Update 2 Years Out

Hello all! I am so sorry that I have been away for so long. It is extremely difficult to try keeping up this blog while taking care of a baby, and I don't have the internet at home so I can't get on and post whenever I wish.

Quick update on my ankle 2 years out from my second surgery. I experienced some very minor problems this year with my ankle. I believe it is because of the swelling I experienced after giving birth. I feel like the muscles and tendons were stretched slightly and I started to feel a strange pop every once in awhile. The popping was on a much smaller scale than normal subluxing peroneals. I believed that it was intrasheath subluxing peroneal tendons (where they were just snapping around inside of their groove, not fully popping out over the bone.) However I began walking every day and slowly the popping went away. So I am hoping that the stretching that occurred in my ankle was finally able to tighten back up. My scar is looking good, but I have scaly dry skin above it. I try to lotion it often but the dry skin remains. It is not itchy or irritating though, so I don't worry about it. Please excuse the low quality phone picture:

I know that I haven't been able to answer all of the questions emailed to me. I never expected that so many people would have subluxing peroneal tendon questions. Going forward, I may not be able to answer every question, but if you have a guest post specifically relating to your ankle, then you can email it to me at emilygreenie@gmail.com. Make sure the title of the email says something about a guest post. Then I will post your experience here, and if you have a few questions you can include them at the bottom of your post hopefully people will post answers or similar experiences in the comments section at the bottom of the post. Thanks so much for reading, and I am hoping that when we are able to get the internet at home that I can update this blog far more often. Awareness of subluxing peroneal tendons is so important since it is so often misdiagnosed!

I'm back!

Hello all!

I am so sorry that I have virtually abandoned this blog. I had a baby 3 months ago and he was diagnosed at week 18 in the pregnancy with a very serious birth defect called a Congenital Diaphragmatic Hernia. Sadly, 50% of these babies die after they are born. Corrective surgery must be done soon after the birth. So the pregnancy was very high risk, and I had to move away from home for the delivery. He was in the NICU for a miraculous 36 days (they originally told us to plan on 4-6 months) and he is now 3 months old and doing better than anyone could have expected. (feel free to check out my personal blog if you want to keep up on that story - http://holdenandemilygreen.blogspot.com) So that is why I have been missing in action!

I would love to help anyone out with questions pertaining to subluxing peroneal tendons still. Please email me at emilygreenie@gmail.com, or use the contact form found on the sidebar. If you would like to write a guest post for me about your ankle experience, I would absolutely love to post it for you. This blog gets much more traffic than I ever imagined it would, so it is a good place to share your story and help others!

It is about a year and a half out from my last ankle surgery. It had been doing wonderfully until the later stages of my pregnancy. It is still not subluxing, but it sometimes feels stiff. I am hoping that it gets better. My husband is in school to become a physical therapy assistant, so he has been helping me to re-strengthen it. Here is a picture of my ankle, taken this morning. (It is very hard to get a picture of your own ankle, so sorry it isn't great!) The red line curving behind the bone that sticks out is the scar. Keep in mind that I have had this surgery done twice now (through the same incision both times) and so my scar may be more prominent than others who have only had the surgery once. Thanks for stopping by, and please contact me if there is a certain topic that you would like to see up on this blog, or if you have questions!

Intrasheath Subluxing Peroneal Tendons

For those going through intrasheath subluxing peroneals (where the tendons pop and snap, but they don't pop out over the bone), I found this article, and I feel that it is extremely informative! Check it out if you feel that you may have a problem, but don't think that it is a traditional tendon subluxion. The cool thing is that the surgery doesn't look as invasive as it does with the type of repair that I had. If you think that you are suffering from this, I would even print out the article and take it in to your doctor to read. It's such a rare thing that some doctors may have no idea what is wrong with your ankle. If you are able to show this information, no doubt they will be impressed, and you will have a faster road to recovery because sometimes being diagnosed is the hardest part! The link is below:

http://www.hindawi.com/crim/medicine/2013/274685

P.S. It has been 1 year since my last surgery! The surgery took place on Dec. 21st 2011. I will take a picture and post it soon so that you can see what my ankle looks like after having a year to heal!

