Left ankle ocd measuring 1.3 cm posterior medial talus

[casper1955]

I have had ankle pain on and off for over a year.  Finally wend to DPM who sent me for MRI.  MRI showed a medial posterior ocd measuring 1.3 cm.  He wants to do injection of lidocan or cortisone to see if that helps with pain.  Do I stay with a DPM or go see an OS.  If go with an OS  over a DPM why?
I live in Chicago area nay suggestions.

[Namelike]

I did the same thing you did, except my DPM sent me for 3 months of PT which did nothing except cost me $1500. My OCD probably ended up worse off because I screwed around and tried to avoid surgery. An OCD is a very serious injury that won't be fixed by cortisone, which is only a band-aid. Go see an OS - do your research and find one who specializes in DeNovo as well as microfracture. Sorry no recommendations in Chicago.

If you're interested read through my post so the same thing doesn't happen to you.

[casper1955]

Thanks for the reply I read through your post and will look for an OS.  Looked on the internet for Chicago and could not seem to find one.  Also seems like some of the literature recommends an OATS procedure

Looking at the MRI it says the lesion 1.3 cm from anterior to posterior x .9 cm from medial to lateral and .7 from superior to inferior, with disruption of the subchondral cortex evident Berndt Hardy type III.

[casper1955]

We'll had an appointment today.  Dr thought it was chronic and probably would require surgery    He thought micro fracture with cadaver cartilage powder.   Did not think we need bone graft for 1.3 cm x .9 cm.    also recommended cortisone injection to see if pain was in fact from OCD and not os trigonum syndrome pain

He did say that during surget he could take care of OCD and trigonum

I do not want surgery until September after Disney vacation so agreed to shot of cortisone.  Surprisingly feels better already.   
Am getting second opine fro os that does denovo.

Thanks for all the posts and comments on this forum.   I learned a lot

[casper1955]

Saw the OS today. he said he can go in and clean it out and perform Micro fracture surgery.  The other alternative was I can try PT to strength the joint.  I chose to try PT.  He did say that the MF surgery is only a short term fix for maybe five years depending on my activity level.  Based upon his experience MF only works for a few years and that he has not found anything that he thinks works better, short of bone graft and cartillage graft

[casper1955]

Well I have had PT and am doing home exercises.  Up until yesterday afternoon I was starting to think I was just a big baby and that the problem was not that bad.  I only had minor ankle pain for the past few days.  Yesterday afternoon about 4 p.m. it hit.  It just comes out of the clear blue and I can not find any pattern.  I could barely stand on it and the pain increased and decreased all night long coming and going.  Up until then I was ready to say I am not going to fix this and just let it ride.  Then when the intense pain hit for the first time in a few days it was like okay I am getting this done and having surgery as soon as I can. 

Today the pain is not as bad and I think it is pretty tolerable.  But yesterday evening and night are still fresh in my mind.  What a #$@%^ thing that is so unpredictable and comes and goes. 

I see the Dr. again next Thursday and we will definitely talk about why it comes and goes, why the most intense pain is on the lateral side and the OCD is on the medial side of the Talar Dome.  We will also discuss surgery options to include Denovo.

Thought this would be a great place to keep track of my symptoms so I can look back on it and also in the event that maybe someone else will learn from my experience or validate my experience with theirs.

[casper1955]

Just had another opinion yesterday Dr recommended MFN with arthrex bio cartilage.   Said bio cartilage works as well as denovo for lesions less than 1.5 cm.  he mixes bio cartilage with your own blood plasma. Prp.   

[BLT]

Just had another opinion yesterday Dr recommended MFN with arthrex bio cartilage.   Said bio cartilage works as well as denovo for lesions less than 1.5 cm.  he mixes bio cartilage with your own blood plasma. Prp.

Did you decide to move forward with it?

[casper1955]

Right now I am planning on having the surgery in September or October.  We have a Disney world trip planned for August and I do not want to be the anchor slowing things down.  So after Disney we are going to schedule the surgery.   I am afraid if I do it now I will still be moving very slow in August.

Also I read your previous posts.  The 2d opinion I received said that MF is only a temporary fix that lasts for about five years depending on your activity and site of OCD.  He said it is like filling a pothole.  He is not keen on any of the other alternatives as he sees it as filling the pothole with just different material.  Also he thinks if the lesion is on the shoulder MF is more likely to fail quickly.

I do not know where yours was located but your timelines seems to validate what he thinks of MF.  Even though he feels that way he still performs MF as in his opinion that is the best current treatment. 

That is why I am still looking around.

