Post surgery journal: MF/BMAC/Biocartilage for OCDs in right ankle

[BLT]

It was about 8 weeks before I got out of the boot (or maybe not, I can't recall and I'm too lazy to go look in my own journal, lol!). And after the boot I was in an ankle brace for at least another month. Going with just shoes alone sounds a bit scary to me, but trust your gut instinct. It's OK to have difficulty walking, but be sure not to have any major pain while walking.

[cshires]

Thanks.

So hard to know what to do with all the different post-op recommendations. I've read a study that concluded that there was no long term difference in people who started weight-bearing earlier rather than later so perhaps that's why we're seeing this advised more.

Here's a link to the study:
http://www.udel.edu/udaily/2013/feb/microfracture-rehabilitation-022513.html

And here's a link to the results:
Comparison of early versus delayed weightbearing outcomes after microfracture for small to midsized osteochondral lesions of the talus - http://www.ncbi.nlm.nih.gov/pubmed/22879399

The thing that's difficult for me to interpret is how to respond to the level of pain and discomfort. I haven't felt any sharp or excruciating pain; however, now that I'm weight-bearing I have a persistent achiness on the medial side that feels too familiar for my liking. Since it's not intense, I feel compelled to continue my full weight-bearing efforts. But that feeling really does make me feel a sense of inner alarm, justified or not. If it was an all-over joint weakness feeling, I wouldn't feel so concerned. It's the fact that it's a familiar defect-like pain in the defect location.

For now, I'm taking a couple days off of weight-bearing. I'll call the surgeons office Monday and see what they say.

[BLT]

I totally get it. During the recovery process there's always that thought in the back of our minds that the defect area is still in the same pain prior to surgery. But we can never tell because pain can travel in different ways. There was one time, about 9 months post-op, where I thought the pain actually came back!!! I just gave it rest for a week and it healed just fine. This happened after doing squats, overhead presses, and deadlifts at the gym. At this point, I'm lifting pretty close to where I was before surgery :-)

[anneb455]

Also, call your doctor and team- these algorithms are just that, and every patient is different. Listen to your body- I say better to move slowly then to blow it by going too fast!

[cshires]

Hey everyone,

I'm just over eight weeks post-op. I would love to be able to report that the medial pain is gone but sadly it is not. I know many people were walking by eight weeks but I still find myself needing the crutches to walk. I'm able to take a few steps each day without the crutches but they are unstable and uncomfortable.

The surgeon's office continues to say that I shouldn't be alarmed. My last message from them said not to worry, that this happens with everyone's recovery. The said the stiffness and soreness on the medial side is normal and due to scarring and that I can push through this discomfort. Their prediction is that it will improve with therapy and motion in approx 3-4 more weeks.

That message from them was nine days ago. I'm walking more with the crutches and trying to increase my ROM (which is not yet 100%). I'm also in PT three times/week. Based on their prediction, this pain/soreness should resolve in 2-3 more weeks.

At this point, however, the medial pain is not improving day-to-day. Sometimes it feels like stretching pain which makes me feel like it is scar tissue. Other times, while I'm walking it feels just like flat out pain - esp if I'm trying to fully weight bear or if I've walked more than just a little. I back off when this happens and try again the next day.

Basically I'm only walking a little bit, with crutches, throughout the day- not very much at all. At most, I've walked a couple blocks down to a coffee shop with the crutches. It doesn't take long until it's painful (only on the medial side). There isn't any way I could lose the crutches at this point - so hopefully this improves.

Would love to hear any "this is normal" or "I've been there!" stories.

[BLT]

Hey everyone,

I'm just over eight weeks post-op. I would love to be able to report that the medial pain is gone but sadly it is not. I know many people were walking by eight weeks but I still find myself needing the crutches to walk. I'm able to take a few steps each day without the crutches but they are unstable and uncomfortable.

The surgeon's office continues to say that I shouldn't be alarmed. My last message from them said not to worry, that this happens with everyone's recovery. The said the stiffness and soreness on the medial side is normal and due to scarring and that I can push through this discomfort. Their prediction is that it will improve with therapy and motion in approx 3-4 more weeks.

That message from them was nine days ago. I'm walking more with the crutches and trying to increase my ROM (which is not yet 100%). I'm also in PT three times/week. Based on their prediction, this pain/soreness should resolve in 2-3 more weeks.

At this point, however, the medial pain is not improving day-to-day. Sometimes it feels like stretching pain which makes me feel like it is scar tissue. Other times, while I'm walking it feels just like flat out pain - esp if I'm trying to fully weight bear or if I've walked more than just a little. I back off when this happens and try again the next day.

Basically I'm only walking a little bit, with crutches, throughout the day- not very much at all. At most, I've walked a couple blocks down to a coffee shop with the crutches. It doesn't take long until it's painful (only on the medial side). There isn't any way I could lose the crutches at this point - so hopefully this improves.

Would love to hear any "this is normal" or "I've been there!" stories.

