Ankle collapsing after fx, surgery. 8 months no treatment. Orthotics made wrong again.

After breaking and displacing my ankle badly I had external fixation, then surgery for plates and screws. Everything looked good, I thought, after 2 months non-weight bearing. I started wearing my shoes with my old orthotics, but my ankle started collapsing, and the arch is becoming flat, now 8+ months later. The ankle has never stopped hurting awfully, despite my pain meds (spine, fibro, etc.).

I saw the surgeon twice - insisted on extra appointments - was put off - just wait. PT made everything worse. In desperation, I saw a podiatrist who recommended better supporting, expensive shoes, which is my only saving grace, then dismissed me. First surgeon (trauma) sent me to an ankle specialist. He put me off until I complained enough to get a prescription for a brace and orthotics.

The orthotics company has made the stuff wrong, unwearable 3 times, can't do anything in less than a month. I saw the fitter again this week, but he hadn't even picked up the orthotics I left at the office weeks ago. The brace may be revised to be made useful, in another month. I have 2 plates on the fibula that stick out at the malleolus, right into the padding of the brace and rubbing on the top edge of the shoe. I lost another 10 lbs from the pain after the surgery and have no fat padding.

On the other side (inside/medial), something is wrong with the tendon that runs under the medial malleolus (posterior tibial tendon), which is causing part of the collapse. I can't turn my foot inward or lift up on my toes. Second surgeon said at second visit he would do surgery in 4 months - shave some bones, put in a graft. Does this sound like a fusion? Because I'm old he doesn't talk to me, runs off as soon as he can. I have a science background and am not stupid! I don't want my ankle fused! But in 4 more months my bones will be so out of place it may be the only thing to do!

I made an appointment with another orthopedic surgeon, whom I trust, but can't get in until end of next month.

My next question is will Medicare allow a second brace?

Alice:
As you are aware, the ankle is an amazingly complex articulation. The bones in the foot and toes numbers more than 20.

Healing after ankle surgery can be very protracted due to waxing and waning swelling. Lymphatic drainage, too, can be impaired - making the lower leg and ankle swollen and painful.

I would be cautious about entertaining another ankle surgery - at least at this time. Too many surgical traumas may set your lower extremity for painful reflex sympathetic dystrophy (now called complex regional pain syndrome).

I had a case of reflex sympathetic dystrophy set in after 3 surgeries over the course of a year to my knee to repair a torn ACL. It was a case of an incompetent initial surgeon that necessitated the 2nd surgery. The 3rd surgery was needed to clear an overabundance of scar tissue that developed as a result of the other two surgeries. My knee said, enough is enough. The RSD was brutal. Absolutely brutal. I would not wise RSD on anyone.

All to say, be cautious about agreeing to another surgery on your ankle. Your ankle may say, "enough is enough" like my knee did.

Although you have had a disastrous orthotic fitting, I would suggest that a new, knowledgeable orthotist may be your best/better option - at least in the short term for recovery of function.

The number of veterans returning home from tours of duty with blast explosions to the legs/extremities has had the effect of the Veterans' Administration and NIH putting additional money and research into orthotics and prosthetics. There is some amazing stuff out there - light-weight composite plastics that are paper thin with superior tensile strength.

Find a good comprehensive rehabilitation center/program and source the orthotists that the center uses. Contact the VA system and see who your local VA outsources for orthotic and prosthetic care.

A dynamic orthotic that is well-designed and personally fitted for your needs may bring you renewed ankle function and hope.

Sending you healing energy and positive karma,
- Karen -

My pain doc agrees with you. He said don't get surgery and give the orthotics company one more chance modifying the brace. Since I'm outvoted (good advice against surgery) I'll try not to have anything major.

I do plan to have the plates and screws removed as soon as I can complain one of the surgeons into it. The pain is intolerable, night and day, way past my pain meds. It's worse than my spine and distracting me from that. It's keeping me from walking, standing to cook a nutritious meal.

I got the new orthotics yesterday, but not the brace. The orthotics are about the same as my old ones, no they won't help, just have some new ones so I don't have to move them. I'll keep using the old ones in my outdoor shoes.

But the brace is nowhere in sight, and I need it. Probably will need it forever unless I get the surgery, and advice from everyone except the surgeon is not to get it. The ankle was broken in October! By the time the brace gets made I may need the original one if I can get the plates removed this fall.

I have 2 plates on the fibula, which is probably why one or both stick out and hit the top of my shoe with every step or just sitting.

I wonder if a plate on the tibia would have prevented the collapse (I call it ankling over).

I highly recommend getting fitted with really good shoes with support built in for ankle problems like mine. I'm wearing the 990 series New Balance which have a metal bar around the heel so the shoe doesn't flop and the ankle is supported. There's another bar in the arch area also. I can really tell the difference between $65 shoes and the new $125 - 155 ones. I put on shoes before taking a step in the morning, have one pair for outside and a different pair for inside.

Alice:
I am sorry to hear that a resolution to your ankle pain and irritating internal hardware is not soon to be resolved.

Current ankle-foot orthoses (AFO) are constructed from light-weight plastic polymers and generally have articulating joints that are also made of high-tensil strength plastic polymers. They are custom molded to you, customized to the contours of your leg and foot.

I do not think that you will have to strong-arm an orthopedist to remove the hardware in your ankle. Most physicians prefer to remove hardware, as people can develop metal sensitivities. Hardware that is permanent includes intramedullary rods and hardware ORIF for hip fractures and shoulder fractures. Ankle hardware is typically removed as there is so little soft tissue to pad screws and plates.

I love New Balance shoes. I favor their wide toe box, They are still made in the United States, one of the few shoe manufacturers not to outsource labor overseas. And their new styles for women are in bright and fun colors.

At least you have a good pair of New Balance shoes to brighten your day. Sometimes we have to look for the inch-stones in our progress rather than looking for larger mile-stones that indicate progress toward a goal.s

Thanks for the replies.

I don't do Facebook - constantly plagued by people wanting to be on my page.

Both surgeons refuse any surgery until a year after the break. It seems to be a policy of all these surgeons. I'm really upset because my ankle is getting worse because, from reading medical material, the posterior tibial tendon is torn. I won't let the surgical resident who told me the tendons were fine practice on me. I can't stand on my toes on the foot, can't even lift up. It should have been fixed last October in the original surgery.

As of 8 1/2 months I still have no brace and the new orthotics are no different from the ones I had for years.

I am planning on calling again to get the most recent x-rays to take to another surgeon for a second opinion. I don't want arthrodesis (fusion) if I can avoid it. I don't mind wearing orthotics forever. I won't go back to the original hospital either, because there is a policy forbidding giving dilaudid for pain, and I don't react at all to morphine and didn't get even remotely adequate pain relief the 2 surgeries there.