Ankle rehab vs surgery? Update...

[Hoof'n it]

You may remember a post of mine from the UDBB, where I had a minor run in with a stair and I lost badly - this was 4 months ago.
I have been to a surgeon and got my MRI & CT scan results back, and I have completely torn my ATFL along with pulling off some bone, so I also have a handful of small bone chips. I have also managed to split my Peroneus Brevis tendon/muscle, which goes up into my calf from the outside of my foot.

While they can't do anything about my ATFL, it's gone, no coming back for it, they can go in and suck out the bone chips, etc. it is major invasive surgery to repair my split ligament... It has 6-12 months recovery time.

I currently have a supportive ankle brace, and we are waiting another 40 days to see if that gives the split ligament enough time to heal. But my Physio is say thing there is really nothing more they can do to help me. We have been doing a lot of 'painful' strengthening exercises, and she just says that we are really in limbo, for the next 6 weeks, until we make a surgery or no surgery decision.

I am very active and have 65 acres to run, 84 heifers to take care of along with 15 horses, 2 dogs and a goat it's not like I can rest it, and it hurts like a bitch (especially after moving the stock, riding the horse and driving) since the support is not the same in the brace as it was with strapping tape. I am not allowed to use tape according to the surgeon

So I guess, to those who have had ankle issues, this is my 2nd Physio ( I'm new to the area, 1st one was terrible ) and I am unsure if this is normal for an injury like this, to say we are in limbo, or if I should seek out another Physio to be more pro-active. I'm sure that while rest is a main component in trying to get this tendon to repair, surely keeping it mobile and strong helps too? Especially given the fact that I am on uneven ground every day on my farm?

Any ideas? Suggestions?

[silk]

If you can manage physio appts in Hamilton, go see Anna Thomas, 56 Mahoe St (Glenview - near the hospital). She's amazing and has helped me hugely with all my horse and non-horse injuries!

I have no practical advice, but Anna was a life saver when I injured my knee (that turned out to be a tear in the knee cartilage) and post-surgery.

[Hoof'n it]

Thanks for the name!
Since I'm in the 'tron daily I can definitely see someone there!

[silk]

She's got about a 3 week waitlist! She is a physio and Feldenkrais practitioner so can approach conventionally, as well as from a biomechanics and functionality point of view. Her hubby is a brilliant acupuncturist, too.

[Kyra's Mom]

Well...if you can rehab it, great but those soft tissues really tend to not heal well. I tore both my peroneal tendons. Unfortunately, I could not get a doctor to believe me that I felt something tore.
No one would order an MRI . I had one that wanted to do surgery without any imaging. He was sure he knew what was wrong--which yes, they were torn but NOT where he thought and they were not subluxating (what he was going to fix). He gave me a whole 5 minutes of his time to declare this. Not really comfortable with his assessment. So, I tried to live with it. It was painful and badly affected my gait and really limited my physical activity. Finally after 10 years, I went to another orthopedic doc who finally ordered an MRI to find that I had badly torn both peroneals--the doc said impressive. I had surgery. My recovery period was about 3 months with gradual return to 'normal' activity. That foot is still funky. I still over suppinate badly and battle nasty calluses that form in places where I shouldn't be walking full weight on it but it is stable and no longer painful (aside from the callus issues). I do not regret the surgery at all. It isn't normal but far better than what I had before. You can either invest the time to rehab from surgery or deal with it forever. I am very happy to not be in pain any more. Can you get a second opinion? That is always an option

Good luck.

Susan

[Hoof'n it]

Thanks for your insights Susan, wow tearing both tendons, that is doing it well but how did you go on for 10 years? I would have let shit hit the fan way before then!

I think the problem for my injury lies in the fact that it is split length wise rather than tore in half horizontally... And from looking at the MRI, it's a big split almost from my foot, around my ankle and apparently into the muscle. With the potential to get longer, apparently I don't do things by halves.

