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  • No ankle cartilage. Help!

    I am 30 years old. Five years ago I suffered a broken ankle. I had pins, screws and a plate attached and one year later had them all removed in two operations and was told that all went well. I have experienced regular mild pain since and only severe pain after very strenuous activity. I reported this to my doctor and was told that it was to be expected when I pushed my ankle too far. My ankle always recovered after a few days rest. Everything changed this year. I started a job where i stood up most of the time, as apposed to my previous mainly seated job. For the past nine months since I started that job I have had severe pain everyday. I can barely put weight on it in the mornings after sleep and any time after sitting. The rest of the time I hobble about in severe pain. I also have barely any up and down movement in the ankle. After a three month wait I finally got to see an orthapaedic doctor in Melbourne (where I live) who specialises in ankles. He told me I have basically no cartilage left in my ankle and my only option was to have an ankle fusion. After researching this and other options I found that this operation leaves you with extremely limited mobility and leads to further ops in the future as a result of pressure on the other joints. What are my options? Is ankle reconstruction an option for me? Or cartilage regeneration? Or anything non-operative? Please, any advice would be wonderful. I feel that ankle fusion is not an option for a formerly active 30 year old.

  • #2
    Seriously, if you have a missed syndesmosis injury (which often happens in conjunction with fractured fibula), then there is a possibility to get a fusion (screw) between the tibia and fibula to stabilise the joint. This may help - too difficult to explain here and not sure whether it applies to you, but perhaps is an alternative.

    I would avoid a fusion like the plague. It will just stuff up your other joints nearby. Wait until ankle replacement is a little better if the pain is that bad.

    I know it sounds outrageous and callous, but you would be much better off with an amputated foot than an ankle fusion. Amputees in the Paralympics can run 100m in between 11 and 12 seconds in the men's races (which is a lot faster than me). If they had a race in the Paralympics for those people with an ankle fusion, the winner would limp in at about the 30 second mark. This is non-sensical to me, that surgeons could suggest an option that is functionally so terrible compared to the alternative of amputation. If your ankle pain is bad enough to warrant an amputation, then have it cut off and start training for the Paralympics (because at least you will be able to run again, and fast!). If you suddenly don't think the pain is that bad, then try glucosamine.
    The staff of injury update are not responsible for views of other users posted in this forum.

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    • #3
      Rebecca, I have a similar predicament where I have seen 2 specialists both of whom have recommended fusion, but I am not keen on closing all doors just yet. I would be very keen to compare notes on treatments tried and am also keen to hear from anyone else with any suggestions.

      My ankle was operated on several years ago to remove some bone fragments and during the operation it was discovered that the cartilage was worn. Since that operation my ankle has got progressively worse, is starting to lean to the outside and is very painful. I have tried physio, glucosomine all with no improvement.

      I would be interested to hear from anyone who has already had an ankle fusion.

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      • #4
        Hi, I have had a ankle fusion 2 years ago.

        It all started with a dislocted ankle in 1986 I was 17 years old. I had surgery to fix the ankle and after the surgery it seemed ok, but never 100% more like 85 to 90%. I played all kinds of sports after the surgery.

        In 2001 I started to have alot of pain in my ankle and went to see a orthopedic surgeon and she suggested physical therapy and advil. I tried both and it did not work. I also tried glucosimine and different kinds of braces. This went on for about 8 months and the whole time I was going to physical therapy. My doctor had mentioned a fusion as a last resort.

        It got to a point where every step I took was like walking on a nail. I went back to my doctor and she suggested a different kind of brace and I told her that was it. I wanted to get the ankle fusion because I was in to much pain.

        The operation was succesful and I was glad to have it done. The operation was about 3 1/2 hours long and it was day surgery. I have heard that some hospitals will keep you for a couple of days. I was laid up for a couple of months. I have very little motion in my ankle now, but I was glad to get it done. My walking is perfectly normal. I do not were any braces or special shoes.

        I know that this is a very difficult decesion to make. I was there. All I can tell you that it worked for me and I am pain free. I have not experienced pain in any of the other joints, but it has only been 2 years.

        If you have any questions please ask

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        • #5
          Good reply Tom. Post dislocated ankle you might expect pretty severe arthritis which would have meant your ankle could give rise to lots of pain.

