OsteochondralDefect.net Community
Osteochondral Defect Discussion => Ankle => Topic started by: sazzakablazza on July 04, 2016, 08:05:15 AM
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Hi,
Brief background: I had arthroscopy with microfracture on 13 Apr, was discharged without a boot/plaster and told to walk as soon as possible, tried after a week with a lot of pain so ceased, had 2 week post op appointment and saw a different surgeon who said his patients non weight bear in a boot for the first two weeks so he then gave me a boot.
I am still on crutches 12 weeks post op and in quite a bit of pain. Still taking cocodamol 30s once or twice a day. I have brought my 14 week post op appointment forward to tomorrow but I was just wondering if anyone else was feeling like I am after 12 weeks?
Sarah
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Hi Sarah.
I hope your post-op appointment went well yesterday. I am 8 months post-op and have learned that this recovery is way long and slow. Also that surgeons offer vastly different advice for post-op weight bearing. I was no weight for 8 weeks, then partial for 4. As I've been recovering, I've had good days and bad...and have gone back into the boot a couple of times when it hurt too much to walk. (In fact, I was just in it this weekend, and am still limping around like I was back in March, so not sure what's going on!)
So, certainly follow your doctor's instructions, but I'd let your pain level be your guide. If your ankle hurts, ease back on what you're doing a bit, ice it, elevate it, keep using the crutches if you need to. Don't push it, so your body has a chance to heal.
That being said, given that mine still hurts, maybe you don't want to be taking advice from me! (Ha.) Everybody heals differently, has a different pain threshold, had slightly different procedures, and various doctors -- but the one thing that seems to be common is that recovery is long and slow. Good luck!
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5.5 months post-op and still in pain. Still limping and most definitely not back to normal.
Had an updated MRI about six weeks ago and the surgeons comments were "looks like a normal healthy recovery." Defects on MRI were not fully filled in but expected to continue healing over time.
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1.5 years post DeNovo, same story here. Joint itself feels great still have some residual tendon pain as well as weakness in my ankle/leg. Don't even try to evaluate how successful your surgery was until you're a year out - that's how long the recovery really takes.
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So my review on Tuesday didn't go how I thought it was going to;
I didn't see the consultant himself, just one of the dressing nurses, she relayed information from him. I explained how the pain seems to be getting worse rather than better and that I am still using the crutches etc. So he reviewed my initial MRI again and apparently my initial injury was really nasty (this had never been alluded to up to this point) and that recovery time is likely to be 1 year plus. Why didn't they pre-warn me about this so I would have been more prepared for the long recovery?! I am so fed up and sick of relying on people as I can't drive yet.
I am in the Royal Air Force and live 200 miles from home in a barrack block. Luckily my sister is posted here with me. If she wasn't I would never be able to go home as the train costs £100 return and I shouldn't really be doing a 4 hour train journey (with 3 changes!) on crutches on my own.
They didn't even scan me on Tuesday. Apparently it is too soon??? How soon was everyone MRI'd/X-Ray'd after their op?
Sarah
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Sarah,
I had an MRI at 16 weeks and I was surprised that it was offered (they did it at my appointment.) From everything I've read, early post-surgery MRI's aren't super informative because healing is in progress and incomplete. Sure enough...that was the result of my MRI. "Defects not yet fully filled in. Progression of normal healthy recovery."
I also have not seen my surgeon since the day of surgery. In my three post-op appointments, I've seen his PA.
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Sarah, being dependent is really hard with the recovery from this injury or defect. I was non weight bearing for 8 weeks and partial for 4 weeks, my surgery was the end of February. I have a lot of swelling and pain at the end of the day and i regularly ice and elevate. I think you are very early in the process, and it is a super hard time. My heart goes out to you. I have not yet had an MRI, nor do I expect one. There is no one answer for how people progress- let pain and swelling be your guide.
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Hi,
Brief background: I had arthroscopy with microfracture on 13 Apr, was discharged without a boot/plaster and told to walk as soon as possible, tried after a week with a lot of pain so ceased, had 2 week post op appointment and saw a different surgeon who said his patients non weight bear in a boot for the first two weeks so he then gave me a boot.
I am still on crutches 12 weeks post op and in quite a bit of pain. Still taking cocodamol 30s once or twice a day. I have brought my 14 week post op appointment forward to tomorrow but I was just wondering if anyone else was feeling like I am after 12 weeks?
Sarah
There seems to be a big elephant in the room here that hasn't been addressed...how is it OK be discharged with no boot or cast, and told to attempt to walk as soon as possible?
