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  • ATFL tear and Brostrom

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    Old 10-04-2018, 10:41 AM   #1
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    gallantus HB User
    ATFL tear and Brostrom

    Hi All,

    I just got a Brostrom done about 5 weeks ago, suppose to start PT next week. I posted about this a while back, but finally got it done. The surgeon mentioned that the source of my discomfort and pain pre-surgery might have also been caused by a bone spurt, which he shaved off during the Brostrom.

    So far, recovery really sucks. I still feel small scale pain, at night I can't even get a good night sleep b/c that pain would be annoying and wake me up. The source of the pain, I believe it's largely caused by the lingering swelling. Most of the swelling from the Brostrom surgery and arthroscopy itself are gone, but there is still some swelling left in the ankle and toe joints. I still don't have the full range of motion due to that lingering swelling at the ankle joint.

    Last edited by Administrator; 01-14-2019 at 08:26 PM.

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    Old 10-19-2018, 08:45 PM   #2
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    gallantus HB User
    Re: ATFL tear and Brostrom

    Just want to give you folks an update, if anyone is curious to know how it's like post-op from the Brostrom. I am on week 7, I am now partial weight bearing with the aircast boot and started physical therapy. Things are much better, I begin to see the light at the end of the tunnel.

    The thing is with an ankle surgery, it's the most painful postop of all types of orthopedic surgery, and all sorts of crazy stuff happens to your ankle. I did not experience a whole lot of pain from the incision, the screw, the scope, etc. etc. In fact, the nerve blockers lasted for about 5 days or so, by the time the nerve blocker worn off, I didn't have any pain from the incision or the surgery itself, the pain killers prescribed to me wasn't even really needed (my tolerance for pain is kind of high though).

    But what surprised me the most was three things:
    (1) muscle atrophy, it only takes one week of not using your leg before it turns into a chicken wing
    (2) the muscle stiffness/lost of motion range, when you don't use the muscle, it starts to stiffen up
    (3) the swelling/inflammation, this will last a long time, I have heard from various sources, up to an year and even beyond (though your physical functionality will be restored even if you still have some lingering swelling, so I was told). The swelling is caused by a few factors, the process of getting cut open and the Brostrom being performed on you, your body wants to send "stuff" to your ankle to heal it and lost of muscle lets the body fluid flows freely down to the ankle (remember that is the lowest part where gravity will pull the fluid down). The swelling for me, hurts like hell (and like I said, I have a high tolerance for pain, maybe the swelling is hitting some nerves?); this pain from the swelling does not happen all the time, but comes at infrequent waves (especially if I don't elevate it properly). You must keep your feet elevated above your heart for almost all the time while not weight bearing, there are certain things you can do to help the swelling (search for it on the most famous internet video sharing website own by the largest tech search company), if you don't keep it elevated for most of the time (I would say at least 95% of the time, I quickly learn to stay elevated nearly 100% of the time) and ice it (I have a cyrocuff), you will regret it, mark my word.

    Also remember I said all sorts of crazy stuff happens to your ankle? Let me tell you the other things that will happen (at least to me). The cause of these crazy stuff is the surgery itself and the fact that your ankle/feet is immobilized and non weight bearing for a such a long time (when you don't use your feet, even more crazy things happens). So I mentioned the three items above, muscle atrophy, everlasting swelling/inflammation and joint stiffness/lost of motion; other things will include: skin dryness, skin peeling off, change of skin color (will eventually go back to normal), joints pain (for me it is on the toes and it was very concerning until it started to go away once I started PT), tingling sensation, weird tactile sensation when you touch things, muscle cramps, muscle weakness, fluids rushing to your feet when you let it down (I couldn't even sit down for a meal, have to eat lying down most of the time, this was the most uncomfortable thing for me and that stupid aircast boot). If you have some other crazy stuff happening to your ankle postop, chances are, it's "normal" by product of the surgery, but of course, check with your surgeon. For me, on the 7th week, starting partial weight bearing and starting PT, those things begin to go away (in fact, today as I am writing this, it feels pretty damn good relative to how crappy it felt). Make sure you push yourself at PT and you MUST do the PT assignments at home too (I go above and beyond, just don't over torque your ankle and undo the Brostrom), PT really really helps A LOT; even if you are just sitting there doing nothing, just move your ankle and toes around and stretch it.