          It also sounds like you did your research and worked out that you wouldn't have great function afterwards but wanted pain free daily walking etc. which you now have.

          Good decision and thanks for the input.

          Ironically if you ever wanted to run in the Paralympics you could get an amputation and start bounding away on a new 'joint' that has range of motion, but it obviously would change your life in a way that was completely different convenience-wise and psychologically for example.

          Also, if ankle replacements ever become as good as knee and hip replacements, you could still possibly get one done after a fusion (although they would be trying to create a new 'joint' out of a blob of bone rather than out of a worn one).

          It is never an easy decision when you have a joint with severe chronic pain and obvious severe abnormality on the scans causing it.

          The main point is fusion = decreased pain from the ankle vs. trade off of no function out of this joint (meaning decreased physical activity or pain coming from other joints taking up the slack)
          The staff of injury update are not responsible for views of other users posted in this forum.

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          • #6
            Ankle fusion and the state of doctors

            Thanks very much for those replies.
            I have to let off a little steam first, so please excuse but take heed.
            I saw another specialist yesterday. He gave me pretty much the same (bad) news as the first specialist I saw last year but was, how shall I put it? A better doctor. A doctor being someone who is supposed to advise, help and care for their patients. I had such a bad experience with the first specialist I saw last year, it put me off seeing or trusting another doctor. So I haven't until now. Yesterday's specialist spent about half an hour with me examining, advising, listening and explaining my situation and options to me and all in a pleasant professional manner. Wow! If only i'd seen him first! The first person I saw saw me for 7 minutes. In total. He addressed me in a curt manner, looked at my xrays, then at my ankle, told me terrible news I was not at all prepared for and while I sat there in shock restraining tears, he left the room and did not return. I paid my $150 and left, distraught and confused. Then I did alot of research on the web and informed myself. This didn't cheer me up but at least I fully understood my situation.
            I am no shrinking violet. I am an intelligent and inquiring person but this still happened to me. Think of all the people who aren't so confident with their communication or language skills. It is not acceptable for some doctors to be negligent in this way. People's health is the cost. Be prepared for this sort of negligence and then move on to a real doctor.
            Now that i've gotten that off my chest..
            I have a couple of months to decide whether or not to have an ankle fusion. It seems that this is my only option. Like the specialist told me yesterday it probably won't be me but my body that makes the decision. My pain is so severe and my mobility so limited now that part of me just wants the op now but I'm torn. I thought total ankle replacement might be an option for me, it seems to be having alot of
            success in America but I was told it isn't advised for osteoarthritis, only for rheumatoid arthritis in the elderly. Which is contrary to what i've been reading about in the states. Aren't we leaders in medicine in Australia? I'm seeing another specialist in June (with the support of the present one) who has actually performed ankle replacements as well as fusions which will be the decider for me I guess. Other treatments such as injections or a brace, which end up doing more bad than good, are only temporary fixes for me. Glucosamine is not helping and above all pain killers don't seem to work on bone on bone pain. As you can see it is all quite a dilemma. Any advice would naturally be great!
            In the mean time i'll keep you updated on my progress.

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            • #7
              Hi Tom,
              I was wondering if you wouldn't mind providing me with some more details about your experience with ankle fusion please?
              I'm seriously considering having this op and have a couple of months until I see another specialist to seriously consider the implications of this surgery. He has explained which bones are fused and which still have movement but i'm really trying to visualise and I guess try to experience what it will be like. I suppose i'd like to know how natural your normal walking is and also in varied situations, such as going up/down hill etc? What movement you do and don't have? Can you raise your foot like when you stand up on tippy toes? How far can you bend your knees when standing or squating? Do you do any other form of weight-bearing exercise? Anything else you can think of. Too many details is not enough for me! I know the recovery period is around 6-12 months. How was that experience? What sort of physical therapy did you do and for how long? Pain. Do you have any pain at all now? My pain threshold is really high but am not excited about going through a procedure like this and then still having pain. Of course there are no guarantees and I will ask the specialist all these sorts of questions but you're in a position they're not in. You've been through it.
              I've had three operations on my ankle already for the original break so I understand that sort of pain and recovery etc. I'm not squeemish either so feel free to be gory if need be!
              Any input from you is greatly appreciated Tom.
              Thanks,
              Rebecca