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An elephant indeed. I did read one study (and referenced it in my recovery journal) that indicated that there was no long-term clinical difference between early and late weight-bearing. Even this study however had a period of at least (if I recall) four weeks of non-weightbearing.
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Sarah, if you really think you're getting worse rather than better, you might seek out advice (and a new MRI) from a different surgeon. There are several reputable ones referenced on this board. I think most of us on this board would say that recovery is much longer than expected and very frustrating at times. The one common thread though seems to be that the trajectory is forward, not backward. Two steps forward, one step back...but overall a progression of better. The one difference you have from most here is the early weight-bearing. It's possible that despite that, you're recovering just fine (albeit slowly.) But since you did have the early (and really rather unheard of) experience of such early weight-bearing I think, in your situation, I might get a second opinion on what's going on in there. Just my POV. Good luck. You'll find good support here as you need it.
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Thank you everyone for your comments.
Update:
Still no better. Pain meds not being very effective, keep trying different combinations to very little effect. And over the past few days I have started getting a sharp pain on the outside of my ankle (near the bone that sticks out - unsure of clinical term) with every step I take. Anyone experienced anything similar?
Thanks, Sarah
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Sarah sorry to hear you are still experiencing pain. Make sure to keep your doctor informed of your progress.
Please also post your (approximate) age as that would affect MF recovery.
Without knowing more about your situation, my speculation is that it could take you a while longer to recover.
In some cases if the OCD are very large , then MF may not even "succeed" (success defined as ankle being better after surgery). . I hope that's not the case for you but it is a real possibility.
The most important thing is PATIENCE. I know its' hard but you need to be patient, and find the strength to be patient, as well as positive.
Patience means giving your ankle the time it needs to heal without rushing it back and re-injuring it or making it worse.
Positive means taking pro-active steps towards recovery such as physical therapy, eating healthy, abstaining from alcohol + smoking, etc. (ok the last few are a little preachy but I'm sure they help a bit. When i got MF my surgeon told me he wouldn't even operate on me unless I quit smoking)
There's a balance between strengthening your ankle through walking and aggravating it. Take it really really slowly and really carefully. Don't be hesitant to switch back and forth between crutches and walking.
Finally, keep in contact with your doctor. Maybe even try another doctor, get a second or third opinion.
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Sarah, I hope you're able to find a way forward soon. Whether that's getting a third opinion or just easing off use of your ankle even more to give it time to heal. You'll get better. Isn't it amazing how much we took our ankles for granted?!
And Alan, thank you so much for this excellent advice. I'm in a bit of a setback mode right now and really needed to hear what you said. It's so hard to stay positive during this recovery and your post was a good reminder that came at the right time for me. This forum in general has been a God send in keeping me sane these past 9 months. My doctor told me it would be 9 months to a year, but I really didn't believe him. (How could it possibly take that long?!)
If you're able to reply back and say what you consider a large OCD, I'm curious.
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Alan, thank you for your advice. I'm 28 in September.
I have contacted my consultant's secretary with my concerns and she is going to pass them on and hopefully I will get a reply soon. I am undergoing physiotherapy through the RAF which is good; slow progress at the moment but my range of movement is increasing which is good! My calf is incredibly tight and is causing me some pain in one of the nerves that runs up my leg so I have been given a tablet to help with that as well as ultrasound from the physio and foam rolling in my own time. Fingers crossed things start to improve soon!
SCSankle, so you are 9 months post op?? How are you getting on?
Thanks guys x
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I'd say give it another 2 or 3 months. It's still a little early from April 13.
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Thanks for asking, Sarah. Like most everybody on here, I've had a slow go of this recovery thing. Felt great at the 7 month point. Months 8 and 9 have been a bit of a set back. I'm finally coming out of that, I think. My best guess is that I aggravated the joint area standing on tip toe on that one leg. Whatever the heck I did I ended up back in the boot a couple different times, blew through my prescription of Mobic, and really scaled back what little activity I'd been doing. I started back to PT this week and am feeling pretty good again. I have my first post-op MRI tomorrow so will see how well the joint has filled in. I keep reminding myself to just give it time. And when I think back to those first few months post op I'm way better now, so am continuing to make progress. It's just so slow at times it's easy to get discouraged.
I hope that you are feeling much better soon! You're younger than me (47 on Monday!) so you're sure to heal more quickly than I am, but each case is unique so trust your body and your instincts and keep taking to your doctors to make sure you're doing all you can to get better.
