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  • Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

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    Old 12-14-2016, 08:41 AM   #1
    girl726
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    Unhappy Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

    My story: I am a 36 year old female.

    Nov 2015 I fell down 1 step and felt a huge flash of pain, a loud crunch & pop major swelling and inability to bear weight on my right foot. Urgent care and x-ray Rx as a grade 2 sprain and I was sent home with crutches and an air-cast.

    Jan 2016 return to my primary because it hurt to walk downstairs and to walk anywhere with an incline. She Rx ankle impingement prescribes 6-8 weeks of PT.

    Jan/Feb 2016 - PT 1x a week and while muscle strength and flexibility are improving pain is getting steadily worse. He recommends I see a podiatrist.

    March 2016 1st podiatrist Rx a ligament tear of the ACFL and prescribes a walking boot and to come back in 2 weeks.

    April 2016 I see podiatrist #2 (my first one had a baby) and she is concerned about my lingering pain and schedules an MRI but tells me to start walking without the boot whenever on flat ground and not at work.

    April 2016 MRI results reveal an OCD lesion (I do not know the staging) and AVN in my talus due to multiple microfractures throughout the bone that was impeding blood flow. Podiatrist #2 immediately refers me to a surgical podiatrist and tells me to restrict weight bearing as much as possible and to NOT try weight bearing without the boot. She was a bit panicked if I have to describe her voice to me.

    May 2016 I see the surgeon and she prescribes limited weight bearing and a bone simulator as a last ditch effort to avoid surgery. Since I am in NO hurry for surgery I agree. She also orders a CT scan (to confirm diagnosis)

    July 2016 MRI #2 w/contrast shows that my AVN is improving (YAY!) but there is still a lot of swelling and the OCD isn't changing at all. She says we could do surgery now or continue with conservative treatment. My choice - I choose to continue with treatment.

    August - November - 2X a week PT starting in the pool, then on land. Said goodbye to my boot in September and hello to a lace up ankle brace. Strength, flexibility gradually improved but the pain never went away - accepting this as a new normal we continued. Towards the end of November though my pain was worsening so we decided to defer to my doctor.

    December 2016 My surgeon said that the OCD was not repairing itself and neither were the peroneal tendons and recommends surgery at this point.

    January 20, 2017 I will have ankle surgery to repair my foot. I am done dealing with the ever increasing pain and my surgeon says it will only get worse if since conservative treatment didn't work. She mentioned drilling out the OCD and filling it with some sort of... something. I probably should know what it is. Any guesses? She also wants to repair the peroneal tendon because she suspects damage based on my symptoms (a lateral tear rather than one that goes across?).

    If I stay off my foot and don't do anything active I have some good days but most of the time any dorsiflextion is very painful and putting pressure on the joint is ALWAYS painful. So any incline or impact is painful. Anyone else deal with this ebbing and increasing pain?

    Since it is my right foot I will be NWB for 6+ weeks so can't drive which will SUCK, but it is what it is. I have three kids twin 10 year olds and a 5 year old so at least they are old enough to understand and be helpful but I think this is going to be really hard for awhile.

     
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    Old 12-14-2016, 08:08 PM   #2
    Mycats
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    Re: Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

    I have dealt with non healing OCD and had peroneal tendon tear, along with ligament tears that did not heal. I had 2 OCD that have been repaired by microfracture drilling, clean out OCD and drill holes to stimulate blood flow to fill in area. I had another OCD that was too large for microfracture and had stem cells injected into cleaned out area. The smaller OCD we tried conservative treatment and I would have days that the ankle felt okay and but most days that I could not walk. Any incline caused pain. Ended up having those OCD fixed when had ligaments repaired since OCD never healed. The larger OCD developed as I was healing from that surgery and required immediate surgery. When my ligaments reruptured I had ligament reconstruction surgery by splitting peroneal brevis tendon and it was discovered that I had a significant tear in the tendon. Surgeon was able to incorporate tear into his split so did not need to be repaired. My surgeon did tell me that peroneal tendon tears rarely heal on their own and I would have needed another surgery. Those surgeries were on my left ankle and after just having surgery on my right ankle for my liagments, I can identify with not being able to drive. Left ankle was so much easier, I was able to go places and not have to rely on other people. 9 weeks post opp and I still have not gotten cleared to drive, hopefully in 2 weeks when he has me start pt I will be cleared.

    One thing you will want to make being NWB easier is a knee scooter and make sure you have basket to carry things in, they are a lifesaver. Ankle surgery is a long recovery and you need to be patient and listen to your doctor. If you have any questions ask. Good luck with your surgey.

