Instability in my Ankle

kehorner

Welcome to the wonderful world of ankle surgery!

I actually had the Evans procedure, which is very similar to the Chrisman Snook (and I'm not really sure what the pros and cons of each one over the other are).

So the Chrisman Snook: There is a tendon that runs behind your lateral malleolus (that bump on the outside of your ankle) and attaches to the side of your foot about midfoot (this is the peroneus brevis tendon). They take this tendon and split it the long way, then cut one half of it up where it attaches to the muscle in the leg, but leave it attached down in the foot. This leaves you with half of the tendon still there for the muscle. Then they drill a hole through the lateral malleolus and also through the calcaneous (I'm not sure exactly where, since they don't do that part in the Evans...). They thread the loose end of tendon through these holes and tie it off, forming a new ligament. They generally will also do an arthroscopy on the joint (at the same time as the other procedure) to check out any junk floating around in there or overgrowths of bone. They will also try to reconnect the torn ligaments if there is anything left.

So it's a pretty involved surgery. I stayed two nights in the hospital on IV pain meds (they might give you the option of going home, but don't do it!!!). You wake up in this huge surgical bandage. Then I went back in a week and they took of the surgical bandage and put me in a cast. One week in the cast, went back to get the stitches out (my scar is like 5 inches long, going from just under the lateral malleolus, then around the back of it and up the leg), and into another cast. I was in the second cast for 4 weeks. So for the first 6 weeks I was on crutches, non weight bearing. At 6 weeks, I got a removable boot, was allowed to start putting weight on it, and started physical therapy. I think I was in the boot for another 4 weeks or something like that, although I'm not entirely sure.

So the total timetable was surgery in the middle of March, off crutches at the beginning of May, and walking around pretty good and able to do some light duty lifting by July. I would recommend two weeks off from work. I had to keep my foot elevated for an entire month after the surgery or it would swell up really bad. The pain was also quite bad, especially the first week or two. (I should mention here that I'm a bit of a wimp... but I had laparoscopic abdominal surgery last year, and the pain from that was practically nothing compared to the ankle surgery.)

But two and a half years later, I have no regrets (well, other than that I tried to do it over spring break and was woefully behind for the rest of the semester...). I can actually go hiking and not fall over, and I actually jogged over uneven ground without spraining it. So the stability is great. However, I should warn you that you might still have pain afterward. I feel pretty good most of the time, but after the jogging my ankle was achy. And you're probably predisposed to getting arthritis there. But I'm happy with my outcome.

There are some other people around who have had the Chrisman Snook, so they can probably add to this. And if you decide to have surgery or have any other questions, just let us know!

Bigdog Two

I had the modified brostrom, which repairs using the existing ligaments instead of using a tendon. Why has a Christman-Snook been recommended? Typically a C-S is recommended only where they find that there is not enough liagment to do a brostrom or if the patient is very large. The C-S procedure is a bit more invasive and has a longer recovery time than the brostrom and with the C-S procedure you will lose some range of motion. The brostrom is not as strong of a fix as the C-S.

I had a 3rd degree sprain in college (15 years ago) and after that I sprained my ankle five or ten times a year. Last summer playing flag football I had what my OS thinks was a partial dislocation and sprain. After that injury I was in constant pain. In August of last year I had an orthroscopic procedure to remove floating stuff in the joint and impingement spurs. In November I had the brostrom plus I had a chunk of tibia cut off that had developed as a result of the constant trauma of spraining my ankle so much. I was in a cast for six weeks. On crutches for 3 weeks (really 4, it took almost a week to go from NWB to full weight bearing). I did 4 weeks of PT and wore an aircast for 6 weeks after getting the fiberglass cast off. Recovery has gone well. I started running at 6 weeks post cast (slowly and painfully). I did 3 triathlons this summer.

Post surgery was very painful for about a week. After that the pain was a lot less and manageable by over the counter painkillers. During the six weeks in a cast it seemed like time was dragging along - but once it was over it didn't seem like that long or that bad. It was nice to have some downtime.

My only complaint is that I still am in pain pretty much all the time, but its a lot better than it was. Its about a 1 or 2 out of ten - before it was a 4 or 5. After I get up from sitting for a while its really painful for a few minutes but then gets better as I walk more. My OS said the pain is likely due to cartilege damage when my ankle popped out of joint and/or arthritis.

Overall I am very happy with the results. I can run. My ankle is tight and stable and I have not sprained it again. The issues I have with pain are a result of waiting way too long to see an OS about my loose ankle.

kehorner

My doctor decided to do the Evans with the Brostrom because my tissues tend to be very elastic and he was afraid that I would just stretch out a Brostrom repair. I was confused at first, because the surgeon looked at my ankle, then asked to see my hands and how far backwards I could bend my fingers. So, since I can bend my fingers way back, he said that my tissues are very elastic (I tend to have extra motion at a lot of joints). So that can be one consideration, although it can also be just that there isn't enough left to do the Brostrom. I also don't know if time since the original injury has anything to do with it.

Bigdog Two

Two weeks ago I was at a birthday party and met an orthopedic surgeon who was doing his fellowship in sports medicine. When I told him I had ankle ligament reconstruction surgery and the modified brostrom he said "hmmmmm." I said what does "hmmmmm" mean? He said, "well, that's not a very good surgery - I mean its the best we can do, there aren't any better alternatives - its just that patients end up having a lot of issues down the road."

It was a bit discouraging to hear that.

What I take his comment to mean (as well as my OS's comments who responded to my question about when I would be back to 100% and told me that I'll never be 100% and likely will need to have my ankle fused in 10 or 15 years) is: (a) most of the time when you have an injury that requires orthopedic surgery you won't return to normal (except maybe if you're a kid), (b) there will be a new "normal" to which you must acclimate yourself, and (c) then you go on with life. If you can't play basketball anymore maybe you can play softball. If you can't run anymore maybe you swim. Etc.