Need input, what would you do?
I’m at week 10 in a few days and feeling pretty good… walking barefoot is fine, push off strength is next to nothing.. But now I’m faced with a decision, my ankle wasn’t right before this happened, read about it here. My doctor said that it almost certainly put more strain on the Achilles and helped it rupture.
Since I really am asking others what they would do, I’ll summarize what’s going on. The talus bone of the ankle which had the Achilles rupture has an osteochondral defect of 9mm x 17mm, meaning the bone there is mush, a leftover remnant of a skiing accident 3 years ago where my bindings didn’t come loose and instead, my foot pulled out of my tightened boot. As a secondary result of that, my anterior talofibular and calcaneofibular ligaments are stretched. This has caused ankle instability to the point that sometimes when stopping quickly it feels like my leg just slides out over my ankle. It also causes nearly constant, but not overwhelming, interior ankle tendon pain which showed up as fraying on the MRI.
My plan was to have the ATF and calcaneofibular ligaments fixed with a modified Brostrom procedure this fall after gobs of physical therapy failed to fix the instability, that was until my Achilles ruptured in August.
It would make sense economically to try and have that procedure this year as we’ve easily met our insurance out-of-pocket with a new baby and my Achilles rupture, but I can’t bear the fact of thinking about another surgery and more time off my feet again this soon. Plus, it would just be nice to let some of my leg strength come back again.
Add on top of that, my allergic reaction to, I think, Lidocaine which you can read about here. It makes me paranoid for another surgery. At the very least it would mean another trip back to the allergist and a fair amount of allergy tests.
So what would you do if you were at week 10 of your Achilles recovery, you know have ankle instability that’s fairly bad and won’t fix itself and could have even caused the problem, and you economically look at your insurance out-of-pocket being fulfilled for this year already? Would you have the stability surgery and set your Achilles recovery back or would you hold off for a year or two and just deal with it?
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Water under the bridge… but I’m curious: is your Achilles doctor the same guy you were working with before? Did you guys talk about doing it all at once (10 weeks ago)?
It seems like you were making good progress with the ankle, prior to the Achilles injury. Was the goal back then to avoid surgery? Or, just to delay it? Has this Achilles injury changed your mind? Do you now believe surgery is necessary, or are you just worried that the Achilles injury has set you so far back that a non-surgical ankle rehab isn’t viable anymore?
If it was me (that’s what asked), I think I’d try to step back and ask: what would I do if I hadn’t ruptured my Achilles? Will I still be able to execute that plan (with a delay of course)? If so, that’s the path I’d try to get back on.
If the conclusion is: yes, I will now need surgery- then I’d probably try to do it soon. Insurance is a (small) factor. Mostly, I’d rather go through 1 more difficult rehab than 2 easier ones… I hate being immobile. Plus, time spent recovering from that 2nd surgery, would be “safe” (tendon healing) time where I’m not at risk of re-rupturing the Achilles.
Just my $0.03 worth. I’ve never played a doctor on TV.
It is the same doctor… I talked about doing the ligament surgery at the same time and he said it wasn’t good for the body to introduce more stress in a time of extreme trauma like an Achilles tear. He also doesn’t like any of his patients to be under anesthesia for more than around 2 hours as he said the risks increase at that point. My impression is that he’s a great doctor and the physical therapy place I go to say all of his patients do very well in rehab.
The goal back then was to avoid surgery, but it never really worked that good… I had tearing pain, although not overwhelming, constantly. I could tense the muscles on the loose ligament side and relieve the pain, but it was very unstable in sports.
After trying to build up the muscles, which worked fairly well as I could almost walk normal even after tearing the Achilles, and still having pain, it was decided to do surgery to tighten them up. I had sort of planned to do that this fall until this happened.
My wife agrees with you, she thinks if I wait and let my leg get strong again that I won’t have the surgery and then I’ll end up rupturing the posterior tibialis tendon that is fraying at the moment and have to do another emergency thing….
My leg just looks like a bone with skin on it at the moment, I can’t bear thinking about this for even longer…. The doc did say it’s only basically two weeks immobile though for that procedure. He’s a big fan of no casts or boots….
I’d just think about the rehab schedules, and make sure they don’t compromise each other. Seems like you’re at about the right spot…
wk 10 (now): schedule surgery
wk 11: get surgery
wk 11-12: NWB (you said 2 weeks)
wk 13: PWB - no boot, guessing 1 week
wk 14: FWB - back to 2 shoes
wk 15: starting rehab.
(I bet that’s an aggressive schedule, given your still angry AT injury)
At wk 15, (conservative estimate, which is what I’d be using in this situation) your AT should be fully healed and ready to endure the rehab from the 2nd procedure.
With my AT injury/rehab, I feel that the other muscles/tendons/ligaments in my ankle are getting worked extra hard, sometimes compensating for the weakened AT. With this 2nd procedure, my guess is (ask your doc) you may find yourself doing the opposite: relying more than usual on the injured AT. I’d therefore want to be careful/conservative at first.
The good news is, once you get through this, you should be able to proceed with rehab in earnest, without compromise from the damaged ankle. No looking back at that point. But, as you’ve already figured out, it’s not going to be remotely easy.
One last thought: maybe it’s just me… but it would be very hard for me to stay motivated for PT/rehab, when I knew I’d just be doing it all over again before too long. I can hear myself thinking: “What’s the point?…”
I think I’d do a lot better when I knew, no matter how hard it was, that the worst was behind me.
Those are all very good points… especially the part about relying more on the injured AT during recovery… but also the point about rehabing only to do it all again…. the allergy still scares me, I should schedule figuring that out quickly then…
Speed i think a lot of your decision ways on what you want to be able to do in the future. If you want to get back into a active lifestyle where the weak ankle may bother or limit you, then go for the surger and get it fixed. On the other hand, if you think you’re going to back off on the activity and hit the recliner, then skip it.
As to schedule, I would hold off until you regain some of your calf strength before getting the next surgery. It’s already wasted away a good amount, no need to completely destroy it. Strengthening surrounding muscles of tendons and ligaments before surgery (when possible) has been shown to give better results and decrease recovery time. Take a few weeks to pump that calf up a bit so you don’t have to start from scratch after the ankle surgery. From my limited knowledge of ankle surgeries, you should be able to get back to FWB after an ankle surgery fairly quickly which will save your calf from too much additional atrophy anyway.