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So I emailed my consultant's secretary 2 1/2 weeks ago with all of my concerns. I finally received a response this morning;
Mr Robinson did give the following advice to your first email yesterday which is:
You are not to worry and everything is fine and that he would like to see you first before arranging an MRI Scan and x-ray.
I just feel like he has dismissed what I have said and how I am feeling. Everything is definitely not "fine".
I sent a further email yesterday - "since last Friday afternoon the top of my ankle keeps locking/catching, constantly feeling like it needs to be cracked. The ankle has always been quite clicky since the operation but this seems to have gotten worse over the past few days. Also, the swelling has increased – it never completely went down but it is definitely more puffy than before Friday". The secretary said she wont see the consultant until the middle of next week now, but if it gets worse go to A & E. Very helpful!
I'm so fed up guys!
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I'm hoping that by now you've made some progress. I just wanted to let you know that I was thinking about you and sending healing vibes your way! It can be a very frustrating and lonely experience being in pain for what others think is too long a time. "Are you still in that brace??"
Don't give up, you'll get better with time and good medical care and physical therapy. I had a low point in August (at 9 months post op) where I quite embarrassingly broke down and cried in the doctors office. Pain in my outer metatarsals and still limping to protect the ankle. I had just had it. Now I've gotten back into PT with a much better therapist than the one I went to in February and it is getting so much better. So keep bugging the doctors for answers -- if you don't like what you're hearing, by all means talk to someone else. All doctors and therapists are clearly not the same. One thing that makes me nervous is to hear you say catching/locking. When I see my surgeon he always wants to make sure that mine is not doing that. Each time he says something like, "A little pain is ok, but is it catching or locking at all? No? Good."
I don't know what he would say or do if I said yes though...so I hope you've gotten some solid answers and are feeling better.
So good luck! Let us know how you're doing.
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Hi again SCSankle,
Catching/locking still happening all the time. I see my surgeon next Monday so hoping for some good answers then!
Thank you,
Sarah
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Saw the Consultant on Monday - absolutely useless. Dismissed all my concerns, wont give me an MRI for at least another 3 months. I sat waiting for him for over an hour and he spoke to me for less than 2 minutes. Felt like he didn't care at all.
So I have been to see a Dr on base and I am getting a second opinion, with hopefully another MRI through the RAF.
Will keep you all updated.
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Follow up MRI booked for 19 Oct, finally feel like I'm getting somewhere!
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That's good news! I have one next week as well, 9 months post op. Still having some issues that I'd hope would have resolved by now. Keep us posted.
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Still on crutches - 10 months post surgery. At the end of my tether. :(
The Military Doctors are injecting my ankle with Ostenil on 22 March. Does anyone know anything about it, or have had it?
2 weeks following the injection I am then going on an intensive rehab course at Headley Court. Then if that doesn't help I will be referred to see a Lt Col Orthopaedic surgeon at Frimley Park Hospital in Surrey for possibly more surgery.
I just feel so lost!
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Crutches 10 months post surgery?
That does not sound good at all. Either the surgery went wrong or your ankle was already in really bad condition.
What is the next surgery option?
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Yep, 10 months. I'm on a strong dose of Lyrica (Pregabalin) but nothing seems to help much at all.
I requested my medical notes and there was mention of more microfracture, which I do not want as it obviously hasn't worked this time, or OATS. There was also mention of carbon fibre foot orthoses???
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Not trying to alarm you. Definitely try to keep a clear head.
But...
From what you've described, your ankle is in an extremely precarious situation. If I were you I'd get second, third, 4th opinions before I went ahead with any surgery or any physical activity that could aggravate your ankle condition including PT, injections, etc.
It sounds bad, really bad. Definitely don't leave your ankle future up to some doctor who clearly either doesn't care or doesn't have time to devote to helping you
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I think Alan is spot on here. Time for a reset on your approach. Based on the symptoms/pain you describe, it sounds like your OCD is still there, possibly worse than it was pre-surgery.
A few thoughts as follows (quick disclaimer - this is based on the experience I went through, and is not necessarily all going to apply for you; I think you'll be able to judge what might be relevant for you, and/or also give you some ideas on things to discuss with your doctor on your next visit).
1. I'd be surprised if the Ostenil injection improves anything. Ostenil is a brand name for hyaluronic acid - think of this as a lubricant that is injected into your joint to supplement the synovial fluid (your body's natural joint fluid). This is a treatment that is most commonly used to treat symptoms of osteoarthritis - not OCDs. I got an injection of Synvisc (another brand name for hyaluronic acid) and it did nothing for my OCD. Your problem most likely that your OCD is still present, not general joint deterioration like osteoarthritis (this would be unusual for someone your age).
