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  1. #1
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    upcoming ankle surgery advice

    So back in September I dislocated my ankle climbing, and also had a minor fracture in the tibia. Long story short, after a plateau in recovery, I got an MRI this week.

    My doctor suggested a Brostrom procedure to fix problems with the lateral ligaments, which the MRI "couldn't see" which he says means they are probably just stretched out. He also said I have minor post traumatic arthritis, and "full width" cartilage damage. Also persistent swelling at the bottom of the tibia.

    There is clicking on the outside of my foot sometimes that I can best describe as tendons slipping around (probably what the brostrom would address). There is also pain right in the ankle when I lean my leg forward, which is probably the cartilage and swelling.
    EDIT: the pain is only when I lean my lower leg forward, and my knee is even with my toes, I can't get it past that. Also, the pain is on the inside/forward part of the ankle, right underneath the front/bottom of the tibia.

    the doc said it would be a simple surgery, and at the same time a scope of the rest of the ankle to see what else may be going on/fixable. He said it would be about a 2.5 month recovery. So long story short, it will end my ski season/job, and if I get it done now, it won't interfere with summer climbing/skiing/stuff.

    Should I seek a second opinion or see another doctor? BTW, I have been seeing Dr. Robinson at Bridger Orthopedics, and he said he does about 2 brostroms a week.

  2. #2
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    It really sounds like its an issue with your ATFL when you mention that you cannot lean forward past your toes. (there are quite a few other ligaments in that area, but it sounds like you are having issues in the talor joint in particular).

    I would also make sure you dont have a stress fracture of the talus/calcaneus which can present similar pain. The stress fracture wouldnt show up on the x-ray, but should on a high res MRI or preferably a bone scan of the area.

  3. #3
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    Quote Originally Posted by lookinback View Post
    It really sounds like its an issue with your ATFL when you mention that you cannot lean forward past your toes. (there are quite a few other ligaments in that area, but it sounds like you are having issues in the talor joint in particular).

    I would also make sure you dont have a stress fracture of the talus/calcaneus which can present similar pain. The stress fracture wouldnt show up on the x-ray, but should on a high res MRI or preferably a bone scan of the area.
    I don't think its an ATFL issue, its specific pain between the tibia and the talus, but only leaning forward, and it is tender if pushed on unweighted, but clearly in the joint itself.

    And the doc said it was probably a subtalor dislocation, since it twisted to the outside.

    Also, the initial xray didn't reveal any fragments or fractures, the CT scan found a very small fracture in the bottom of the tibia, but nothing in the talus, which is what they were looking for. The MRI did not reveal any fractures, but I am not really sure if that is what they were looking for.

    Also, the X-ray and CT scan both happened in October, the MRI was Tuesday this week.

    EDIT: the pain isn't near the ATFL, its on the top/inside half or so of the talus/tibia interaction

  4. #4
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    Interesting, it sounds like your pain is coming from below the Tib-fib ligament area(dont rule out a bone bruise, those can be nasty, slow healing, and hard to detect), buuut I still would have him check out your ATFL. If your talus subluxed I wouldnt be surprised if something was going on there. The lateral side of the foot is usually very well supported and inversion sprains are much more common. That "slackness" you feel on the outside of your foot sets off alarms for me. But then again im not a certified surgeon haha

    I would not overlook those stress fractures either, there is very low bloodflow to that joint and talar fractures do not often heal completely when casted are often surgically pinned. Stress fractures can sometimes be so small that even a trained doctor misses them on images and can plague athletes for years.

    Good luck man, keep us updated!

  5. #5
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    I will ask my surgeon about stress fractures. It almost makes sense, as that pain has only recently cropped up. As for the ATFL, that may be what he is addressing with the brostrom, and may also be the one causing my clicking feeling, its in that general area.

    Also, I definitely have some serious anterior instability. I inherited my mothers horrible ankles, and have probably long since destroyed much of the minor anterior ligature, which could have been what allowed the dislocation to happen in the first place?

    Anyway, our spring break is coming up week after next, so I am gonna try and schedule sugery right before/during that so I don't miss much school. I will keep y'all updated with new developments, and possibly cool pictures.

  6. #6
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    After thoroughly molesting my foot just now, I would bet serious money I have some torn stuff in the ATFL area. The CFL was really sore for a few months, its fine, but the ATFL feels bumpy and feels like the source of the clicking... But we will see.

  7. #7
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    The slippage you feel is possible subluxation of the peroneal tendons. The pain you get with weight bearing dorsiflxion is likely due to the damage to your articular cartilage/ post traumatic arthritis you doc mentioned.

    A scond opinion is never a bad idea. But if you've done your rehab and things still are problematic then sometimes there needs to be a surgical fix.
    fighting gravity on a daily basis

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  8. #8
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    Quote Originally Posted by Vinman View Post
    The slippage you feel is possible subluxation of the peroneal tendons. The pain you get with weight bearing dorsiflxion is likely due to the damage to your articular cartilage/ post traumatic arthritis you doc mentioned.

    A scond opinion is never a bad idea. But if you've done your rehab and things still are problematic then sometimes there needs to be a surgical fix.
    I think your right on the money with the peroneal thing, although I think that may have been a pre-existing thing, my ankles are funky. As for the cartilage/arthritis, how permanent could this be? Is it a surgical fix, or slow recovery/rehab?

  9. #9
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    Articular cartilage damage an be addressed with micro fracture and sometimes work well...if that is indeed what your problem is. The brosrom procedure is a ligament reconstruction procedure.

    Your feeling that you have ATFL problem is probably accurate, you don't have ankle dislocation without that.
    fighting gravity on a daily basis

    WhiteRoom Skis
    Handcrafted in Northern Vermont
    www.whiteroomcustomskis.com

  10. #10
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    Bingo sounds good to me man!


    edit: i dont know what kind of resources you have, but if you know someone who knows what they are doing, it wouldnt hurt to put a light tape job on that sucker to keep things in line till surgery. Just dont get dependent on tape after things get fixed up because it takes the job away from your stabilizing muscles which can ultimately lead to weakness.

    Quote Originally Posted by Vinman View Post
    Articular cartilage damage an be addressed with micro fracture and sometimes work well...if that is indeed what your problem is. The brosrom procedure is a ligament reconstruction procedure.

    Your feeling that you have ATFL problem is probably accurate, you don't have ankle dislocation without that.

  11. #11
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    So here is an update. I had surgery, they ended up fixing quite a few things.

    They shaved torn synovial tissue, scraped off a bone spur, shaved some frayed cartilage, shortened/re-attached a couple ligaments, and did something else to the joint structure.

    Fun stuff...

  12. #12
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    Digging up an oldddd thread, but just had what sounds like the same surgery. Caught a nasty shark going mach 1 on a powder day at Copper last January. Could tell it was a bad sprain, but got back on skis by mid Feb. Never got back to the point were running or uneven surfaces felt like a good idea, and could tell the ankle just felt totally unstable. Doing pretty agressive PT for several months just seemed to piss off the peroneal tendons.

    Pulled the trigger on modified brostrom for the ATFL and CFL (with an internal brace). Scope cleaned up a bone chip off the talus, bone spur off tibia, and assorted other cartilage "trimming".

    On track to get cleared for most physical activity 12 weeks post-op, but can tell I've already lost quite a bit of strength (6 weeks post-op now).

    When were you able to get back to skiing? Climbing/running, etc?

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