Author Topic: After 3 surgeries, doctors don’t know what is still wrong with my ankle. Ideas? (Read 2144 times)

Namelike · « **on:** November 18, 2018, 06:05:12 PM »

Hi all, I was once very active on here and I know I haven’t been around much lately. I was hoping to heed all of your advice because I am feeling a bit hopeless.

I will try to keep this brief. I’m M/32, 5’9”, 160 lb, Tennessee, US. This is my original journal: http://osteochondraldefect.net/forum/index.php?topic=190.0

I sustained an OCD/osteochondral injury in 2011 from a severe sprain. My ankle never recovered and I had extreme pain with activity. PT failed so I had a microfracture surgery in 2012. My ankle was perfect for 6 months then the new cartilage wore away and I was worse off than before.

I had BMAC/bone marrow transplant (not very invasive) in 2014 which failed. Then later in 2014 I had DeNovo juvenile cadaver cartilage transplant, which seemed to work great.

Since then, since pretty much 6 months after surgery, the bone/cartilage felt good but I had what I always assumed was tendonitis - both on the peroneal tendon (primary pain) and posterior tibialis (secondary). MRIs have shown that the previous OCD looks good and they don’t show much in terms of tendonitis. Yet somehow I still have so much pain/aggravation.

I have seen a few different surgeons and a podiatrist. Multiple rounds of PT have only flared up my ankle. Wearing a boot felt great but the pain resumed after taking off the boot. At the recommendation of pds, I recently got custom orthotics which seemed to work great for a bit but I have relapsed.

My ankle now just feels super aggravated and pissed off a lot of the time. It feels like an extreme pinching (almost a stabbing) pain in the area of my peroneal tendon. I also feel pain around my posterior tib area, but the pain also seems to travel all around my ankle - it is hard to localize. It happens with impact while walking but also if I just rotate my foot around while resting. Even with the orthotics my gait still feels off, my leg/ankle/foot feels weak, and the foot feels loose in the joint.

My foot just slipped off the step and I slammed my foot flat onto the ground, and I felt a shockwave or pain throughout the outside of my ankle (I’m guessing in the peroneal) and subsequently all around the ankle. It was just horrible.

Does anyone have any ideas? Is it still just as simple as tendonitis? At this point how could I treat it? After 3.5 years it feels chronic and severe. Thank you all in advance.

pds · « **Reply #1 on:** November 19, 2018, 01:56:23 AM »

I was in a similar boat about a year ago with some persistent tendinitis that I just couldn’t kick. It was finally a combination of things that did it for me:
New orthotics
KT tape to take the stress off the tendons
New physical therapist
Stopped wearing dress shoes
Stopped using NSAIDs (for example ibuprofen). Then can interfere with healing.

That all seemed to help quite a bit.

Having said that, I also had an OCD that was probably some of my pain. When was your most recent MRI?

Best of luck!!! That’s a real bummer!
Paul

Namelike · « **Reply #2 on:** November 19, 2018, 07:11:25 AM »

Thank you. I might try PT again. Here is the most recent MRI report from August. The report is unclear but every surgeon I go to says the OCD looks good and what you would expect to see after DeNovo.

Impression
1. No evidence of peroneal or Achilles tendon abnormality.
2. Mild tenosynovitis of the inframalleolar flexor digitorum and
inframalleolar flexor hallucis longus tendons.
3. Cortical bony defect involving the medial talar dome could be the
sequelae of Denovo cartilage repair as reported in the electronic
medical record without visualized loose body.
4. Please see above comments for further description.

END OF IMPRESSION

Electronically signed by XXX on 8/15/2018 10:46 AM

I, XXX, MD, have reviewed the images and verify the above
interpretation on 8/15/2018 10:52 AM.

Electronically signed by XXX, MD on 8/15/2018 10:52 AM
Narrative
HISTORY: M67.90-Unspecified disorder of synovium and tendon,
unspecified site M19.079 - Primary osteoarthritis, unspecified ankle
and foot; Unspecified disorder of synovi Anatomy of interest
[S_S]:->Ankle;

TECHNIQUE: MR imaging of the LEFT ankle was performed. Sequences
obtained include axial T1-weighted and T2-weighted with fat
saturation; coronal T1 weighted and PD weighted with fat saturation;
sagittal inversion recovery and gradient echo..

