re: Prognosis - Right Ankle?
Here's a bit more info on that proceedure. In general a bone scan would be the best first investigation to look for any "hot" spots. This will rule out any stress fracture or confirm the value of further investigation.
You also have a nerve exit point, for memory of the superficial peroneal nerve about where you dot is. This is a common site of pain post ankle injury and one which if treated locally to that point with things like soft tissue massage release techniques and neural mobilization works rather well.
Please let us know how you get on.
BROSTROM/Brostroem/Brostrom-Gould repair
Recurrent sprains tend to stretch out or tear the lateral ligaments (on the outside of the ankle) resulting in further ankle instability. Pain is another symptom, especially when squatting is attempted. Ankle sprains can be stabilised by strengthening the peronei muscles and propioceptive training. If surgery is needed, the Brostrom-Gould repair plicates the torn ligament and uses a periosteal flap to further strengthen the repair. Athletes do return to sports after such procedures without loss of motion.
There is more information on this and modified proceedures here:
Modified Brostrom Procedure - Wheeless' Textbook of Orthopaedics
BROSTROM REPAIR: REHABILITATION PROTOCOL
FOR CHRONIC ANKLE INSTABILITY
General Considerations:
• Time frames mentioned in this article should be considered approximate with actual progression based upon clinical presentation. Careful observation and ongoing assessments will dictate progress. - No passive inversion or forceful eversion for 6 weeks.
• Avoid plantar flexion greater than resting position for 4 weeks.
• Carefully monitor the incisions and surrounding structures for mobility and signs of scar tissue formation. Regular soft tissue treatments (i.e. scar mobilization) to decrease fibrosis.
• No running, jumping, or ballistic activities for 3 months.
• Aerobic and general conditioning throughout rehabilitation process.
• M.D. appointments at day 1, day 8-10, 1 month, 2 months, 4 months, 6 months, and 1 year post-operatively.
0 – 3 Weeks:
• 90° immobilizer for 3 weeks. - Nonweightbearing for 3 weeks--no push off or
toe-touch walking.
• Progress from posterior splint to pneumatic walker once most of swelling is gone.
• Pain and edema control / modalities as needed (i.e. cryotherapy, electrical stim, soft tissue treatments).
• Toe curls, toe spreads / extension, gentle foot movements in boot, hip and knee strengthening exercises.
• Well-leg cycling (bilateral once in walker with light resistance), weight training, and swimming in posterior splint after 10-12 days post-op.
3 – 6 Weeks:
• Progress to full weight bearing in walking boot. Walking boot weight bearing for 3-6 weeks post-op. Aircast splint for day-to-day activities for 6-12 weeks post-op. - Immobilizer for sleeping for 4weeks, then Aircast splint for 4-6 weeks.
• Isometrics in multiple planes and progress to active exercises in protected ranges.
• Proprioception exercises, intrinsic muscle strengthening, manual resisted exercises.
• Soft tissue treatments daily and regular mobilization of intermetatarsal and midtarsal joints. Cautious with talocrural and subtalar mobilization.
• Cycling, aerobic machines in splint as tolerated, and pool workouts in splint.
6 – 12 Weeks:
• Gradually increase intensity of exercises focusing on closed-chain and balance / proprioception. - Passive and active range of motion exercises into inversion and eversion cautiously.
3 – 6 Months:
• Progress back into athletics based upon functional status. - Wear a lace-up ankle support for athletics.
re: Prognosis - Right Ankle?
Thanks physiobob for the reply.
I should point out that currently, I can barely walk, so I am not following the rehabilitation for a Broestrom Repair. It is not so much pain (though it is incredibly painful) but a mechanical limitation - I simply have no dorsiflexion at all and if I tried, it just won't happen no matter what I do.
re: Prognosis - Right Ankle?
Best get a good set of physio hands on you to see why there's a mechanical block. If in Sydney for a weekend I'd suggest the gang as the NSW Academy of Sport in Narrabean. But for someone 1000km North you must be close to the border? There's some good physio's in Byron and the surrounding area.
re: Prognosis - Right Ankle?
Just an update.
I saw an orthopaedic surgeon today who has ordered an
MRI of the very specific areas of intense pain along my fibula (there are two very specific spots - about 25mm apart). I will do this on Tuesday 13 January. I have had friends and family confirm that there is certainly an abnormality along the bone as if someone has broken a rod in half then glued it but the surfaces didn't mate correctly. This can be felt at the two spots along my fibula (about 80mm and 105mm above the tip of lateral malleolus).
While I am on the verge of a diagnosis (529 days after the injury!), the condition is now so bad that I cannot walk without a brace (orthodic boot) and even then it is painful. This means I only do essential weight-bearing such as going to see a doctor. i.e. I am in jail for good now.
Thanks for the advice from this forum so far.
Re: Prognosis - Right Ankle?
Just interested in asking a few questions, dibblego.
Have you had any changes to the skin around the foot or lower leg. Skin look glossy? Any hair growing around that area? Boiling hot or freezing cold at times? Skin super sensitive to the touch? Often red or purple? I tried to view on the photos but you didn't compare to the other side and the resolution quality isn't great.
Keen to hear back from you.
Re: Prognosis - Right Ankle?
Hello QuickStart,
"Have you had any changes to the skin around the foot or lower leg."
There is some very mild swelling. I think this swelling has always been there - just that the tissue debridement on 11 December 2008 has made the surrounding swelling subside a little.
"Skin look glossy?"
Maybe just a little around the area of pain, but then maybe I am biasing. If it is, it is barely noticeable.
"Any hair growing around that area?"
No more than everywhere else on my leg.
"Boiling hot or freezing cold at times?"
My leg feels cold at all times ever since recovering from the injury in 2007. I have also lost an enormous amount of muscle on the right side of my body - right up to my shoulders.
"Skin super sensitive to the touch?"
If you touch the area of pain, then I will make a noise - the pain is that gut wrenching type. Otherwise, no other sensitivity.
"Often red or purple?"
No.
Sorry about the photo. I might try to take another one.
What might be interesting to note is that I am finding it increasingly difficult to breath - I suspect due to the muscle atrophy. Twice now my breathing has been so difficult that I started to panic.
Re: Prognosis - Right Ankle?
I am booked for an
MRI of my broken fibula on Tuesday 13 January and I have long maintained to doctors that whatever-it-is, it is deteriorating. I have only recently discovered I have a broken fibula since a tissue debridement on December 11 alleviated a lot of my general pain and swelling - I can feel it through the skin - it is most obvious.
However, my leg is cold and I keep getting sweaty flushes. I am worried about the potential for further complications - my body feels like it is in crisis.
Should I be worried?