I also hear what you are saying regarding soft tissue injuries, but the surgeon is hoping that it will try and knit itself back together with rest and support. Although she knew giving me instructions to keep off it would fall on deaf ears, hence the support brace.

If I'm not right in 6 weeks time, then I will definitely be pro-surgery but I guess the stronger my ankle is going into surgery, the better it will be in rehab and in the other side? Hence I guess my quandary with the physio's POV....

[Kyra's Mom]

Yes, mine both tore longitudinally. They are now re-tubularized .

I just lived with it. Kind of hard to do anything when no one believes you have the problem (I had little swelling from the get-go when I stepped in a hole). The jerk surgeon that wouldn't order any imaging did literally throw me an orthotic prescription as he flew out of the room that did help for quite a while...until it didn't. Finally whining to my primary care doc got me an appointment with THE foot surgeon in town (really hard to get in to see). He at least gave me the time of day and was interested in LISTENING to me. Neither one tore in the "usual" place so if the first guy had done surgery, unless he extended the incision, he would have missed the damage . Mine tore more into the foot...not nearly as extensive as yours...yikes.

I initially didn't think I have a very good result from surgery. I still couldn't walk very well and my hip and anterior thigh were giving me fits. I thought it was from the way I was walking. Well, I suppose from various unplanned dismounts and walking wonky for 10 years, my right hip was trashed. So, in February of this year, I had my hip replaced. Wow...I can walk again. The foot works better than I thought. So now, I am glad I got the foot fixed. Having an unstable ankle, foot can cause problems up the line.

Good luck...I hope you can find a therapy cure but don't discount the surgery. Yes, it is a long time for rehab but then it should be fixed. Mine has been very stable and has held up well this far (surgery in 2013). Before surgery, I had a terrible time negotiating uneven ground...which happens to be where all the critters reside.

Jingles coming your way.
Susan

[Kathy Johnson]

Well, I should've done a search! But who would have thought, although I think this injury is fairly common in riders who've been riding around with their heels down for so long.

Hoof, I lead your life. 40 horses, programs, a million things to do. I am able to do my paper work in my bed-office where I can ice it. So, I can stay on it for a couple of hours, then try to RICE a couple of hours. Then it feels better and I go abuse it again. Trying to stay off the pain killers because they mask so much, but I think it's so trashed it no longer matters.

I am very persistent but it took a couple of weeks for the doctor to look at it. It's better, not sharp shooting pain any more, but burning. It feels ok to ride, but I don't want to fall off and rupture something. I pushed through the Xray and MRI quickly, but they were slow giving me the results. I'll have an appointment with the podiatrist soon, I hope.

Here are the MRI results from the other thread:

1. plantar faciitis (I knew I had this but was pretty well over it, so I don't know if it's contributing).
2. tear on the ATFL
3. tear on the CFL
4. split tear on the peroneal tendon
5. synovitis

Stupid, stupid injury. Ridiculous. But I feel less alone now.

[Hoof'n it]

This photo is how I currently survive... Rigid strapping tape, and a lot of it. (Excuse the cow poo!) after 4 months of strapping, I have finally got the right strapping method that works, it's a mix between different Physio techniques
The ankle brace just didn't work, this supports not only my ankle, but also up into my calf muscle.
I don't take pain killers either.

If I didn't strap it, I wouldn't be able to function on a farm.
I nearly couldn't function in London, when I was Over there with no access to strapping tape. All the cobble stone and uneven streets saw my ankle swell up and just protest!

[Kathy Johnson]

That looks amazingly comfortable and might fit in a boot. Are you riding?

[Hoof'n it]

Sooo, rehabbing my ankle is not going well, still having big issues with stability while on the farm, and pain while driving, doing farm chores, in bed, etc... And very little way of results as far as trying to strengthen the ankle. Needless to say riding has been out of the question, same too with any type of physical activities apart from gingerly walking around my farm raceways moving stock etc... Physio and I have resigned ourselves to the fact that surgery is definitely going to happen...