My non-medical advice would be it's probably still considered normal. At 8 weeks I started walking, but with a boot. On March 25th I started wearing the ankle brace. That means at about 10 weeks post op I was walking without any real protection on my ankle. I recall I was still having pain and was definitely limping.

[cshires]

Hey everyone,

I'm coming up on 11-weeks post op in a few days. This is no quick recovery, that's for certain. I was warned but I don't think you really quite get it until you're experiencing it yourself.

So here's the update. I'm walking but still mostly with assistance. I started taking the crutches outside and walking around the block a few times a day- basically working up to a mile every day. Then I went to one crutch. Several times a day I'm able to forgo the crutches and walk around without them, but not for very long before it starts to hurt so I grab a crutch. I also biked five easy miles at the gym the other day with no issues.

The bottom line is my ankle and foot feel rather wrecked. Sore and stiff and progress from day-to-day seems minimal...but week over week it is noticeable. I do have pain still on the medial side, some occasional popping, and what feels like pain right in the joint (beneath the medial incision).

I'm taking it one day at a time and trying not to be alarmed.

Onward and upward...or at least forward.

[BLT]

Keep it going! I remember at 11 weeks I was towards the end of getting rid of the crutch. I still used the boot though.

[cshires]

I'm coming up on 13 weeks post op in a few days. Here are the milestones from the past 2-3 weeks:

- I went from two crutches to one crutch to NO crutches.
- I started driving again.
- I started showering like a normal person (i.e. able to get in and out easily)
- I started getting out of bed WITHOUT needing a crutch for the first 20 steps to start the day.
- I started being able to go upstairs with more ease (without holding on, even). We moved our bedroom back upstairs.
- I started having the experience of several times a day feeling like I had a near-normal ankle (this feeling is fleeting but it is happening!)
- My foot stopped turning crazy shades of red and purple.
- I'm having less and less swelling (not to say there isn't any swelling- there is.)


Here's the flip side:
- I'm struggling to recover my full ROM. Dorsiflexion is pretty difficult for me. I can get to 11 degrees (started at negative 2) but I need to recover 2 to 4 more degrees. It still feels slightly jammed and I can't go downstairs easily at all. I'm side-stepping and holding on.
- Without assistance (one crutch), I can only walk a short distance (half mile) before I'm limping and in pain.
- The medial-side pain is still present, although (I believe) it is less and less each week. My belief is the pain is due to join weakness. I'm now doing leg presses and calf lifts at PT and the gym so I'm hoping that will help resolve the pain that's still present.

I have high hopes for the next four weeks. My goal is to walk a mile without assistance in the next 2-3 weeks. I can do that now somewhat easily with one crutch.

My 12-week post-op appointment (will be closer to 16) is May 12 at HSS.

[jnj15]

Christina--great to hear your progress!

I wouldn't worry too much about the ROM, as mine was stiff even up to about a year after. Just keep pushing through the stiffness and you'll get there!

[BLT]

12 weeks is still early and it looks like you're starting to see the return on your decision for surgery. I hope that at 24 weeks you'll see an exponential increase in your healing.

[Nancy P]

How is pain now?  I'm 6.5 months post-op, pain worse again like before surgery?  Had MRI Sat., going Tomorrow for results, nervous...hoping the little bit of dancing I did 5 mos. out didn't undo, etc.  HELP!

[BLT]

How is pain now?  I'm 6.5 months post-op, pain worse again like before surgery?  Had MRI Sat., going Tomorrow for results, nervous...hoping the little bit of dancing I did 5 mos. out didn't undo, etc.  HELP!

Let us know how your results came out.

[cshires]

14-weeks post-op today and I've been crutch-free for well over a week now. Feels great to move about more easily.

So here's the current situation. If I'm just puttering about the house I have little to no pain at all. However, four days ago I started walking about a mile to 1.5 miles each day without any assistance (previously I did this with a crutch) and now I'm having quite a bit of soreness again. I'm able to force a normal gait most of the time but I usually end up limping after about a half-mile (especially on uneven ground.) My pace is slow regardless. I slow down even more when the limp sets in to force a proper gait. I also stop and stretch.

I'm still in PT three times a week. I'm riding the bike at the gym 3-5 miles at a time a couple times a week and doing upper body workouts. My PT is working with me to build strength by doing leg presses and balancing on one leg. Standing on one leg is still quite difficult for me though I can manage it for a few seconds.

Next update: standby for the pain-free mile. I can't wait.

Thanks BLT and Jason for your encouragement!

Happy spring everyone.

[BLT]

At 14 weeks post op I was no where near what you are doing. However, I did take a more conservative approach.

The soreness will be there...and probably for a few more months. Of course, again, it will vary from person to person. Depending on how good the surgeon was and the extend of how your body naturally heals, it is hard to tell if you'll be back to how mother nature intended for you to be. The one mindful thing to watch out for is whether you have that sharp catching pain again that suddenly stops you from doing what you want to do. I'd almost say soreness is not a big deal, as my surgeon kept saying it's still healing.

As of today, I still have bone swelling, and I'm consistently told to just keep giving it time. But no complaints...I don't run. I can do almost everything else fine without that horrible pain that once consumed my life!