ankle instability – Gluten Free Runner Gal

January 2014: Second and Third Opinion from another Orthopedic Surgeon

After six months giving physical therapy a try and doing absolutely no running, my left ankle still wasn’t holding-up. I went to see another surgeon (we’ll call him Surgeon A), this time more prepared for the answer he gave. He went through and did the same things as the previous surgeon: another round of xrays and standing on one leg, etc. He also came to the same conclusion, that although no issues showed up on any of the tests, I probably needed surgery on my ankle to make it better.

Surgeon A had a lot of experience and was highly sought after in my town, but he described the surgery to me as he was speaking into a tape recorder just under the speed an auctioneer would. In the middle, there was something said along the lines of, “and the patient understands there is a metal suture that I will not remove post op.” I stopped him right there and asked if that meant that a piece of metal would be lodged in my ankle for the rest of my life. He said, yes, but it’s no more metal than that of an earring. Post op, I heard him dictate that I was to be in a non-weight bearing cast for three weeks, then a weight bearing cast for three more weeks, then a boot. Despite not feeling comfortable to ask more questions, or go over what exactly the surgery entailed again more slowly, I went ahead and scheduled a date two months later for surgery (his first availability). I asked the nurse at the check-out counter what exactly the type of surgery I was going to have preformed: ankle ligament reconstruction and ankle scope. And off to Google it was to figure out what those meant.

After much time on the internet, I became more familiar with the procedure but still had questions and concerns. The first surgeon I saw, had recommended another surgeon if I decided later on that I wanted to do surgery. So, I decided for one last (my third) opinion from another orthopedic surgeon (Surgeon B).

Surgeon B was new to practice – only one year out of finishing her residency. She did not do any further xrays, after asking if anything had really changed since my last set of xrays, and I said no. She asked me to explain what happened and what my problems were and she listened. She sat me down on the table and took my ankle in her hand. She then began twisting and turning it, and then she pulled my ankle out and down. I heard a small pop. She did it again, and again another pop. She then explained that she could pull my ankle out of joint very easily and that was not normal. Believing more in clinically what she found than in test results, she explained how my ligament had become too lax and could not support the ankle joint staying in place all the time, and went through what surgery would do.

From my understanding, she would use a small camera to examine the inside of my ankle joint. This was to ensure that no small pieces of cartilage had chipped off at any point from all my ankle sprains, and was called an arthroscope. Then, she would cut my lateral ankle ligament and suture it back together and take a portion of the ligament and suture it to the bone (with the placement of a small metal screw that would remain in my ankle). There would be a lot of scar tissue that would form around the cut and it was one time that scar tissue was a great benefit because it would help to tighten the ligament even further. I would be in a cast and be non-weight baring for six weeks. After this, if everything went well, I would be placed in a cam-walker (boot) and start physical therapy. If everything went well, I could start running, very slowly, in three months. She also stressed that the surgery would be necessary (even if I waited ten years) to prevent or stop any arthritis from developing in the ankle due to the additional movement my ankle joint experienced with the lax ligament. Video of Lateral Ankle Ligament Reconstruction

Night and day, was my initial thought. Now, I understood things. I had a lot of reservations about which surgeon I should pick to perform the surgery. Both surgeon recommended the same surgery and procedures. Surgeon A had a lot of experience but didn’t make me feel comfortable. He also had a less conservative approach to casting after surgery. Surgeon B had less experience, but was fresh out of medical school and current on the latest and greatest information. She also explained things clearly, permitted me to ask questions, and ..drum roll… she listened.

So I went with Surgeon B. I cancelled my appointment with the other surgeon, and was set up for surgery just two weeks later.

A great explanation of the procedure, along with very helpful images, can be found in this article:

Surgical Considerations in the Treatment of Ankle Instability by Judith F. Baumhauer and Todd O’Brien

After more than a year with ankle sprains, knee, and now hip pain, I stopped running in August 2013. I had never been a runner with on-going or repeat injuries, careful to warm-up before hard runs and stretch before every run. So I was determined to figure out what was root of all my problems.

Dr. Knee had not been as helpful as I had wished, so I thought to try finding another doctor: someone who focused on Sports Medicine or ankles.

So I found an orthopedic surgeon who specialized in ankles (one of the four in town). He ran another set of X-rays on my ankles in twisted positions. Again, nothing unusual showed up, just like my other x-rays and MRI (but he did find a bone spur in my arch where i had torn my plantar fascia). He looked at my feet for about five minutes, trying to find my pain and asking me to stand one leg, etc. Then he said, “Well, you will need surgery if you ever want to run again, or wear an expensive motion-limiting ankle brace which may or may not work.” In my mind my response was “$$&;@@#%^?!!!! You must be mistaken.” I did discuss it with him for a few more minutes, desperately going through every scenario with the Dr. in which I would not need surgery. In the end, he said that I had basically stretched my lateral ankle ligaments and there was no way I could get them to be “stretched back” and my ankle was unstable. Well yeah its unstable, I keep rolling it. And that if I wanted the surgery, I’d have to see another surgeon because, oh by the way, he was retiring.

Not happy with my answer, I left his office determined not to have surgery. I would try not running at all and doing physical therapy for at least 6 months, and go from there.

As it happened, my dad (the avid runner) mentioned my issues to his chiropractor, who also specialized in Sports Medicine (and was the team doctor for a couple of local colleges and the arena football team). My dad described my problems to him, and immediately he told him I had ankle instability. He asked if I would come in to see him and he would look at my ankle and get me started on some therapy. He also did not like the idea of jumping to surgery. So, I thought, why not?

I learned from him that chronic ankle instability, was truly a clinical term. And that there was potential to gain some of my “tightness” in the ligaments. This is my understanding of what occurred from the original ankle sprain:

While rolling my ankle off of an 8″ curb, the lateral ligaments of the ankle were stretched out and had small tears made in them. The tears healed, but the ligament did not retract to its original size and remained lengthened. Thus, creating a lax ligament that was not able to perform its function of holding that ankle joint in place.

As a result, the other muscles and ligaments in my foot, ankle, even lower leg, had to work harder to compensate for the additional movement in the ankle joint. If those muscles and tendons became over-worked, then my knee and my upper leg and my hip became out of alignment slightly and those muscles and tendons tried to compensate for it as well. See how the problem spreads?

The goal with the chiropractor was to strengthen the muscles around the ankle and get rid of some of the scar tissue. So physical therapy began, with minor exercises to improve my range on motion. For two weeks, it hurt and nothing improved.

Then the chiropractor went to a seminar on ankle injuries. Next time I saw him, he took hold of my feet and felt all the bones and their placements. Most of the bones in my left were out of alignment (comparing it to my right). He went to work to set everything back. Yes, he literally popped my talus, my arch, my toes, even my knee, and to my shock my lower back. It hurt some and throbbed as usual afterwards. However, the next day, I had no pain in my ankle, knee, or hip!! It was a miracle.

I went to the chiropractor one or two days a week, doing the physical therapy and getting realigned. If I didn’t do anything too strenuous, the ankle stayed in place for about a week. I walked for exercise during this time, and went from 20 minutes to 50 minutes before rolling the ankle. It was a huge improvement. However, despite wearing an ankle brace, I”d still roll my ankle walking on a flat surface. By January of 2014, five months after seeing the first surgeon and doing physical therapy, I thought it was about time to get a second opinion and explore my options.

Tag: ankle instability

The Solution: Lateral Ankle Ligament Reconstruction and Arthoscopy

The Problem: Ankle Instability