10 months since impact - bad news.
To make a long story short: From about 6 weeks post-op until today, I have been progressing pretty much steadily, however, I have been bothered with ankle pains and swelling. My PT assumed further ankle injury, and, indeed, that what it was. Because my ankle and claf would anyways be too weak to handle surgery, we figured out we would do what we could with conservative treatment until I had recovered better form the ATR. And, since conservative treatment for most ankle injuries are similar, it wans’t much to gain from taking an MRI. Furthermore, as my PT suspected that several things were wrong, it was better to wait, and reduce the options for error when interpreting and MRI. That is all history, as I have now taken and MRI, and got it interpreted. Verdict was out a few days ago, and it’s nothing to celebrate:
1. Ostecondrits dissecans of the talus. Ostechondral lesion at the medial corner of my talus bone, plenty of oedema, and a bone fragmet freely dislocated inside the joint. If sounds like some ancient language not spoken for the past couple of millennia, a good description in english is found here: http://www.eorthopod.com/content/osteochondritis-dissecans-talus
I have been receiveng appropriate conservative treatment for this condition for the past 10 months, apparently without good result. Bad news #1: One more surgery, followed by 4-6 weeks of immobilisation. Great.
2. Minor subchondrial fractures to the tibia - related to #1. Conservative treatment has been effective in the sense that the cartilage is now healed, although the bone behind the cartilage is still damaged. Hopefully, this won’t cause me much more problems, but will potentially make me susceptible to contain arthritis.
3. Peroneus brevis tendinoses and longitudinal split. Bugger. It is hard to find good information on this condition, however, from what I can undertsand, this may very well be an old injury, that I may have had on and off for as long as 15 years, but that haven’t been acute until my ATR put extreme strain on everything in my ankle/foot. I was probably lucky that it did not rupture at the same time as my ATR, and I hope that it does not require surgery, but, most likely, I am also in for surgery on this one: Bad news #2: I may need surgery on my Peroneal brevis tendon, which typically requires 3-6 weeks of immobilisation.
Bad news #3: While surgery on the peroneal brevis typically will heal in a cast or boot with the toes pointin downwards - same as after an ATR - surgery for ostechondritis is typically done from the front, requiring immobilisation with the toes pointing upwards. The opposite. Bugger. Two operations, and something like 3-4 months immobilisation. What could be worse? I surely hope my peroneal brevis does not require surgery…
I haven’t been much of a blogger on this site so far, however, with one more summer coming up, that may change. I will need all the inspiration I can get. But, if someone can fix my ankle, I can run. and if I can ever run again, I think the comrades is top of my list. Or the Lewa Safaricom . Stay tuned.
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Sorry about the bad news, and good luck with it.
Thanks Norm
At least this will be a panned surgery, and a planned recovery. Hopefully, this will put less stress on my family, and improve the prospects for active recovery. I think I con now conclude that running around after my then one-year-few-months old son was not good for recovery… And that rupturing your achilles while your wife is 6 month pregnant with #2 is not good for family life.
Wow. That is a lot to take in, after trying to rehab an ATR. Glad you have a physio who seems to get it!
That’s rough. Stay tough mentally. You’ll run again. Runners get the cumulative physical and mental benefit of all that running when it comes to recovering from any injury.
The better your imaging, the worse your diagnosis. I’m taking a guess that #2 may exist amongst many. I come across many spine MRIs often and anyone over 40 it sounds like they are falling apart with degeneration and arthritis (they are, but very slowly and normally).
Arthritis may or may not hinder activity for some time. I’ve had medial meniscus scoped out of my knee at age 20. Told by one doc at the time that I had arthritis and should golf and swim. I was 20, been playing everything for 24 years since. Knee acts up occasionally but I still enjoy my sports and push my knee hard. I’m sure I’ll pay in some years but then I’ll take up rowing, boxing or cruises. ; )>
Agree with Janis, sounds like great physio. Another helpful post on this blog from a PT student who talks about atrophy and using ES while immobilized. Given you’ll plan your surgery, wonder if it might help to get those leg muscles to as large as possible pre-surgery.
I’m at 9 months post-op. Been back playing ice hockey, ball hockey, flag football.. my Achilles is doing well more confident every outing. (had groin pull and hamstring pull recently but that’s another story).
However, my ankle is still sore and swells up each time and often from a day of ‘office walking’. Went to ankle specialist and all OK, but x-ray not MRI. Big difference.
Also I say if our joints haven’t failed us by the time we die (apologies to those planning to live forever) then those joints haven’t lived to the fullest. Eat well, build those muscles, and make your heart and health better in the process. Hurdles, ironically, force us to enjoy life’s little moments…ie. life.
What bionic says about MRIs to the back has recently been borne out by a number of careful experiments: MRIs of the spine are BAD FOR YOU!! In one study, 50 healthy adults with no back problems — past or present — were given MRIs of the back, and the MAJORITY were diagnosed with severe problems! In another study, a large number of chronic back pain sufferers were all given back MRIs. Randomly, HALF were ignored and the other half had consultations to see and hear the results. On long-term followup, the ones who were ignored had done significantly better!!
I’ve also shared a personal story about a series of MRIs of my ~95-year-old Dad’s spine which were consistently, significantly, and dangerously Dead Wrong in (a) what they found (which apparently was never there) and (b) what direction it was going: The scans got worse and worse as Dad’s backache went away, never to return in his remaining ~3 years. The MRI folks wanted to do open-spine surgery to remove the growing “shadow”! (And BTW, my 3 Ultrasounds on my second ATR weren’t any more impressive!)
Whether that pattern holds for our (equally complicated) ankles or not remains to be proven, but it wouldn’t surprise me. The question remains in both cases: What’s a patient to do??
On the other hand, a close friend had a painful back problem and received a number of diagnoses including, most commonly, a herniated disc. Went on for a long time, X-rays and so on, and my friend then saw a top specialist. who examined him, took a history, made him walk up and down stairs, bend, etc.
Promptly MRI’d and found a large tumour compressing the spinal cord, and about to cut off all response to the lower limbs. Very real.
Understand what you say, but ….
I can agree with the notion that a high-quality MRI can ‘reveal’ problems that aren’t really problems. That’s why we are choosing to ignore damage to my shinbone. After all, the cartilage, which is the important thing in the joint, appears to be fully healed on that bone.
My talus is a different story altogether. Firstly because it does cause me troubles, secondly because the loose bone fragment is large and apparently not connected to blood supply (the talus bone is notorious for poor blood supply). The chance that this will get better by itself, or by continuing conservative treatment, is slim.
Regarding my peroneal tendon, I still hope to treat this one conservatively, but not sure about the prognosis yet. Meeting with podiatrist tomorrow morning.
Regarding back problems, I think MRI still has it’s advantages, but you definately need to treat the imaging with humility. The spine does receive a fair share of beating, and it is contructed to tolerate high levels of damage before it actually becomes an injury that can’t be treated with conservative methods, i.e. rest, exercise, chiropractics or similar. A friend of mine had a double stress fracture (two discs next to each other) and a prolapse in between them. At age 18. It ruined her handball carreer, but she was, and still is, a good runner. And it caused her no more trouble. All it took was three months of conservative treatment: Rest, alternative exercise, and manipulative techniques (manual therapy rather than chiropractic, but it’s similar in prinicple).
But I’m sure an MRI of her spine wouldn’t be pretty…