Prognosis - Right Ankle?

[physiobob]

Firstly you can attach the images and they will be viewable in the post. This is more efficient as they will be reduced to load faster.

Secondly, your MRI does show the full fibula if you change the sequential numbers at the end of the image reference in your first post. It does not show any major non-union to the right fibula although there is some trauma to the lateral ligament complex so it's nice to have seen that and have it comfirmed with your latest posting.

I believe the Surgery you have had uses the peroneus tendon (peroneus brevis - see attached image) to harvest a graft. From what I have seen and what you're describing your pain is probably related to the tendon graft healing and you need to give it more time.

Here's some bunf on the Modified Brostrom Proceedure.

- Surgical Technique:
- curvilinear incision is made over distal anterior border of lateral malleolus;
- if peroneal tendon exploration is necessary, then consider a posterolateral longitudinal incision;
- beware of peroneal tendons inferiorly, sural nerve (which lies over the peroneal tendons), lesser saphenous vein
(which can be ligated), and branches of the superficial peroneal nerve (intermediate dorsal cutaneous nerve);
- after dissection procedes thru subQ tissue, identify and preserve the inferior extensor retinaculum, which runs parallel to the CFL;
- this is mobilized for later attachment to the anterior edge of the fibula;
- identify the ATFL, which appears as a thickening in the anterior joint capsule;
- if it is torn, it is usually torn from the fibula;
- make anterior capsular incision along anterior margin of fibula down to its, distal tip, leaving a small cuff of tissue
attached to the fibula (to facilitate later repair);
- identify the CFL at the inferior tip of the fibula;
- ankle is then placed in valgus and dorsiflexion, and the redundency of the ligament is assessed;
- sutures are passed thru the proximal edges of the ATFL and CFL;
- drill holes are made in the distal fibula;
- sutures are passed thru the drill holes, and are tied;
- the posterior edge of the extensor retinaculum is then opposed to the anterior edge of the fibula;
- this advancement of the retinaculum will help re-enforce the repair, limites the inversion, and addresses associated subtal instability;
- modified procedure using peroneus brevis:
- procedure results in significant loss of eversion and inversion;
- tendon harvest:
- procedure involves exposure of the peroneus brevis, while maintaining the integrity of the superior peroneal retinaculum;
- anterior third of the tendon is isolated distally and split from the distal position to the musculoskeletal junction;
- this tendon portion is transected at its proximal aspect;
- tendon anchorage:
- a drill hole is made through the distal fibula, and the split portion of the peroneus brevis is passed thru this hole;
- tendon is tensioned with the foot in mild plantar flexion and eversion;
- post op care:
- standard involves 6 weeks of casting, but there is some evidence that there are better functional results with
3 weeks of casting;