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!

My Ankle Injury Story (And a Couple of Ankle Pics)

Sorry I haven't been updating this blog as much as I should. For work, I began writing for proformcoupon.com so my focus has been elsewhere lately, but I really want to increase awareness of peroneal tendon subluxation! It has been almost a year since my last ankle surgery, and I'm happy to say that my ankle is doing pretty well at this point. Up until about a month ago, it was still painful to touch the outer ankle bone and the surgery area, but now it is doing much better. My husband is in Physical Therapist Assistant school right now, and he has been coming home from school lately with all of these little range of motion exercises to practice on me. Even though he only started doing them a month or two ago, I think they have really helped  with the healing process. The bottom line is that this injury isn't something that you recover from overnight after your casts and braces are removed.

I received an email today asking about how I was originally injured, and I realized that I never really talked about that on this blog, so here was my response to her:

So I have gone through the surgery twice now - once about 5 years ago, and one almost a year ago. With the first occurrence, I was riding a longboard (long skateboard) on a paved trail, and I hit a rock that was sitting on the path. It caused me to fly off of the board, and it all happened very quickly. It felt like I just smacked the outer side of my left ankle on the pavement really hard. It was very painful but I just figured it was a sprain because it showed all of the characteristics of a sprain. I didn't even think much about the popping when it started because I figured it was just a temporary thing and part of the recovery process. Finally, more than a month after my injury, I went to get it checked at an instacare because I could see that it wasn't getting better. They took x-rays and such, but then just referred me to ankle specialist. The ankle specialist told me that I would need the surgery, and that was that. The recovery from the first surgery didn't seem too awful really.

I re-injured my ankle 4 years later, literally just running from my car to my front door, and I just rolled it. I was shocked, and it hurt so so badly. Worse than with the first injury (probably because it tore up everything that they had tacked down in the first surgery). I guess I am kind of prone to this injury because I have very flexible (and thus unstable) joints. The second surgery was last December, and the first week of recovery was horrible. I was extremely sick because of the medications. I was on bedrest for that first week, but even after I was off bedrest I didn't want to get up for anything. Luckily, after about the first 2 weeks, I felt much much better and I was able to return home (I had been staying at my parents house so they could take care of me). It has been almost a year since that surgery and my ankle feels good and stable. I don't regret getting either of the surgeries, though the second doctor/surgeon seemed more knowledgeable to me about the whole thing and I feel like my ankle isn't going to "come undone" again. Hope this helped a little, and if you have any specific questions, just let me know. I'm just trying to raise awareness a little because I was so frustrated when I realized that there is a serious lack of information about this injury.

If you haven't read about my most recent recovery from ankle surgery, check that out here.

And I'd just like to leave you with two cell phone pictures that my sister took right after they removed my cast at the beginning of January this year. They took off the cast 2 weeks post surgery. These were taken right after the stitches were removed (which was a very painful process!) You can faintly see the 'YES!' that I wrote on my ankle before the surgery to make sure they were operating on the correct ankle. You can also see some purple pen marks around the scar. Also, my ankle and calf are really thin because they had started to atrophy. And the last thing to take note of is my blue toenails. I had gotten a pedicure a few days before the surgery so that my toes could "look cute" in my cast. Then at the hospital they said they would have to remove the polish so that they could make sure that my toenails weren't actually turning blue after the surgery. I begged them not to take off the polish, but I was doubtful that they would listen. When I woke up from the surgery, my first question to the nurse was whether or not my toenail polish was still there. And it was! The little glimmer of happiness in my life that day :)

Recovering ankle update: Out of the cast!

Hello everyone, I got out of my cast on Friday!