    Also, crazy stuff just doesn't happen to your ankle, also to your body. For one, because you can't move around, you are not promoting bowel movement, so yes, you will have irregular issues with number 2 and it sucks. Some parts of your body will get a bit sore because you are constantly lying down. So. . .make sure you move around in ways you can and safely even though you are non weight bearing yet and eat lots of fruits and vegi's it will help you in the bathroom.

    Now, at the moment of me writing this, fluid no longer rushes down to my ankle (this is a HUGE relieve), I can actually sit up and beginning to get more range of motion and muscle is slowly coming back, I sleep better at night (half of the reason is b/c all of those symptoms are going away from moving again and I am no longer sleeping with that stupid aircast boot), a world of a difference at week 7 for me for sure.

    Hope this helps those who have no idea what to expect with a Brostrom. For those who are deciding to do a Brostrom, my advice to you is:
    (1) make sure you have a good surgeon, my surgeon is from the top ortho hospital in the country, the doctors from this hospital are teams doctors for all of these professional sports team and they perform surgeries on all sorts of pro athletes. There is only one hospital with this type of reputation in US, even in the world. Also I personally don't like doctors with years and years of experience, these are the old dogs who thinks they've seen it all, so they are very dismissive and arrogant with god-like ego's and they barely give you enough time of the day before rushing to the next patient; I like the doctors who are 7 to 15 years post residency, who have plenty of experience but still have many years of career ahead of them, so they are not arrogant, they are still "nave" wanting to do their best job with each patient. My surgeon spent A LOT of time with me pre and post surgery and he was VERY VERY detailed, he spotted my bone spurt when no other doctors spotted it (I saw 5 other doctors, 3 orthopedic surgeons specializing in foot and ankle and 2 podiatrists, before this orthopedic surgeon (he also specializes in foot and ankle). Which BTW, I personally would not trust surgery with a podiatrist, just my personal opinion) because he actually looked at the MRI and Cat scan himself instead of solely relying on the radiology report alone, he spotted things on the MRI and Catscan that wasn't even listed on the radiology report (bone spurt and calcium deposit). And it turns out that that bone spurt was likely a big part of my ankle problem in combination with the injured and scared ATFL. Now on the same token, he is a doctor, I wasn't trying to hog up all of his time from his other patients, so I also utilized the PA a lot, in fact, all of my emails went to my PA and the PA will answer them and if he needed to ask the surgeon questions, he will.
    (2) once you are cleared to start partial weight bearing and start PT, things will really start to turn around. For me, it was week 7, so make sure you keep this in mind before you lose patience and get all depress and stuff.
    (3) Take PT seriously, blowing it off will be one of the biggest mistakes of your life.

    Lastly, of course I don't have a crystal ball to tell you if my ankle will heal to pre-injury, but I can tell you this, I FEEL like it will (I'm not saying I will, but I feel I will) be very close enough to fulfill all the physical functionalities to the limit I used to pushed myself to pre-injury, but that's once the swelling/inflammation is completely gone and muscle all comes back, I say this just based on how the ankle feels now and the progress in the last week and how many more weeks/months of progress waiting for me.

    Last edited by Administrator; 01-14-2019 at 08:16 PM.

    Old 12-06-2018, 10:12 PM   #3
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    Re: ATFL tear and Brostrom

    Another update - 14 weeks post-op.

