Surgery Q & A

One of my readers emailed me and asked the following questions about my ankle surgery! Rather than just responding to her, I thought it would be a good opportunity to share my answers here, just in case some other people out there have the same questions. If anyone reading this has any other questions, feel free to email me at emmagreenie@live.com and I will try to answer any questions you have as quickly as I can!

Q. Following your first accident did your peroneals completely sublux (i.e the superior peroneal retinaculum is torn or damaged)?

A. Yes. After my first accident, the peroneals were subluxing completely. The doctor told me that my retinaculum had been stretched beyond the point where it would heal itself naturally. So the tendons would pop clear up and over the fibula (outer ankle bone), then they would snap back into place. With my second injury, the peroneals didn't pop out quite as far as they did with the first (probably because of the way that the retinacula was fixed during the first surgery), but the popping hurt much worse with the second injury.

Q. With your surgeries (first and second) what was performed? Did the surgeon repair the retinaculum and deepen the groove (fibula)? 

A. In some cases, the groove must be deepened. This usually happens when people are born with shallow grooves, and that is part of the reason that their tendons began subluxing in the first place. I consider myself very lucky because my grooves are deep enough and they did not need to be deepened by the surgeon.

I am also lucky because during both surgeries, my tendons didn't need to be repaired. Sometimes the tendons will tear, either during the initial injury, or as a result of all of the popping out as they are weakened. It's my understanding that if your groove needs to be deepened, and/or the tendons need to be repaired that the healing time may take slightly longer, and may be a bit more painful. I never had an MRI, and in both cases, the doctors decided to wait until the surgery to see if it was a groove problem, or if the tendons were damaged. Luckily, both times it was just the retinacula that needed repair.

Q. If your SPR (superior peroneal retinacula) was repaired how did the surgeon perform that part? I've seen the drilling out of fibula and making a latch to hold the SPR in place. Looks "full on" : )

A. I honestly don't know a whole lot about how the retinacula was repaired in the first surgery. (I was 18 at the time, and didn't think to question many things about it - my mom would know a whole lot more than I would). I believe that with the first surgery he cut part of the retinacula out and then stitched it back together to make it tighter.

With the second surgery, my new doctor wanted to make sure that this wouldn't happen again, so I did have the fibula drilled and I believe some of the retinacula was pulled up through it in order to keep in in place. I have heard of people having a bone block, where basically a piece of bone reinforces the opening that is covered by the retinacula, but I didn't have that. I do know though that the healing process was longer with the second surgery, and I would attribute that to the fact that my bone was drilled through. It took about 9 months before my fibula finally stopped hurting when it was touched.

Q. You were in a hard cast post second surgery for 8 - 10 weeks? Did you use a cam boot (strap in inflatable walking boot)?

A. I was actually in a hard cast after my second surgery for only 2 weeks (sorry if I said 8-10 somewhere!) I found it very interesting that the doctor put me straight into a hard cast (when I woke up from surgery it was already on). The cast was very loose and cushioned with gauze to allow for swelling, and for the first 4-5 days following the surgery, the swelling made the cast feel very tight and almost claustrophobic. However, after that period it was fine for the remaining week and a half or so. I did not put any weight on my leg while I was in the hard cast. However, every doctor is different. Bhargav, who has been sharing his recovery with us, says here that he had a hard cast that was able to bear some weight. I was fitted for a walking boot after the hard cast came off.

Q. How long before you could say walk 40-50 mins at pace for exercise?

A. After being fitted for the walking boot, I was on crutches and couldn't bear weight for another 2 weeks (see timeline below), but after I was able to bear weight on the walking boot, my mobility no longer felt restricted. I assume that this question is referring to being able to walk without the aid of a walking boot or brace, in which case it would have been about 4 months after the surgery.