INTRAVENOUS CONTRAST ADMINISTRATION (milliliters of Gadavist): No IV
contrast administered

COMPARISON: None

FINDINGS:

There is mild thinning of the anterior talofibular ligament, which is
likely related to postsurgical changes. The anterior and posterior
syndesmotic ligaments, posterior talofibular, calcaneofibular and
deltoid ligamentous complex are intact.

There is a moderate amount of fluid around the inframalleolar flexor
hallucis longus tendon sheath and small amount of fluid around the
flexor digitorum longus tendon sheath without intrasubstance signal
abnormality. The extensor and flexor tendons are intact.

The peroneal brevis and longus tendons demonstrate normal signal and
are intact.

The Achilles tendon is intact, normal in size, and demonstrates
normal signal.

The Lisfranc ligament is intact. Alignment of the midfoot is normal.

The plantar fascia is unremarkable. The sinus tarsi is normal. The
soft tissues are normal. There is no joint effusion.

There is a 0.8 x 1.3 cm cortical bony defect along the medial talar
dome with mild subjacent subchondral edema. There is mild subjacent
fading edema. There is no intra-articular loose body or joint
effusion. There is no fracture.

pds · « **Reply #3 on:** November 20, 2018, 07:36:20 PM »

Have you done an ultrasound to have them take a look at the tendons where you’re getting pain?

Have you tried seeing another podiatrist? If it’s not a surgical thing then they might be best for the kind of pain your having.

I can understand your frustration. Sounds like it’s not obvious what’s going on.

Lets Do This · « **Reply #4 on:** November 20, 2018, 08:15:54 PM »

Hi Namelike,

Just read through your original thread from a few years back. What a bummer you still have pain. If I'm reading correctly, the doctor/MRI say your OCD is "still fixed" and "looks like what it should look like post-Denovo."

Clearly the pain has come back, as it seems to have historically following your surgeries.

Seems like it could be one of three things. 1) OCD is perhaps creeping back? 2) Tendinitis 3) Something else entirely

I just looked up tendinitis myself as I'm unfamiliar with it, but it seems like it can be i.d. through xRay. There are levels of treatment (which you've seemed to have tried a few already)
https://www.mayoclinic.org/diseases-conditions/tendinitis/diagnosis-treatment/drc-20378248

The surgeons and podiatrist you visited all said the OCD looks typical for post surgery. You may want clarification as to what "typical" means, in other words, making sure that it is still "fixed" and is not the suspect of your pain. I was reading your MRI report. I have zero medical experience, mind you. However I greatly analyzed mine and I notice that yours reads "edema" and "moderate fluid" in different parts. If it were me, I'd highlight anything that seems not OK and ask the doctor to explain each. "Is moderate fluid normal?" Is fading edema normal?" etc. And if they say, "Well, it's to be expected following surgery," then I'd ask further, "Well could it be causing my pain?"

I would think they would've picked up on tendinitis in an MRI, but maybe then again, MRI folks can often look for only the thing they are looking for, and may not report back on other findings even if they are there. Just something to consider.

I echo others in saying to return to the doctor (s) and or perhaps seek out further opinions to really identify the source of your pain. You are in Tennessee I saw? There would likely be top surgeons who service the sports teams for different universities. They may have a smidge more expertise than other surgeons might and can really help you target your issue. (I had a great original surgeon in my local area, but when I was faced with a repeat surgery I ended up going to doctors at HSS and Yale for numerous opinions.) Tiring, but worth it.

Keep up posted!

pds · « **Reply #5 on:** November 25, 2018, 11:03:31 PM »

For what it's worth, I had a similar situation where I had Denovo and then lingering pain for several years. My ortho said that my MRI showed some roughness around where the OCD was but not to worry as that was expected because it never looks the same afterward. He was wrong. My pain was from the OCD which the Denovo never really healed properly. I suffered for years before finally getting 4 different opinions from different doctors and settling on OATS to repair the OCD. The MRI description of "There is a 0.8 x 1.3 cm cortical bony defect along the medial talar dome with mild subjacent subchondral edema" certainly seems troubling. Might be worth getting a few additional opinions from other ankle specialists.