Ankle Outcomes Part I: Surgical Advice
As many of you are aware, at my birthday party last June I rolled my ankle severely. Then, when my foot wasn’t healing as quickly as it should, the similarities between my current predicament and my previous tendon tear experience prompted me to drop in on my sports doctor. Multiple visits to my physician and an MRI later, the verdict was that I had developed advanced tendinosis in my peroneus brevis tendon from this latest injury and an associated tear. Another tear? !*&*#$+?!!! This was the same spot that I had had exploratory repair surgery on about four years ago so I was quite grumpy about the prospect of another miserable slicing event. Could an operation be avoided? I had to wait months to find out and now the wait is over for you too.
At the end of November, I was finally able to see my orthopedic foot surgeon to learn if surgery would be necessary to fix my newest tendon rip. After viewing my MRI, he had a slightly different take on my problem than my sports doctor. It was his opinion that I had hurt more than just my tendon with that roll. He believed that I had suffered what is called a grade III ankle sprain. In a grade III, the ligaments that run on the outside of the ankle are completely torn. He thought that my ankle joint had most likely been damaged by my misstep as well.
Not all of his news was bad though. He told my thankful ears that ligaments heal quicker and better than tendons. Tendons don’t get good blood flow so they recover slowly and often not completely but such is not the case with ligaments. In short, my ligaments should mend on their own. What about my temperamental tendon? He said that at this point another tendon surgery was not necessary or advisable for several reasons. He had me at “not necessary” but, for the curious, here’s his explanation why:
For starters, tendon repair surgery is most beneficial the first time around. Subsequent surgeries typically don’t see as good of results. More scar tissue and less blood circulation with each operation mean that you’ve got a onetime shot of fixing a tendon before things get a lot more complicated, as in artificial sheaths, grafts, and other complex unpleasantness.
Also, after tendon repair surgery the tendon usually thickens. While this dense material isn’t normal tissue, that thickening does help prevent the tendon from tearing again. Therefore, according to my surgeon, most people don’t come in repeatedly for this type of operation unless they are obese. He estimated that the minor split in my tendon should remain minor as long as I stay petite and as long as my MRI was accurate, which they are in about 80% of cases. If I don’t gain weight, I will most likely never have to have my tendon fixed again, which is why my doc forbade me from following my tendon’s thickening example. What a bummer, I was planning on gaining 100 pounds this summer but I guess I’ll have to delay my plumping project indefinitely.
Although surgery wasn’t needed, my surgeon didn’t expect my ankle to come bouncing back anytime soon. Due to the history of my foot, which apparently is quite sordid, he thought it could take up to a year for it to heal. My doctor distinctly remembered my peroneal tendons as some of the worst he’s ever operated on. Great. Glad to know that my ankle is famous for being screwed up. However, even with my foot’s baggage, he thought it should continue to slowly mend from last summer’s insult and, as long as it keeps improving, that lengthy recovery is no cause for concern.
He had some advice on how to encourage my ankle back to its version of normality: 1. Wear my brace on any uneven surfaces for the next six months at least and longer if my foot is still not feeling very strong. 2. Participate in physical therapy to improve my balance and decrease pain.
He told me a couple of comforting tidbits in closing: 1. Although my injured ankle feels weak to me, it’s actually very strong. I guess I am tougher than I realize even at my flimsy points. 2. This awful sprain was a fluke of bad luck. Despite my ankle’s problems, this type of injury shouldn’t happen to it again…unless I get really unlucky again.
With the threat of another foot operation removed, it was time to relax and concentrate on the discomfort of rehab. Next week, on Ankle Outcomes, I will be discussing my many exhilarating visits to the physical therapist. This installment will be full of unbridled anguish, unstable characters, and profuse scarring. You won’t want to miss it. Until then, although the suspense is gripping, I’d recommend not holding your breath or falling off the edge of your seat.