    Things are really turning around. I am full weight bearing with absolutely no boot, brace or ace bandage, nothing. (Side note: my surgeon did not suggested that I needed a brace or an ace bandage after coming out of the boot, but I was just being super careful, not trying to undo the Brostrom, I just slowing and maturely progressed out of the boot into a brace then into the ace bandage, now I'm out of everything. My surgeon actually told me not to rely too much on the ankle brace or ace bandage as he wanted my ankle to go unassisted to build it back up)
    • I am walking about, doing all sorts of chores around the house such as changing light bulbs, cooking, grocery shopping, etc., essentially normal day-to-day is all back in motion.
    • There still exist lingering swelling, I have heard and read that this swelling can last a year or more. I personally think (I am not a doctor, so just my unscientific thoughts and guess), ONE of the reasons why the swelling is still there is because I have yet to fully build up all the muscle that I've lost from atrophy while in the cast and boot. B/c of this lost muscle, it's not fighting gravity which is pushing the fluid down my leg. When I spend a long day out, walking and standing for a long time, I do feel the swelling, the swelling then causing some level of pain/discomfort.
    • My calf, tibialis anterior muscle, fibularis brevis and all of those muscles are working it's way back from the atrophy. The current measurement around my calf on the surgical side is 13 and 1/8th inch, compared to my non-surgical side is 13 and 7/8th inch (I have chicken legs to begin with). So the difference is 6/8th of an inch. Just 2 weeks ago, it was 13 inches vs. 14 inches. Yes, the muscles on the non surgical side got bigger b/c I had to use it more and in the meanwhile as the surgical side's muscle shrank. And now they are slowing evening up. (Side note: when I got out of the cast, my lower leg on the surgical side was like a stick, it was mortifying to see)

      However, various muscles in the feet and ankle are still very weak and has a long way to go; especially my abductor hallucis muscle, it was tiny and I can barely feel it few weeks ago, it's gotten better, but definitely can't compare to my non surgical side. I still can't curl my toes all the way in and I cannot do single leg, standing calf raises on my surgical side. MAKE SURE YOU DO YOUR PT HOMEWORK ASSIGNMENTS AT HOME, if you want to get your muscles back.

      In fact, all of the muscles on the bottom of my feet are gone from atrophy when I got out of the boot, it hurts when I have walk bare footed, b/c I have no muscles to cushion it! I had to wear a slipper around the house. It's gotten better now, but still not enough cushioning.
    • Range of motion. This was one of my single biggest complaint after coming out of the boot. I had no range of motion. Now majority of it is back, I'm plateau for the remaining, but my PT said he thinks I should get it all back in another 4 to 5 weeks or so. However, at this point, I have enough range of motion that I can carry on my day-to-day life with full function; sports still got a long way to go. WHEN YOU START PT, FOCUS ON THE RANGE OF MOTION AS YOUR PRIORITY, THE MUSCLES WILL EVENTUALLY COME BACK ONE WAY OR ANOTHER, BUT IS A CHANCE YOU CAN PERMANENTLY LOSE THE RANGE OF MOTION FROM WHAT I HAVE HEARD THROUGH WISPERS. I try very hard to stretch at least once a day for about 25 mins, my goal is 3 times a day, 25 mins each; there are days that I am just too busy to even do it once a day, but I really tried to do at least once a day.
    • Specific to range of motion, once the ATFL is fully healed and attached (my surgeon said it's around the 3 month mark post-op), I started sliding my feet gently forwards and backwards to help get back that remaining range of motion. For me personally, the last lingering range of motion that I need to get back, this is the key. I will be focusing on this.
    • When I came off the boot, I had hyper-sensitivity on my feet, along with all sorts of crazy things happening, like pointer toe and middle toe being stiff and when I try to curl it, it hurts. The only weird feeling left is the hypersensitivity, it's gotten a lot better and I can feel the progress where it will be normal again. Also, after being in the cast and boot for so long, my ankle and feet was baby smooth, a lot of the skin peeled off which contributed to the hyper-sensitivity.
    • My surgeon will clear me 6 months post-op to go back and do all sports and activities. Now that simply means that my ATFL is fully healed, it does not necessarily mean that rehab is fully complete and ankle can perform pre-injury; that can take up to an year as I was told.