    Last edited by Mycats; 12-14-2016 at 08:09 PM.

     
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    Old 12-15-2016, 06:13 AM   #3
    girl726
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    Smile Re: Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

    MyCats thanks for your response!

    I thought I was crazy with the ebbing and increasing ankle pain. Yes - ANY incline or going downstairs is so painful and has been for over a year. Also, if I do anything with impact - even a day of more than usual amounts of walking - it throbs and aches regardless of motion or pressure. I do have good days and the mornings are always better than the afternoons and evenings so then I have moments of panic where I am like "am I rushing into surgery?" But I can't do anything because I am so limited due to pain. If I do nothing I feel better for the short term but we tried conservative treatments and the pain never went away so I then remember why I agreed to surgery in the first place.

    I am hopeful that there is nothing seriously wrong with my ATFL and Peroneal tendons but I understand why she wants to check since I will already be under and she will already be in there. I keep expecting to be told I am being a big baby and to deal (and this is just in my mind not from anything my doctors have said) but every time I go there she reiterates that I have a real and significant problem and she wants to protect and repair as much mobility as possible.

    I have a knee scooter and am getting another from a friend so I can have one for work and one for home. I also have a shower bench coming from a friend who works as a nurse and I am thinking about the iwalk - but a necessity will be the scooters and something to use with my crutches on ice and snow because ankle surgery recovery in January in New Hampshire poses its own set of safety and mobility concerns.

    9 weeks out you still cannot drive? Is this because of the the type of surgery you had? were you in a cast or boot or both? I will be having my OCD filled and the ligaments repaired if needed. She said 6 weeks in a cast then a walking boot (when I had one before I was able to take it off to drive) then a brace. Is this realistic?

    Also, I have right now a tad over two weeks planned out of work, I am a high school teacher so I would not want to take too much more but know that I will take time as needed for PT and doctor's appointments. My doctor thinks this is realistic and I am good with this but in reading a lot of boards I am now questioning this timeline. Someone told me in a ******** group I should plan to be out of work for 2 months!

    Thanks for your insight and comment I appreciate the information.

     
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    Old 12-15-2016, 08:51 AM   #4
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    Re: Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

    You are not rushing into surgery since you tried conservative treatment and it did not work.
    This was actually my second surgery on the right ankle since june, I failed a ligament tightening procedure on right ankle. It is unusual to have bilateral failures, but left ankle failed due to traumatic injury and was doing exceptionally well until traumatic event, that is why we went with this procedure first on right ankle. Ligaments just never healed on the right ankle after sugery . He did allow me to drive at 8 weeks after first surgery when ROM and stenght improved, taking boot off to drive. We did try conservative treatment before second surgery because he put in an internal brace to keep ankle from turning. However the pain, swelling and instability did not go away and my doctor, my pt, and I knew it was not going to get better. The peroneal tendon ligament reconstruction is a much more complicated surgery and i have not started pt yet. While I do not have any pain and little swelling my ROM is very limited and i have no stenght in ankle, so driving is out of the question.

    My surgeons procedure for me is post surgical splint for 2 weeks, cast 4 weeks and boot 4 weeks, then to aso brace with sneaker. 6 weeks of NWB the gradual weight bearing in boot.

    Every one heals different and has different pain levels, so your time line might be right for you but not another person. It will also depend on what your surgeon ends up doing. As long as you have a way to get work and you are feeling well enough to work and your doctor is allowing you to work then you should be okay to work, being stuck in house is the worst. I am not currently working, but went back to school to get my masters in social work when all my problems started. I was able to go back to school and do my field placement 2 weeks after surgery on my left ankle with no problems. I actually went to class 2 nights a week, 1 week after my first surgery, this was during summer so no field. My right ankle was different because I can not get to school or to field placement so i had to take medical leave. But if I was working and could get there it would not have been a problem after 2 weeks. When you are working you want to keep leg elevated as much as possible to help with swelling. Just be careful using crutches when snow or ice it can be dangerous, I always used knee scooter in those situations. Just listen to your body it will let you know what you can and can not do.
    The first few days after surgey are the worst for everyone, just take pain meds as directed to stay ahead of pain. After the it seems to be different for everyone. I was able to stop pain medications 1 week after surgery for the most part, only needing occasionaly during 2nd week.

    Good luck with your surgery and recovery.

