Journal for Left Ankle Denovo Surgery on Jan 14, 2015

[BLT]

Glad to hear it is going well.  Just be careful.  It can be very tempting to rush into something that is to much so maybe no jumping yet.  I really like hearing such positive comments.  Again good luck with the healing

Thank you. And I echo the carefulness. I'm only doing what physical therapy tells me to do. Outside of PT I'm keeping it simple.

[BLT]

I'm about seven months post op now. Boy does it feel great!! The residual pain I was referring to isn't gone yet, and Dr. Ferkel isn't completely sure what it is. However, he did notice that my flat foot was agitating that area, so I'm now wearing custom fit orthotics; which I should have been wearing anyways regardless of whether I had this surgery or not. The pain is starting to subside. Occasionally I feel pain right when I get up from sitting at least 30 minutes, but there's been major improvement since I started wearing the orthotics.

Pain in the OCD area is still non-existent! Physical therapy is going really well. My ankle feels stronger as I am now doing exercises that focus more precisely on the ankle. I've gone back to the gym and have started my workout routine, but with very minimal weights. The bike doesn't hurt my ankle. The only thing I haven't done is run, but I'm waiting until January 2016 before I start that. Right now everything is next to no impact on the feet. But overall, how is it going? EXCELLENT! I can't express how grateful I am for feeling today. Denovo does f*cking work!!!

[Namelike]

Awesome news! What exactly is your residual pain you are feeling? I am still having pain in the tendons surrounding my Achilles and down to my lower inner ankle at 8 months post op. I feel pain in that area, kind of like it pinching, on the outside of my ankle when I walk and on the inside when I go up on my toes.

[BLT]

Awesome news! What exactly is your residual pain you are feeling? I am still having pain in the tendons surrounding my Achilles and down to my lower inner ankle at 8 months post op. I feel pain in that area, kind of like it pinching, on the outside of my ankle when I walk and on the inside when I go up on my toes.

It's funny - I can never give a clear description of this pain. I have no clue if it has anything to do with the tendons. Here's my elementary way of describing it - it feels like a small rock is sitting right underneath the skin where the cuboid bone is. It hurts when I sit for a while and then get up. The pain lasts for less than a minute. Afterwards as I continue walking its non-existent until I sit down for a period of time and get up again.

[tewchihuahua]

I've got another two days before I'm ordered to stop using crutches all together. I have to say, I cant' wait. Since starting physical therapy this past Monday, after each session it's much easier to notice improvement. I remember on the first day of using one crutch it was so difficult and painful in areas of my foot that were still swollen; luckily the pain wasn't in the ankle.

Since Monday it's been much easier. I had to learn the technique for using only one crutch, and I noticed initially I was doing it wrong because my right neck was starting to become sore. The key thing was to keep my body straight. I have a bad habit of slouching so it was quite an adjustment initially. My PT has been extra conservative, he felt with so much "trauma" to my ankle being conservative would be best. But he's really good with his hands, so even just the "massage" he gives me already improves my range of motion.

Another interesting tidbit is he is very familiar with Dr. Ferkel's work because he has had several patients from him. He feels he's probably one of the best ones to go to for ankle surgery, and that SCOI (Southern California Orthopedic Institute) is one of the best organizations for orthopedic surgeons. It made me feel much more comfortable hearing him say that. He also said that MF surgery is typically not successful, and especially for young folks because we have expectations of being very active again after healing. The activeness breaks the fibro cartilage and then the pain returns (as we have discussed several times on this forum). He says typically MF would be best for older folks who intend to do very little or no high impact activities to their ankle. So there probably is a time and place for MF, but he doesn't recommend it for young folks that intend to do high ankle impact activities. Unfortunately Denovo is new to him, so he didn't have much comment on it.

But it looks like I'll be using the boot until March 26th.

Ferkel must have learned that in the last 15 years, because he didn't hesitate to microfracture me back in 2000 when I was an active 16 year old. Sure enough, I started feeling the pain about 10 years later. That makes me a little mad.

[casper1955]

10 years ago MF was the suggested protocol   Even now many insurance companies will not pay for DeNovo and will only pay for MF.  Unfortunately my insurance company is one of those. 