Q. Sorry to ask, what about scarring?, Did you have endoscopic surgery or open surgery with an approx 10 cm cut? 

A. Both of my surgeries have been open. For the second surgery, the I was cut open in the exact same spot as the first so I don't have two separate scars or anything. The scar is between 2-2.5 inches long, and it runs under my ankle bone. (You can see the pictures of it at the bottom of my previous post, here). I need to take some updated pictures of it, now that it is almost a year post surgery. The shape and length are still the same but it is not too noticeable now. It just looks kind of red and shiny. After my first surgery it did not stand out as much as it does now, but since it has been opened twice in the same spot, it's understandable that it shows more.

Here's another picture of it, immediately after the stitches were removed. It is a little more high def than the ones on the previous posts because it wasn't taken with my old cell phone.

I do have a picture of my ankle after I drew a henna tattoo on that ankle, and here's a picture of it before I took the henna off. You can see the scar a little bit in this pic, and see that my ankle is a little swollen. This was about  4-5 months after the surgery.

Q. Have you been able to return to skate boarding, running?

A. Sadly, I gave up skateboarding after my first surgery. Not because I was scared of it, but just knowing that I have loose joints and that I am prone to this injury, I decided not to take that risk anymore. Plus, I never was good at skateboarding, haha. I just did it because I thought it would be cool, but in all honesty I have horrible balance and it was never one of my passions or anything. If I was good at skateboarding then I probably would have taken it back up. As far as running goes, I ran cross country in high school, but since then I haven't ever really trained for a race or anything. I really just run to stay in shape, though I don't do it as often as I should. After my first surgery, I didn't change anything about my running. I really just never thought I would re-injure my ankle. After the second surgery (considering how easily I rolled my ankle and needed the second one), I began being more careful. Even now, I am still very careful when I run, or walk on uneven surfaces. I read some treadmill reviews, and ended up getting a treadmill because for me, running on a flat and steady surface feels safer. Swimming is also great exercise and I enjoy it very much - and I don't have to worry about my ankle when I swim. I have very lightly twisted my ankle while walking since my second surgery, but it felt very stable and never hurt. So my hopes are that the second surgeon really has fixed it for good.

Here is a brief timeline of when things happened after my second surgery:

Sept. 2012 Twisted Ankle, went to instacare (who said it was only a minor sprain)

Oct. 2012 Went to ankle specialist since I recognized that my peroneals were subluxing

Nov. 2012 Met with surgeon in Northern Utah (4 hours from home)

Dec. 2012 Went in for surgery the 21st, and was put in a hard cast when surgery was complete. Was extremely sick and on bedrest the first week. (I'm allergic to pain medications, which is why I was sick). Second week was feeling a bit better, and could hobble around on crutches.

Jan. 2012 Two weeks after surgery I went to the doctor and had my hard cast removed and stitches taken out. I was fitted with a walking boot (one that used straps and an air pump to tighten). I still wasn't allowed to put weight on the walking boot for 2 more weeks.

Late Jan. 2012 One month post-surgery I was able to start putting weight on my walking boot. This was initially hard to do since I hadn't put any weight on that leg for an entire month. After getting used to it though, I felt much better.

Feb. 2012 Two weeks after beginning to put weight on my walking boot I met with the doctor again and he fitted me for a smaller, soft ankle brace. (This was 1.5 months post surgery). I wore nothing but flip flops with it, though you could fit it into some shoes. I was told to go to physical therapy one month after being fitted for the brace, and to continue using the ankle brace for about 2 months total. (and to use it for any rigorous exercise for up to 6 months post surgery)

March 2012 I didn't go to a physical therapist, though if I was going to, now would have been the time. I didn't go because I am a poor college student with horrible insurance and the surgery cleaned me out financially. Since I had gone to physical therapy after my first surgery, I began doing the exercises and using my theraband at home.

April 2012 I stopped wearing the ankle brace in early April, and because I had been doing my exercises, my ankle felt good and stable. My ankle continued to be sore to the touch and slightly swollen up to 9 months post-surgery. Now it is what I would consider to be normally sized, and it doesn't hurt. The range of motion is nearly the same as my good ankle.

I hope this has been helpful to some people! I know it is very long. If you have any other specific questions, just let me know and I will do my best to answer them!