2. Get a copy (or better still, multiple copies) of the MRI images and radiologist report from the facility that did your MRI. The facility should be able to give you a CD (or several) with the images on there. Bring these MRI images to other surgeons like Alan suggests - to get a 2nd, 3rd, 4th opinion. This will help speed up the process, instead of these surgeons ordering their own MRI images.
3. For your next opinion(s), it really pays to see a surgeon who has a lot of experience with OCDs. This is probably the hardest part to figure out - which surgeon to go to, and if you'll be able to get to see them (based on their schedule, your health care coverage/insurance, etc.). In the US there are a number of surgeons people on this forum have recommended. Unfortunately I don't know much about surgeons in the UK - possible others on this forum do.
4. Between now and when you get your next opinion(s), the most important thing is to do no further damage to your ankle. Use pain to be your guide here - if it hurts a lot, you are likely doing more damage. If you have one, wear a rigid walking boot for getting around - this may even allow you to walk without crutches. But if you need to use the crutches also, use them too. I found that Blesdoe makes a rigid boot that's easy to walk in (http://www.bledsoebrace.com/products/lo-top-boot/). I'm sure you can order online from somewhere in the UK. Until you get you next opinion(s), I'd be very cautions about doing any physical therapy or rehab. If your OCD is still present, rehab will likely not help.
5. When you mention a carbon fiber orthoses, there are a few things that your doctor may have been thinking of. Most likely, insoles that tilt your foot in a direction so as to alleviate the pressure on your OCD. These can be helpful. I wear them every day.
6. If more surgery is required, its possible that microfracture by a skilled, knowledgeable surgeon will work. Also ask about denovo, and biocartilage. OATS is an older technique that is still used, however usually only if the several other of the former techniques have not worked.
I hope this helps. Best of luck with things!
Dave
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Thank you for your comments :)
I will keep you both updated on my progress.
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Good luck Sarah. I'm so sorry to read your latest posts.
The advice that Alan and Dave have given sounds good.
I don't have anything to add but to let you know that I'm thinking about you and sending good thoughts your way. Everyone on this forum is pulling for you. There's got to be something that can help your ankle improve. Keep us posted.
Take care,
Sharon
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Good luck Sarah. I'm so sorry to read your latest posts.
The advice that Alan and Dave have given sounds good.
I don't have anything to add but to let you know that I'm thinking about you and sending good thoughts your way. Everyone on this forum is pulling for you. There's got to be something that can help your ankle improve. Keep us posted.
Take care,
Sharon
Thank you very much Sharon! x
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Sarah - it's very disheartening to read about this. When I read about doctors that don't care, it reminds me of what I go through when I accompany my dad to the doctor's office.
OCD require good understanding, like really good understanding, on the part of the patient. When I first had my OCD, microfracture was still the main solution at the time. Now there's more, so in a way you have something to look forward to. Some of us that had it much earlier had to endure years of pain before something viable was found.
That bad doctors are quick to judge and place blame on the patient or don't listen to the patient. They think all patients are alike and tend to prescribe the same treatment options across the board. Avoid these kind of doctors as much as you can. You need a surgeon that looks at each case with a fresh set of eyes.
I wish you the best, I really do.
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Sarah - it's very disheartening to read about this. When I read about doctors that don't care, it reminds me of what I go through when I accompany my dad to the doctor's office.
OCD require good understanding, like really good understanding, on the part of the patient. When I first had my OCD, microfracture was still the main solution at the time. Now there's more, so in a way you have something to look forward to. Some of us that had it much earlier had to endure years of pain before something viable was found.
That bad doctors are quick to judge and place blame on the patient or don't listen to the patient. They think all patients are alike and tend to prescribe the same treatment options across the board. Avoid these kind of doctors as much as you can. You need a surgeon that looks at each case with a fresh set of eyes.
I wish you the best, I really do.
Thank you very much BLT.
Ostenil (hyaluronic acid) injection next Wed 22 Mar, then a 1 week rehab course 5-13 Apr. We shall see how it goes!
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Update;
So I had the Ostenil injection one week ago and my ankle feels worse if anything and I have been given Tramadol to take when required.
I am being admitted to Headley Court 5-13 Apr. I saw my physio who will be with me during the rehab course and she said it is more for education and pain management etc due to the fact I cannot do much exercise because of the pain. It is looking highly likely that I will be having more surgery, but I had pretty much already accepted that fact.
I am going to request being referred to a Lt Col orthopaedic surgeon who works down in Surrey for a consultation.
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