I do plan on being very active again.  The only thing I probably will not do is complete a full iron man something I had planned on doing well into my 60s.  The marathon is hard on the feet and I am sure on the ankle also. 

[BLT]

I've got another two days before I'm ordered to stop using crutches all together. I have to say, I cant' wait. Since starting physical therapy this past Monday, after each session it's much easier to notice improvement. I remember on the first day of using one crutch it was so difficult and painful in areas of my foot that were still swollen; luckily the pain wasn't in the ankle.

Since Monday it's been much easier. I had to learn the technique for using only one crutch, and I noticed initially I was doing it wrong because my right neck was starting to become sore. The key thing was to keep my body straight. I have a bad habit of slouching so it was quite an adjustment initially. My PT has been extra conservative, he felt with so much "trauma" to my ankle being conservative would be best. But he's really good with his hands, so even just the "massage" he gives me already improves my range of motion.

Another interesting tidbit is he is very familiar with Dr. Ferkel's work because he has had several patients from him. He feels he's probably one of the best ones to go to for ankle surgery, and that SCOI (Southern California Orthopedic Institute) is one of the best organizations for orthopedic surgeons. It made me feel much more comfortable hearing him say that. He also said that MF surgery is typically not successful, and especially for young folks because we have expectations of being very active again after healing. The activeness breaks the fibro cartilage and then the pain returns (as we have discussed several times on this forum). He says typically MF would be best for older folks who intend to do very little or no high impact activities to their ankle. So there probably is a time and place for MF, but he doesn't recommend it for young folks that intend to do high ankle impact activities. Unfortunately Denovo is new to him, so he didn't have much comment on it.

But it looks like I'll be using the boot until March 26th.

Ferkel must have learned that in the last 15 years, because he didn't hesitate to microfracture me back in 2000 when I was an active 16 year old. Sure enough, I started feeling the pain about 10 years later. That makes me a little mad.

I say this with the best possible intentions - as casper1955 had said, in the year 2000 I don't think Denovo was even an option, and doctors used what they thought was the best procedure at the time. MF, according to my research, was more or less perfected during the mid-90's, so it would need several years of real data before they concluded that MF generally isn't a long term solution. I'm sorry you feel this way about what happened. I totally understand. You had 10 good years, I only had about 2. Dr. Ray Nickel in Ventura performed MF for me, and I think he did the best he could at the time. And besides, who knows...Denovo could end up failing in the long term. It hasn't been around long enough to draw any consistent conclusion. All I know right now is that it worked for me, and I will cherish each moment that it continues to work.

[jnj15]

I am so glad for your OCD site! I noticed for the first few weeks after I started walking I would get all sorts of pain in my foot--my therapist said it was from atrophied muscles in the foot, so we've been working on all sorts of balance and other foot strengthening exercises, and I'm pretty sure it's been helping. Perhaps that would help if you are not working with a therapist anymore?

[BLT]

The custom orthotics are working. The pain isn't completely gone, but it's gone down A LOT. So for those of you with flat foot that are considering any kind of OCD surgery...custom orthotics is something to look into.

[Namelike]

The custom orthotics are working. The pain isn't completely gone, but it's gone down A LOT. So for those of you with flat foot that are considering any kind of OCD surgery...custom orthotics is something to look into.

Thanks for the advice, I'm going to ask about orthotics at my appointment in 2 weeks. For the past few months the pain in the tendons around my Achilles has been pretty significant, but has actually started to get way better (almost unnoticeable) in the past week - ever since I started doing balancing exercises on a blow-up stability cushion.

How much did the orthotics cost?

[BLT]

The custom orthotics are working. The pain isn't completely gone, but it's gone down A LOT. So for those of you with flat foot that are considering any kind of OCD surgery...custom orthotics is something to look into.

Thanks for the advice, I'm going to ask about orthotics at my appointment in 2 weeks. For the past few months the pain in the tendons around my Achilles has been pretty significant, but has actually started to get way better (almost unnoticeable) in the past week - ever since I started doing balancing exercises on a blow-up stability cushion.

How much did the orthotics cost?