[BLT]

Your pot hole analogy is fairly accurate. You could think of cars constantly driving on the filled pot holes as impacts on your ankle. Eventually the filled pot hole will crack again. From my experience I would very much categorize MF as only a temporary solution, but with the caveat being it depends on what sort of activity you do after full recovery and PT.

I've spent some of my time scouring the internet to see what NBA athletes have experienced with MF. Some athletes recovered really well and performed with no issues, while others failed shortly after. So I'd make a guess that it goes back to what you and many others have echoed on this forum: it depends on where and how big the lesion(s) are. But I'd add one more piece to it: it likely also depends on how the fibro cartilage grows back as well. Surgeons don't shape the cartilage, they only trigger the growth of it. Suppose that the fibro cartilage grows back in such a way that it isn't stable enough to take impact. On the other hand, it's possible that it grows back in just the right shape that it can take some level of impact with no negative consequence. I'd say there's just so much that goes into it that it can fail on multiple points.

FWIW, I can give you an idea of my activities after the surgery. My surgery was performed on November 11, 2010. By March 15th 2011, I was on plane to Taipei. Taipei is very much a walking city, and I was completely fine. Prior to my flight I was diligent with following the doctor's recovery instructions and then subsequently followed a very strict PT schedule. In a nutshell, by 5 months I was completely cleared for my trip and I felt like a new man. If you wait, it's fine too. But I thought I'd let you know how my experience was in case you changed your mind.

Although I really hope you find a surgeon that knows more about new treatment, such as Denovo. To be frank, all treatments are likely going to be some kind of "filling the pot hole" solution. I don't see how else it can be fixed. The next logical thought would be, which material is BEST for filling that hole?

[casper1955]

BLT I agree with you that the current state of medicine pertaining to fixing ocd of the ankle is attempting to determine what is the best procedure and fill material. 

[casper1955]

I have had a couple of bad days where I can not even walk any distance and have trouble going up and down stairs.  I was going to wait until fall to have surgery.  The reason is youngest son is getting married May 29, 2015 and then we are going to Disney with grand kids in middle of August.  If I have surgery in March will I be walking by end of May and will I be able to walk around Disney in the middle of August.

Or should I wait until fall?  It seems the pain and limitations are getting worse.  Probably in my head more than my ankle.  Any and all thoughts and comments are always appreciated. 

[dave1234]

I was 6 weeks fully NWB; another 6 weeks partial WB where I weaned myself off crutches.  Basically, I was not fully off crutches until the 12 week point (If I had to walk long distances e.g. 1-2 miles, I'd do so with a walking boot and crutches for additional support).  At the 12 week point, I was able to walk short distances without the walking boot e.g. a few blocks.  By the 6 month point I was able to walk for 1-2 miles, but at a slower pace.  Now at 12 month, I can walk ~2 miles at a pretty brisk pace, with no significant pain afterwards. 

If your recovery looks like mine, then you'll just about be able to make the milestones you indicate - not a lot of walking at the wedding (and do so in a boot), and more walking at Disney - although you probably won't be as mobile as you'd like to be. 

another option would be to wear a walking boot for the next 6 months (assuming it helps - it did for me pre-surgery), and then get surgery after August.  The trick is to get a walking boot that actually allows you to walk with a close to normal gait.  I found the following to be very good:  http://www.braceshop.com/bledsoe-mid-calf-leg-walker.htm

Best of luck with things!

[Namelike]

I was 6 weeks fully NWB; another 6 weeks partial WB where I weaned myself off crutches.  Basically, I was not fully off crutches until the 12 week point (If I had to walk long distances e.g. 1-2 miles, I'd do so with a walking boot and crutches for additional support).  At the 12 week point, I was able to walk short distances without the walking boot e.g. a few blocks.  By the 6 month point I was able to walk for 1-2 miles, but at a slower pace.  Now at 12 month, I can walk ~2 miles at a pretty brisk pace, with no significant pain afterwards. 

Dave - I had DeNovo on 12/22 and one of my good friends is getting married in the Virgin Islands mid-April. How were you at 4 months? Do you think you would have been OK to walk on the beach then or would that have been too much stress on your ankle?

[casper1955]

I cannot talk about recovery period but have visited hundreds of beaches and walk about 100 miles a year on a beach.  The one thing to be careful of on a beach is the varying contour of the beach.  None of them are flat and many have little holes dug here and there.  Also the water will cause modulations in the surface of the beach.  Virgin Island beaches as I remember them are soft sand so you will sink in the sand.  Kind of like walking on foam or your pillow.  Just make sure you are aware of that and take care not to put to much stress on the ankle and watch foot placement so you do not twist the ankle.  I do plan on walking on a hard sand beach about four months after surgery. 

Good Luck