I was in the cast for about 4 weeks. Once out of the cast, my foot feels all weak and wobbly. It takes some time to get adjusted to walking. I am putting most of my weight on my right foot. I have an aircast that protects my ankle from rolling until I get back my strength through exercises.

Aircast Airsport

I start physical therapy tomorrow. My surgical wound seems like its almost healed (see the picture below). There was a lot of dead skin over it when they took the cast out. The ankle was also pretty stiff. My surgeon checked to see if the tendon was now stable and not subluxing. I did not have the strength to push against his hand so he applied some pressure and felt that the peroneal tendon was stable and wouldn't pop out. That is all for now, I will add in another post once I start physical therapy!

My ankle after coming out of the cast

Follow up from Brian

Hey guys, if you haven't read about Brian's P.T.S. Experience yet, check it out. In the meantime, here is a follow up that he sent to me, via email, about it. I especially love that he talked about various stretching exercises that he does in order to keep his ankle feeling nice and strong. Thanks for sharing Brian! Glad to see that you are doing so well now!

I'm glad that you want to share my story on your blog, and would be happy to help anyone out who can benefit from it.  I know that when I went through this, there was no forum like this at all.  One of the reasons I provided so much detail was because there's very few detailed explanations (that the normal "non-medical" patient can understand).  Truth is, a lot of physicians probably don't even have a lot of experience with it because as you know it's rather uncommon.  Honestly, in a way, it was very therapeutic and liberating to tell my story.  I probably mentally held onto this way too long.  Thank you!

Yeah, I think for a few years even after I described I would get some occasional stiffness, aches, etc.  But it was almost always after doing a lot of activity (like a long jog).  Compared to the uninjured ankle, it might just be "a little more sore" the next morning.  But, not a big deal.  The one thing that I noticed for a long time, which has improved (but maybe not fully, as I still have to be conscious to stretch every now and then), is my soleus muscles can still tighten up quite a bit.  To kind of stretch it out, I will put my hands against a counter top or wall and then bend my knee while doing a calf stretch.  I can usually go down quite a bit further on the good leg.  Also, sometimes I will do a "deep squat" with just my own body weight and sort of "sit on the back of my ankles" for about thirty seconds.  Also, I'll sit on a seated calf raise machine, put some weight on it, and just let my foot stretch out for about 30 or 40 seconds.  That really stretches them out.  For the most part, this "feels good" (in a normal exercise stretching kind of way).  But, over the years, I've just naturally seemed to have gotten a lot of ROM back without really doing anything special.  

To this day, I still run a lot, row on a crew team, and lift weights three or four days a week.  My ankle never slows me down and I never think about it, or even have any concern for it.  The scar, which looked horrible for the first few years, doesn't even look that bad anymore.  All the feeling nerves grew back and it doesn't "feel numb or strange" anymore either.  It did for several years.  Even though going through the injury was awful, the after effects of it seem to be more desirable than perhaps a bad sprain or fracture (at least you don't seem to have to worry about instability, arthritis, etc. like you do with the other more "normal" ankle injuries).

It's kind of ironic that  I recently sprained my other ankle doing a trail run by my house.  I'm seven weeks out and seem to be recovering as planned for a Grade II ankle sprain (ATFL tear).  Still some pain and stiffness after being a boot for a month, but actually "improving" (as you know how it is with the subluxation... doesn't seem to "improve" a whole lot after you reach a certain point).  I went to the same surgeon.  When he saw me, he said "I remember you!  You were a young guy back then" (ha!), but only goes to show how much I was in his office for this particular injury.  He's probably had a thousand or more patients since I last saw him.  He kind of discharged me years ago and I never really followed up with him.  I told him that "you fixed my problem last time" and he looked genuinely relieved.  He said "I wasn't sure if I did or not" because I had the pain, etc.and never really sent him a letter or anything (I figured he was too busy).  Anyway, I had him check for the subluxation and he said I was fine this time... but like anyone who has been through this surgery, I'm always paranoid about it!!!