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Foot tendons tearing daily - Suggestions other than fusion?

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Chronic Pain
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Posted 8/9/2018 6:07 PM (GMT 0)
A few days ago I stepped on my foot, just stood on it, and it felt like all the ligaments tore loose from the outside of my foot. It was bad enough to go to the ER, but I knew they couldn't do anything, no specialists there, so I just took my pills. I was back on my knee walker for 3 days, waited 2 weeks for my doc on vacation..

History:
I broke my ankle 3 years ago and have been miserable since then. I had 2 surgeries immediatley, then a tendon graft on the inside of the ankle a year after that, and last year another surgery for outside tendon rapair, leg tendon lengthening and a wedge inserted in the outside of the foot to stop pronation.
Some of my previous posts:
/www.healingwell.com/community/default.aspx?f=16&m=3881589
/www.healingwell.com/community/default.aspx?f=16&m=3976441

I've had continuous pain for the whole time, daily strains on the outside of the foot, limping a lot, can't walk without my shoes with orthotic inserts. I'm already living on opioids. Muscle relaxants and nerve meds don't work or have too many side effects. This isn't a medication problem. I've tried 6 different foot/ankle braces.


Yesterday I saw my surgical podiatrist, who actually seems quite competent (compared with opinion from an ankle specialist MD). He was able to move my foot joints without causing pain. Pushing gently on the swollen area above the cuboid bone and in the area of the plate caused my to jump. He gave me a steroid injection in the side of the foot where there is lots of swelling and pain. I can go in again for more shots if they help. (Yes, I know there is a limit on steroid treatment!)

Doctor's Long Term Solution: only alternative is FUSION. No Thanks!

Anyone with another suggestion or a story?
Posted 8/9/2018 9:16 PM (GMT 0)
Alice:
Your ankle has been at a weaken point for some time. Repeated ankle strains and sprains can cause chronic ankle instability. Ligaments and tendons are stretched with each sprain or strain and, ultimately, lose their inherent stabilization of the ankle and tarsal articulation.

Think of an elastic band that has been overly stretched and no longer retracts to its former length.

Ankle fusion has a very low rate of success in alleviating ankle pain. The reason being that load forces and required flexibility of the foot and forefoot for walking/ambulatory transfers to other tarsal bone articulatings not accustomed to those forces. Arthritis inflammation, stiffness, and swelling pursues despite the fusion. In addition, vascular blood flow is often diminished in older adults (venous insufficiency). Ankle fusion is notoriously prone to failure.

You mention that you have had several ankle splints. Has not a single splint been comfortable? There are quality ankle splints that address chronic ankle instability. These splints allow relatively free dorsiflexion (needed to advanced the body over the foot during forward walking/ambulation) while stabilizing the joint from excessive pronation or supination (both mechanisms of an ankle sprain). Some people wear functional ankle splints virtually 24-7 to help prevent the scenario you experienced. I like the web site “Better Braces” for discussion of ankle instability and options for dynamic splinting (provides photographs of a variety of splinting options, both prefabricated and custom-molded). Type into your web browser: “www.betterbraces.com”

Lateral instability is the more common finding, owing to the postural line that passes from the hip to knee to ankle. A person with “knock knees” will also be more prone to lateral ankle sprains. A person who is grossly over-weight will also be more prone to repeated lateral (outside aspect) ankle sprains.

Be aware that local corticosteroid injections do have the effect of weakening ligaments and tendons. Repeated injections will worsen your plight. Steroids act to degrade collagen and fibrin at a cellular level. Fibrin and collagen are the basic building blocks of ligaments and tendons. I would urge you to reconsider additional steroid injections into the ankle.

I think your best bet is to continue to look for a dynamic ankle splint that meets your needs for both comfort and medial/lateral (inside/outside) stability.

I am sorry that you continue to have to endure an unstable ankle.
Karen
Posted 8/10/2018 12:48 AM (GMT 0)
Thanks for the advice and the website! I'll definitely look for something different from local stores and prescription place! The cheap ones are comfortable but don't support laterally. The Rx ones are too many layers and ties - too bulky, ruined my expensive support shoe. I can afford something on my own. I have good dorsiflection, but horrible lateral instability! I know not to keep on trying steroids (10 years of spinal injections and nerve burning).

I said I didn't want the fusion. Thanks for the support. I wouldn't be able to walk in the woods with the grandkids, finding mushrooms.

I never had knock knees, just broken ankle that wasn't fixed right. I'm thin. I've always had flexible arch, needed orthotics. The doc said I had no ligament tears, but that wasn't true. That's what you get when you don't demand an ankle specialist in the ER. But then, there aren't any handy. I think my foot is building atrhritic bone growth, feels thick around the ankle and I've lost most ability to turn foot to either side.

I had a few days of PT, but insurance only allows 20 visits. I suppose I could argue chronic condition and demand therapy to retain what flexibility I have left. It works for post-polio patients (court case won). I'll ask my pain doc next month at appointment.

Meantime, knee is hurting, hip starting to hurt, and spine already a mess. Limping is not helpful!
Posted 8/10/2018 1:11 AM (GMT 0)
Alice:
Seriously, visit the web site “BetterBraces.”

BetterBraces has every type of support imaginable for every joint in the body.

The selection of supports for ankle instability due to repeated sprains/strains is impressive as well as state of the art from a biomechanical and construction standpoint.

They have a good reputation and offer helpful advice in selecting a brace/support based on your needs.
Karen
Posted 8/10/2018 2:34 PM (GMT 0)
I went to the site. I have tried two of the braces.

The aircast stirrup is given to patients right after coming out of the walking thing. It was preetty wimpy.
Then I had one of the laceup types from a different company. Too bulky for shoe.

I am impressed that there are some other styles that may work and the company offers help choosing what would work. I like the look of a couple, and there is more information to read. Prices are reasonable, less that what my insurance probably paid and comparable to some of the store products that were useless.

Thanks for the information!
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