However, I have just received the notes on what my surgery is going to entail, and I am gob smacked.
A fight with one measly step, is going to mean a lateralizing calcaneal osteotomy, basically breaking and resetting my ankle bone, to enable better stability, they are also going to replace my peroneal tendons with tendons from the inside of my calf muscle, and they are also going to explore and see if anything else needs fixing. F*^K!
I hope this is worse case scenario, as I was just assuming they were going to clean up a few bone chips and replace a few tendons.... Not break my frickn ankle!

I have a appointment with my surgeon tomorrow to go over these! Stay tuned! I'm officially crapping my dacks!
If this happens, I'm going to be out of commission for a seriously long time. FML.

[Josette]

Hey Hoof'n it - sending MASSIVE jingles your way!

[Chisamba]

I have had three ankle surgeries, which were the result of a badly turned ankle and bone chips on the talus bone. I strongly recommend you talk to some one who works with stem cell for soft tissue repair. They take stem cells from your thigh, and then grow them in vitro, and then inject them back. Stem cells are marvellous things that rush to the site most needed and turn into cells to replace torn and injured tissue.

since they are your own cells there is no auto immune reaction, and injuries that were previously though irreparable have had very good response to stem cell.

the biggest issue is stability, my phisio had a leather boot that laced onto the ankle that had stablizers on either side, it fit inside my shoe and was a life saver wrt to being able to do my farm work and ride. I would love to take a photo of it and send it to you, but my dog ate it.

jingles

[Kyra's Mom]

Jingles for a good outcome. It blows but as you have found out, those darn tendons just don't want to heal, especially if you are dealing with less than pristine flat footing.

Jingles coming your way.

Susan

[Rhianon]

Ouch and double ouch. I'd also look into the stem cell thing, if possible. My vet swears by it!

[Hoof'n it]

So feeling a bit better after the surgeons appointment. I have surgery booked for early March. So hopefully my mares have foaled and been rebred by then.
It's still unclear as to why I have major instability in my ankle so we are doing more imaging diagnostics before surgery.
We do know that we will be repairing my peroneal tendons, but unclear if they will be doing the 'big' breaking my ankle to reset it, or putting screws in somewhere else, until they figure it out exactly. It may not be until they are in there as to what they decide to do.

I will ask and find out more about stem cell therapy, but I assume it's more of a thing that happens after surgery? To promote repair?

[Hoof'n it]

So, I have just had my ankle surgery and won't be weight bearing for a good few weeks.
Surgey showed that I had indeed done a great job in destroying my tendons in the ankle. But luckily they didn't have to do anything to the bones, like shaving, re breaking or screwing them.

So I'm now laid up for 6-8 weeks. Luckily all my foals are on the ground and the mares have been rebred, so it is probay the best time in the season to be off the farm.

How's everyone else's ankles holding up?

[Tarlo Farm]

I'm raising a glass to you from my relatively weightless position. Spring is arriving, you rest your way into winter. Hugs!

[fergusnc]

Here's to a speedy recovery......

[redsoxluvr]

Get well soon!

[Kyra's Mom]

Jingles for a speedy recovery. 6-8 weeks is just a blip in the big picture .

When I had my peroneal tendons repaired, I was told 12 weeks non weight bearing. I got a bit of a reprieve at 7 weeks, I could start taking the boot off for some stretching exercises and was able to start some partial weight bearing. That was 3 years ago. So far, so good. I initially thought I didn't have a very good outcome but the last couple of years of the foot problems, I started having hip problems that I though was related to the way I was walking. Mind you, I was trying to live with the bum foot and it was 10 years between injury and repair so oh yeah, I'm sure it helped muck up my hip. I had the hip replaced last year and have decided that the foot is pretty good all in all and it was the hip was causing a lot of the problems post foot surgery. I think that limb is pretty good now .

Susan