    After you read all that I wrote, the progress sounds trivial and incremental, you must have asked yourself: damn, will this guy's ankle ever get back to pre-injury. While it does sound like the progress is slow and incremental, but based on the progress, I feel like it will get pretty close to pre-injury (I say pretty close, b/c I doubt it will ever be 100%, maybe 98%), of course only time will tell but I am hopeful at this point based on progress and how much more progress is supposedly waiting for me.

    The last few things I have to work on now are (1) getting the full range of motion back (2) getting all the various muscles in my ankle and feet back and lastly (3) agility training.

    One last thing I want to mention, my surgeon and my PT said my progress is much ahead of what they see in other patients with the same procedure done. My surgeon said at month 5 post-op is when most patient feel things are turning around but for me I felt things was really turning around at my month 3 post-op appt with my Surgeon and now 2 weeks after that 3 month post-op visit, things are continue to progress. So that being said, your progress may not be on the same track as me.

    Last edited by gallantus; 12-07-2018 at 07:51 AM.

    Old 12-06-2018, 10:48 PM   #4
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    hyperalgesia HB User
    Re: ATFL tear and Brostrom

    Wow thanks for this! This is the most optimistic thing I've read from a patient and I sort of assume is the normal recovery course. It might never be exactly how it was pre-injury. But the important thing is it's a big improvement. Glad to hear it!

    Last edited by Administrator; 12-07-2018 at 12:18 AM.

    Old 12-07-2018, 09:21 AM   #5
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    gallantus HB User
    Re: ATFL tear and Brostrom

    I’m glad my info was helpful for you. I have search far and wide to get other people’s personal experience with the Brostrom before deciding to do mine. But there was not a lot of this information out there. Like you said, the folks who had success probably doesn’t come back to share their experience.

    Anyway, I nevertheless decided to do the Brostrom based on what little information I was able to gather. Now that I’ve done it, I want to share as much as I can. The few reasons why I decided to do the Brostrom are:
    • I am still relatively young, 40 years old, so heeling and recovery is going to be better now than later. So I don’t want to wait around only to decide to do it later when I am older. (which by the way, my surgeon said I have recovered faster than most of his other patience thus far.)
    • I had done stem cell therapy prior to the Brostrom which did tighten my ankle for a brief period of time and took a lot of the inflammation away (at least I think the tightening was from the stem cell therapy and not from me doing home PT), and during that period my ankle felt somewhat close to what it used to be preinjury and that was a great feeling, so I have data that once my ATFL is tighter, it will fix my problem. And the Brostrom is an ATFL tightening procedure.
    • I also had a bone spurt which my surgeon believes is contributing to my pain/discomfort, so he would kill two birds with one stone during the surgery. He knock off the bone spurt and did the Brostrom all at once.
    • I find that taping my ankle when going out, helps prevent a good portion of the discomfort/pain and gives my ankle better support. And so I was taping my ankle every damn day and I just can’t imagine doing this for the rest of my life.
    • I used to be a high school athlete and I love being physical and counting on my body to be independent and do chores, fix things around the house, go for hikes, jogs, horse around with my boys. When I taught my older boy how to ride his bike, my ankle was swollen the next day, and I don’t want to be like this for the rest of my life, b/c it really sucks.
    • There are few pro athletes that have done the Brostrom and they are operating at their peek.

    Last edited by Administrator; 01-14-2019 at 08:27 PM.

    Old 12-17-2018, 09:29 AM   #6
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    Mombyrd HB User
    Re: ATFL tear and Brostrom

    I had a Brostrom repair and a micro fracture done (cartilage repair) 2 years ago. I have excellent ROM, no pain or stiffness but do have residual swelling. Not much but I see it.
    It took me a good 9 months after surgery to feel like me and get a good night sleep.
    PT was tough at first but as I said, I have excellent ROM.
    Keep at the ROM exercises. I still do mine. Ice is your friend.
    Best wishes and happy healing.

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    ankle arthroscopy, ankle injury, ankle instability, ankle ligament, ankle ligaments

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