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    Old 11-11-2005, 09:08 PM   #1
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    Chronic Ankle Pain

    Hi everyone! I am new to this board, but was hoping you all could share with me your experiences and help. I have a problem with chronic recurrent left ankle inversion. It has really been bad the last 10 months. In May my family MD ordered xrays, a lace up ankle brace, and 2 months of PT. The xrays show I have an avulsion fracture at the distal tip of my tibia, but nothing else. I have not really had any success with the PT or brace, and my ankle is getting worse as time goes on. I finally switched family MD to a new MD, who referred me to a Podiatrist. I saw him 1 1/2 weeks ago. He ordered more xrays right there at my appointment and told me that he also saw some stenosis at the subtalar area of my ankle joint. Upon completing some other tests in the office, he said that he is pretty sure that I have torn and stretched my anterior talofibular ligament, torn my peroneal tendon which is also subluxing, and possibly have some issues with the cartilage in my ankle joint. He scheduled me for an MRI to see the extent of the damage, which I had on 11/9/05 (no results yet). I asked him what would happen next if everything he thinks is wrong is confirmed, and he said that I would most definitely need surgery. He said that they would have to repair the ligament and tendon, and use arthroscopy for the ankle joint.

    For anyone who has had any experience with these types of injuries, what am I in for? It sounds pretty extensive to me to have 3 different things worked on at once. How is the recovery process? How long for non-weight bearing, weight bearing, crutches, walking boot, etc.? Also, how long were you off work? I am a RN in the NICU and am always on my feet. This surgery is going to be rough on that for a while. How is the pain, swelling, etc.?

    Any stories, information, or help you could give to me is greatly appreciated. Thank you.

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    Old 11-11-2005, 11:27 PM   #2
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    Re: Chronic Ankle Pain

    I didn't have the torn tendon, but my ligaments were all torn up. I had two repairs done: the Brostrom, in which they put the ligaments (or what's left of them) back together) and the Evans, in which they use part of one of the peroneal tendons to make a new ligament (by splitting it, cutting one end, and threading it through a hole they drill through the bone). They also did they arthroscopy. I think with any ligament repair, it's standard for them to do the arthroscopy along with it, because by the time you get to the point that you are getting it repaired, you've usually got junk that needs to be cleaned up in the joint. I know they shaved off some bone and stuff in my ankle.

    I would say you're going to need to take a month or so off work, at least. I don't know if your hospital has any sort of limited duty plan or something like that, that you could look into. I spent two nights in the hospital calling the nurse for demerol. I was on crutches NWB for 6 weeks (first in surgical bandage, then casts), then into the removable boot and walking as tolerated (I got rid of the crutches within a few days) for another several weeks while I did PT. I don't remember the exact timelines of everything, but I know I had the surgery in the middle of March, and in June I was helping my brother move and carrying boxes.

    I'm a grad student, and I stupidly thought that I could have the surgery over spring break. I had it on the Wednesday of break. I had my mom come out to help me, and she ended up staying for a month to drive me around and shop and cook and clean. She drove me in to school, dropped me off at class, I sat in class with my leg up on the table popping pain pills, and then she took me home. I basically had to keep my leg seriously elevated all the time way up high for the first month. I couldn't drive myself to school because it was a 15-20 minute drive and I couldn't sit for that long with my leg hanging down, so I had to have my mom drive me and sit in the passenger seat with my leg up on the dash. Finally around 3-4 weeks I was able to let it hang down for longer periods of time without immense throbbing pain and swelling, but my toes would still turn this wonderful dark purple color whenever I stood up for even 5 minutes. That continued for the entire time that I was on crutches. Once I started walking in the boot, that went away.

    I would think that you could return to work fully once you were able to walk in the boot. Doctors pretty much have their set recovery timetables for various surgeries, so you could probably plan on returning to work full time a week after you are allowed to ditch the crutches, barring any complications. That will give you time to actually be able to walk without them. It's funny, because you are NWB for 6 weeks, then you go in and the doctor takes off the cast, looks at it, says it looks good, puts you in the boot, and says that you are allowed to walk without the crutches now. So you figure you can just go ahead and take a step, right? That first step that you stupidly try to take hurts like nobody's business!!! So then you have to take it slowly and start putting just a little weight on it with both crutches, then down to one. I used both crutches for two days, then one crutch for two days, then I was done with them. Oh, and the other thing that really hurts is getting the stitches out, especially the scope hole stitches... Take a pain pill before you go in for that!!!!!

    So yes, this surgery is pretty brutal. It's a long recovery, and I found it to be quite painful. (I am a wimp, but I had my gallbladder out laparascopically and I would rather get my gallbladder out than get my ankle done again.) But I have absolutely no regrets about having it done. My ankle doesn't go out on me anymore, and I don't fall over for no reason now, and I can actually walk without worrying about tripping over the smallest thing and hurting myself. The surgery might not relieve all of the pain but it will definitely help with stability. I still have some aching at times, especially after certain activities (like running on uneven ground), but it's not like horrible pain, it's more of the soreness that you notice after you sit down in the evening.

    There are several others who have had similar surgeries, so I'm sure they will fill you in on their experiences as well. Welcome to the boards, and do let us know if you have any other questions or need advice about anything.

    Old 11-12-2005, 07:25 AM   #3
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    Re: Chronic Ankle Pain

    Sounds like you have a lot going on, but along with what kehorner said, they usually scope the ankle as there is usually junk they need to remove. I have had peroneal tendon surgery on both ankles within the past year. Let ankle last November and right ankle this past May. I was in a cast for two weeks, on crutches, then walking boot for four weeks, only had crutches for first few days after walking boot was put on, then into a lace up brace for six weeks. Didn't start PT until I got the lace up brace. My left ankle is very stable now, and my right one is about 85%, it takes time to recover from ankle surgery, the ankle gets very weak from being immobilized and it takes time to get the function back. Keeping your foot elevated as much as possible is a plus. I remember my ankle still being quite swollen at the six week mark, after I started PT, they were able to get the swelling reduced quite a bit.

    I also work on my feet all day and the first time I was out for six weeks and came back part time for the next two weeks, the second one I was out for nine weeks and came back full time. You really need to be able to take the time to let it heal completely as you wouldn't want to have to re do any of the surgery. Hope this helps. Let us know what the doctor says.

    Old 11-13-2005, 10:58 AM   #4
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    Re: Chronic Ankle Pain

    My situation sounded pretty similar to yours.
    I had two surgeries: one that was arthroscopic to clean out the joint because of the stuff floating in there an bone spurs. Then I had a modified brostrom to tighten the ankle up. I also had a torn peroneal tendon. My ankle was subluxating when I walked and I was in constant pain (usually between 3 - 5 out of 10 on the pain scale).

    I had the surgery on Nov. 23 of 04. I was NWB for 3 weeks and took about another 5 or 6 days to go full weight bearing. I was in a cast for a bit over six weeks. Then I had PT and an aircast (just a brace) for 5 weeks. I started running again at 12 weeks. It was pretty painful and slow. I kept at it. I did three triathlons this summer and am doing pretty well. I still have pain most of the time, worse first thing in the morning or after I have been sitting for awhile. But its a lot better than it was.

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