     
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    Old 12-15-2016, 07:15 PM   #5
    ahodus
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    Re: Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

    I had an OCD lesion in my right ankle also. I had to have two surgeries 13 months apart to repair it. My first was drilling/mircofracture and peroneal tendon repair. It helped for about 6 months and I was back to the same pain. The second was the OAT's procedure and that has successfully healed the OCD. Both times I was NWB for 6 weeks and than allowed to gradually weight bear again. Each time I also went back to work (had someone drive me to and from) at two weeks part time and was back to full time at 4 weeks. Depending on how much you are able to rest and elevate you foot during the day will be a large factor in returning to work. After the first surgery I finally had enough strength back in the foot the begin driving short distances at 8 weeks post-op. The second it was closer to 10 weeks before it felt strong enough.

     
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    Old 12-16-2016, 08:42 AM   #6
    girl726
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    Re: Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

    ahodus thank you for your insight, sounds awful having two surgeries period, let alone during such a short amount of time. Do you think your longer recovery time comes from the repeated surgery or was it more invasive the 2nd round? Or was it due to the type of procedure? I know my doc said she would be filling my OCD with some sort of..something, I will find out what in about two weeks- this time I will write it down. I am hoping that I won't have much regarding the tendon repair, but there is something wrong there so since I am going in for surgery it makes sense to just fix whatever is torn there and not continue to just to PT until my post surgical PT.

    Before your surgery do you mind me asking about your pain? Did it lessen with rest but increase with any and all activity? I know no one who has this so it is hard to compare stories.

    I am a high school teacher so I will be able to for the most part manage I think, but it is going to be a challenge. I am trying to be realistic about my recovery and my school is being very supportive but most importantly I need to be present for my students when I return to work so I will have to wait and see if there are limitations. The driving thing though, I am hopeful that it will be 6 weeks like my doctor said but I am not holding my breath because NOTHING about this injury has gone according to plan.

    Last edited by Administrator; 07-26-2017 at 07:40 PM.

     
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    Old 12-16-2016, 06:51 PM   #7
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    Re: Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

    Yes my second surgery was much more involved than the first and I believe the ankle was weaker going into it so took longer to get the strength back. The second one was what is called the OATs procedure. The surgeon transplanted a core of bone and cartilage from my knee to the OCD lesion. In order to access the lesion they had to cut bone and reattached it will screws. Thankfully the cores have incorporated and healed very well.

    My pain presurgery was sharp stabbing pains. I could tolerate walking for about 10 mins same with driving. The pain never totally went away with rest just was less severe. But it interfered with every aspect of life. I tired pt, cortisone shots, and bracing before each surgery with no success or relief. I have no regrets on going through surgeries. In the 6.5 years from the second one I have had virtually no OCD joint pain. My only complaint is the screws do not like the cold weather. But some wool socks and soaking it in warm water help.

    I would recommend reading the link pinned at the top of the board about how to survive NWB. There are a lot of good tips and tricks.

     
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    Old 04-13-2017, 09:46 AM   #8
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    Re: Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

    Hi, i am hoping that your surgery in January of this year was successful and you are healing nicely.
    I have a similar story and want to know if surgery experienced by others like yourself on the ankle has favorable results.
    Thank you for you reply.
    Wish you a speedy recovery
    B

    Last edited by Administrator; 06-13-2017 at 10:01 AM.

     
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    Old 04-13-2017, 10:11 AM   #9
    girl726
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    Re: Talus OCD, AVN and Peroneal Tendon Injury from an ankle "sprain"

    Hi billie104,

    I am about 12 weeks out from surgery and walking without a boot (wearing a compression sock and lace up brace) and driving (finally! but I just started that on 3/27) it has been a long road and I am still nowhere near where I would like to be. I have PT 2X a week and will continue to go until summertime and probably then keep going too. I am walking but not without pain, but I had a bit of a complication with excess bone cement forming a barrier in the joint but my doctor says that will break down overtime. It restricts my movement though so I am working on that as well as tendons and ligaments in PT. Additionally I have had a few steroid injections to reduce the keloids I have developed on my surgical scars.

    I think that bone wise the (OCD) issue is better (aside from the bone cement issue) but the tendons and ligaments are very short and that is not a pleasant experience to work through although I am progressing nicely according to my doctor and physical therapists. Nerve pain and numbness continue to be an issue, that sural nerve is touchy and while things are repairing it is a bit like electricity sometimes in my foot - the sensation anyway.

    What type of surgery will you have? A combination of three? I ended up with bone repair for the OCD on my talus, peroneal tendon repair (turns out it was pretty torn up in there) and scar tissue removal and repair to my ATFL.

    I think the results overall will be favorable but right now I am still in pain and that makes it hard to see the big picture and hopefully the absence of pain which is the goal.

    Best of luck!

    B

     
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