My orthotics costed me about $100 sometime back in 2008. However, I hear this price is not typical. Somehow my chiropractor knew how to get one made. At my most recent visit to the Orthopedic, I was quoted $450 

[BLT]

I can't believe it's been over 10 months since surgery. On October 19th I had a little scare after coming home from the gym. After doing my usual weight lifting routine, my left ankle was slightly hurting again. Of course I got scared, but I decided to give myself a rest so that I would be ready to travel in 5 days. My ankle did heal up and I was ready for international travel. I first flew to Bangkok for 10 days. I walked everywhere as if my ankle wasn't ever diagnosed with OCD. It felt great, while I was walking. When I got back to the hotel and rested my foot, the fatigue and pain around the ankle did set in. I expected this, so it wasn't necessarily a problem. Despite the pain and fatigue, if I got up and started walking again, it was fine. Meaning, the pain disappeared.

Obviously I'd prefer no pain at all, but this is so much better than before the surgery. Prior to surgery, the pain at the OCD site would prevent me from walking again after resting. In order to walk again, I'd have to tightly strap the ankle brace on and usually take a 50 mg pill of Indomethacin. The brace and medicine are no longer necessary. I still didn't push it too much. I made sure most of the time I wore a shoe with orthotics and not sandals unless it was at most two blocks of walking. It felt great walking amongst other civilians in public while not experiencing the pain that I once had to endure in silence.

My ankle isn't as flexible as it used to be and I feel I may have hit a plateau. I want to improve it, but I've already decided it's OK at the current state. I've also decided that if this is the best my ankle will be, it's also acceptable. The bottom line is, while my ankle isn't 100% back to normal, I have managed to get a good part of my life back: traveling the globe. Obviously I can't predict what will be the result 6 months or a year from now. I just know I'll be waiting at least another year before I consider doing any activity that requires me to "stomp" on my foot, like running or jogging. And this works for me because I'm not an avid runner.

For anyone else recovering from Denovo, I hope it's going smooth too. I know it hasn't been the case for everyone, and I really do hope a solution will be available as soon as possible for those not getting the results they want.

[ocdnetadmin]

That's awesome to hear you were able to walk around.  I was worried before my Southeast Asia trip as well but I did 3 months walking around everywhere! I think the right footwear makes a huge difference.

Also I'd recommend just never, ever doing any kind of running, jogging, or jumping.

My microfracture has lasted 8 years now.

[kingtywin]

Hey guys,

just trying to warn anybody reading this post about what can go wrong with this treatment and the need to take it really easy after the surgery. I know all the doctors say to go weight bearing after 8 weeks or so, but I really don't think it's long enough. My ankle felt great after 8 weeks, so I went right back to full activity right away. A year later, and I'm worse than where I started.

I think the main thing is to get MRI/ arthroscopic assessment to make sure the lesion is completely healed before you take a single step. My doctor didn't do wither of these things, and that's one of the reasons I have a new doctor now.

Just trying to warn you, because while you might feel ready after 8 weeks, being on crutches for 3 to 6 months, or even more, sure as hell beats not being able to walk for the rest of your life.

[Namelike]

Hey guys,

just trying to warn anybody reading this post about what can go wrong with this treatment and the need to take it really easy after the surgery. I know all the doctors say to go weight bearing after 8 weeks or so, but I really don't think it's long enough. My ankle felt great after 8 weeks, so I went right back to full activity right away. A year later, and I'm worse than where I started.

I think the main thing is to get MRI/ arthroscopic assessment to make sure the lesion is completely healed before you take a single step. My doctor didn't do wither of these things, and that's one of the reasons I have a new doctor now.

Just trying to warn you, because while you might feel ready after 8 weeks, being on crutches for 3 to 6 months, or even more, sure as hell beats not being able to walk for the rest of your life.

I mentioned this in your thread, but I would like to again discourage providing actual medical advice with regards to recovery. The orthopedists are experts in the field and have developed their own recovery plans based on clinical data and experience - to act against their will (by using crutches for longer than expected, etc.) might actually hurt your recovery. I was more conservative than I think I needed to be and now I am working through fixing tendinitis because my leg is still too weak, even after a year.

I agree with the idea of getting a post-op MRI - however I would think that most would agree 8 weeks is too early, as it is known that DeNovo takes much longer to grow and integrate with native cartilage. My doctor has every patient get one a year after surgery to see how things are coming along. Even though mine looks great, he warned me that the new cartilage is not fully integrated into my own until 2+ years, so no running/jumping/pounding until then.