reasonable given your symptoms. Sometimes there are more conservative treatments that may or may not work but they preserve your options for future treatment should it become necessary.

     
    Old 06-08-2015, 01:00 PM   #4
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    I had both the Arthroscopic debridement and lateral ankle reconstruction in October 2014. They are separate procedures but often done at the same time. I had the Arthroscopic debridement once before in 2010. For the October 2014 surgery, I was out of work for 6 weeks (partly due to my 1.5 hour drive to work) and did physical therapy for 3 months after my 6 weeks. Be prepared to need assistance at home. The first 4 or 5 days I was out of it on meds for pain. I would say if you have the surgery, follow all the doctors instructions. Do not try to hurry your recovery.

    Four things to have Aircast Ankle Cryo/Cuff w/Cooler (it is the best ice pack ever, they can put it on when they finish surgery), Knee Walker it will give you more mobility than crutches (you can rent the Knee Walker and of course you will still need crutches), the bag to put over your cast for showers, and a shower chair.

    Best of luck to you.

     
    Old 06-08-2015, 06:06 PM   #5
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    Clarication: the arthoscopic debridement is one surgery and the brostrom gould is the same as lateral ankle reconstruction
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    Old 06-08-2015, 08:11 PM   #6
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    i think you know your body best. if this is limiting you and you want to be an active person and it effects your job like it did me, surgery is a day to look forward to.

    i think my injury was worse than yours, i tore everything up on outside of ankle and my peroneals were sublexing. my joint would flop over trying to step on something as big as a pebble. i would push off and have it sublex and shoot paints up my foot and it would lock out crooked so i couldn't put my foot down again until i popped it back in line. the whole thing freaked me out, never thought i would walk again.

    im 13 months post op and still am not normal. for some reason what i assume are flare ups that don't seem to show external swellilng, leads to sharp pains behind outer ankle bone. this started months ago as i continued to increase my intensity.

    proprioception is still off and this can get you into trouble, i went back to wearing a brace for risky activity. i get the impression its more about where i plant my foot and how i use it vs. the repairs being unstable.

    i will not play basketball like i used to for fear of rolling my foot which i don't want to do ever again. so i would be scared in your case of cutting high intensity sports at full confidence.

    i have been told i can still get better but i have been stagnant for months. i am not letting it stop me from being active and doing lots of stuff on my personal time, but the little issues can make me limp sometimes and i still get aches and pains daily which im constantly obsessing about in the back of my head. it has effected my old physical job.


    maybe its a tough call i don't know. i don't have other health issues and never been hurt or had surgery before. i don't like hurting or having a limiting injury so my gut tells me that in the right doctors care i would like to take a shot on surgery and move on with life. but you can't guarantee anything.

     
    Old 06-09-2015, 06:22 AM   #7
    samhills10
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    Hi All

    Thanks so much for your replies.

    I think from the research I have done, I don't doubt the surgery is the correct one. I have been to see various trusted consultants and was initially recommended this treatment by a reputable sports physio a few years ago.

    My only real concern is whether or not my injury is serious enough to justify the treatment, especially taking into account the potential risks and the lengthy rehab that p[eople have identified.


    [QUOTE=damac2004;5366759]

    i will not play basketball like i used to for fear of rolling my foot which i don't want to do ever again. so i would be scared in your case of cutting high intensity sports at full confidence.

    QUOTE]

    It is interesting you say this. As stated before the majority of daily activities I can do with no trouble, whilst always feeling a slight twinge and weakness I can go abuot my day very normally. my main motivation was that I it would feel stronger and I could play football with greater confidence, not less! I don't know if this is just your experience or whether this is fairly common? The impression I get is that if you go about the rehab as planned and follow physios/doctors guidelines everything should be ok. I certainly don't want to end up worse off, especially as I am still very mobile. I just want to be better off for playing sport, and have less risk of arthitis or other problems later in life.

    Re the things needed post operation(Aircast Ankle Cryo/Cuff w/Cooler, Knee Walker etc) is there anyway these can be found more cheaply?? And re the ice pack how does this get applied post operation? My understanding was that you are put straight into a cast and then moved into a boot a few weeks later....

    Thanks All

     
    Old 06-09-2015, 09:43 AM   #8
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    I would ask the dr about the cyro cuff before buying it. Sometimes insurance covers it and I wouldn't have been able to use it for months. You are correct that most people are casted, usually with surgical cast first and then a hard one before the boot. It does feel great but I wasn't allowed to use ice with my casts at all. I could use it with the surgical cast but not with hard casts.

    Don't forget that Damac and I both had peroneal tendon repairs which add to the complexity of the healing and surgery. We're more likely to have limitations afterwards than you are. Having said that I am allowed to do anything, including any sport as long as I am braced for risky activities. The issue for me has been anticipating what was risky ahead of time. I am still learning to walk on hills and I fall somewhat easily doing that. Last week I learned when doing lawn work I need to wear hiking boots. I had my brace on and my toes were twisted but my ankle wasn't which is good. I've had a few times I've turned my ankle under, one related to worn out sneakers and another just a mystery, plus the fall the other day. I have new sneakers coming and if I have any more instability I"ll be going back to the ortho.But for the most part any issues I have tend to seem to come from the peroneal repair. When I turned it the first time it went all the way under and I did feel the Brostrom for the first time ever but it was better fast. My dr said that any activity is fine but to keep in mine the repairs can tear so use caution with bracing. He said basketball and tennis particular were things I could do ; there are absolutely no "do not do this" activities. I am not a football player but if I were I'd be allowed to play and probably would be fine doing so with my brace. I might have asked if there was a brace that would maximize my safety with that sport but that would be it.
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    Old 06-09-2015, 01:51 PM   #9
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    yeah i also was told to use my foot and ankle and hard as activity progressed. use it or lose it. i wasn't told to limit activities but brace during risky stuff. but i think its obvious if you are a high level athlete and aren't quite right as rehab progresses that you will have to limit and adapt in some way.

    i see tennis stars for example that use certain braces to tend to previous ankle injuries so im guessing the only way to truly adapt is to train for your sport but smartly. problem is for somebody like me is its my first injury and its very easy to pull back at every bump in the road. and everytime you get sore you wonder in the back of your head if you are injuring yourself again.

    in my case i have got back to hardcore hiking and have been doing day trips for months with a pack. never thought i would be doing that again. i have been effected a bit on the clock with work because its not fun to hurt and not be able to take the same breaks, etc.


    did your doctor talk to you about how those parts when torn badly will just scar up and not heal on their own? so its like a frayed rubber band and a ticking time bomb in a sense.

    i was told limitations and messing with your gait, etc. could lead to long term problems/arthritis as you try and adapt and could lead to other injuries trying to pick up the slack. makes sense to me, if it were me im doing surgery BUT do your research and only go with a qualified ankle ortho. don't trust the foot podiatrists or regular docs based on my experience.

    sadly i have found there is a huge gap in the right/good treatment in this area rather than just looking in your phonebook and finding a doc in that category that has surgical privelages. there are lots of docs that don't compare to the top in their field and hack people up and make them worse

     
    Old 07-17-2015, 07:37 AM   #10
    samhills10
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    Hi all

    Appreciate your above replies. I went ahead with surgery and it has now been 4 weeks. 2 weeks with a back slab and 2 weeks in a cast. Yesterday the cast was removed and I am now in an air boot for the next 4 weeks at which point I will be FWB assuming all is well. I have been told to begin PWB, 25% of my body weight and gradually increase.

    I just wanted to get an idea of other people's experiences of the boot and this stage of the rehab. Initially I was really looking forward to having the cast off and going into a boot and being able to put weight on my foot. While this is the case, the boot is heavier and clumpier than I had anticipated and occasionally digs in and hurts the ankle. Also, when resting on the sofa or going to bed, it is nice to be able to take the boot off, but also means the ankle feels weak, vulnerable and exposed. I still have a limited range of motion and am trying not to flex the ankle too much at this stage.

    Slowly getting used to it and feeling more confident walking, however not yet to the point where I feel confident enough to go back to work. I am based in central London and the commute involved approx and hour of walking altogether each day. They have signed me off initially for a further 2 weeks.

    Appreciate any advice from anyone else who's had experience of this!

    Thanks

    Sam

     
    Old 07-17-2015, 11:02 AM   #11
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    Re: Please help! Ankle surgery- Arthroscopic debridement and lateral ankle reconstruc

    i had more stuff done than you technically it sounds like. i ripped all that stuff apart on outside of ankle, jones fracture and had to have peroneal/its cover fixed due to sublexation,, etc. they did use my own parts so i guess i had some meat left to work with. i was basically crippled so i had to go through with it.

    i was told the initial setup of the repairs lasted 6 weeks and that i needed to keep the foot neutral for the most part. i was allowed to wash the area and let it breathe but i did not start doing range of motion stuff, etc. on my own during those short times out of the boot. for example the left to right motions were a no no. i was told basically unless i had an accident or tried to walk barefoot, etc. the repairs should hold just like they do in the operating room when they are testing range of motion, etc. but you wouldn't want to push it. for me the pain would have stopped me anyway. if it didn't i would have hated to let my body trick me and then bust the repairs so best to get your docs guidance.

    i started with splints and then had to use the boot after just a few weeks. my doc said i could plant the foot with crutches but it was too painfull barefoot. with the boot i was able to put full weight on it around the house the first day! i was in that boot until just under 2 months post op when i went back into my regular shoe with a brace that i still wear during risky activity.

    i started physical therapy under a month post op. this started out simple with them doing basic massage and motions and used some machines with pads that sent shock, etc.

    the boot i had had you had to learn to walk with and roll into the step not like your normal shoe. also the difference in height will tweak your hips, etc. so if possible they sell spacers for your other foot to bring the height up to the same.

    even though my boot had air bladders i also found it would hurt around incision and other places with swelling. i had to use an ace bandage that wasn't too tight to give myself a buffer and also placed foam strips along the contact areas that bugged me, then it was much better.

    during the healing process i found the boot to be heavy at rest and sleeping. i had big couch cushions to raise my knees and make a platform so i wouldn't roll or have my feet drop off. then i put a mound of blankets under my boot foot to give it some resistance to falling over which it would want to do just with gravity. and it would hurt trying to fight it, letting it fall, etc.

    at first with the boot i was just moving around the house and i would get tired and knew i was week. but then i was allowed to do as i saw fit and could go shopping although slowly its best to keep good form and get those risers for shoe or else you will try and get ahead of yourself in the boot and it will tug on your foot and tweak.


    i was amazed that when i got into my shoe i walked out of the office. it felt like my foot was asleep for a week. i took my time and looked down and straight ahead only. range of motion was a little tight, weak, but i could hobble along ok. my first shopping trip i had to go home early and there was a break in period the first week with physical therapy and short walks.

    but after that, i was able to attack the physical therapy, 2 steps forward 1 step back for the next few months. functioning ok but lots of aches and pains out of nowhere. i think i was walking atleast an hour a day by month 3 post op in addition to my pt and exercises at home.

     
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