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              • #8
                Hi rebecca,
                I shall have another attempt at replying.
                I have had my right ankle fused in august of last year, I have now learnt that I have a possible non union of the fusion and will have to have revision surgery.
                I learnt this from a specialist in Melbourne that may be a mate of the one you saw, or indeed the same one!!
                I am comeing to terms with the prospect of having to go through the process of doing it all over again. Not such a daunting thought, more the worry of "will it work this time".
                I opted to get it fused for pain alleviation and so far, no good. I guess the non union is fully reponsible for this which is a right pain, pardon the pun, I was looking forward to a relatively pain free foot and will have to wait a little longer it seems.
                If you wish I can fill you in on the intimate details of the arthrodesis at a later stage.
                cheers
                John

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                • #9
                  activity level following ankle fusion

                  Hi Rebecca

                  I'm an active 50 yr old who was used to climbing moutaineering kayaking and a bit of running. I smashed the lower end of my Tibia in an accident. After it was mended I was left with post traumatic arthritis of the ankle joint. I was offered a fusion but when I did some research it suggested that I wouldn't be able to run and that other joints would eventually suffer. For a while I considered a below knee amputation as the only way to recover full mobility. I got to know a Royal Marine officer with the same problem who had opted for the amputation and gone back in the Marines at full fitness.

                  However, none of the surgeons would go along with this and eventually one of them introduced me to another army officer, Andy. This man is 36yrs of age and had a fusion 5 years ago following a parachute accident. I met up with him and aked him how active he was. I was amazed! He can not only walk normally but does long route marches with a full pack. He skis, climbs rock and ice and most amazingly he runs (10km in 40mins). He is presently training for a triathalon. He didn't start running until 15mths after his fusion. He uses normal shoes and boots with sorbothane insoles.

                  Talking to Andy has inspired me and so 7 weeks ago I had a fusion. It was done arthoscopically which is less invasive and has a faster recovery time than open joint surgery.

                  Andy and I are aware that at some time in the future we may get further joint problems(but it's not always the case). If that happens, below knee amputation is an option but we'll cross that bridge if we come to it.

                  As for footwear after the fusion I'm going to check out Masai Barefoot Technology shoes. They have a rocker sole and are highly recommended by our local orthotist.

                  I hope this helps.

                  Best wishes. James

                  Comment


                  • #10
                    Hi Rebecca my name is Tammy and I am searching high and low for info on ankle surgery which may help my partner with his ankles. He broke them both over 20 years ago and is in extreme pain daily. He broke the left one again playing basketball. He is very active and loves his sports, or should I say he would like to be!. It is soooooo disheartening to read the options available. I do know that he swears by a cream call "A little bit of relief" which probably helps more with the arthritis more than his actual ankle problem, but when its a daily thing if it helps its good. He takes tablets daily and our bill for panadol etc is huge!!! (Mainly Nurofen he likes to use). We have 2 young children and the heartbreak is terrible when he can not run and play with them like other dads. As I said we are searching for something but he doesnt even want to have to consider fusion. I dont know if you have read anything regarding frames on the ankle to pull the joint apart thus giving room for new growth of cartiledge, the frame is on for approx 4 months. I only know of these procedure from what I have read on the internet and dont know where this is offered. I wish you all the luck with what ever you decide to do and after reading your letter and others have discovered there are many more in the same predicament. Best of luck with the decisions you have yet to make.

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                    • #11
                      experimental ankle surgery

                      My 19 year old daughter will be having experimental ankle surgery this Friday the 29th. The ankle was smashed in a car accident just over a year ago. She has no cartilage and after a year of plates and screws and pain meds is in pain pain pain. Walking is basically a hobble. She was told by numerous OS to that fusion is her only hope. Also that within 5 years or so that she would have arthritus in her foot as a result of the fusion. We checked out all her future possibilities. We applied to Duke for experimental ankle replacement. Note that she is bone on bone and arthritus set in within a month of the accident. The answer from them is that no case study exists for her case and she was rejected because of her young age. We continued on with no health insurance to find a OS willing and agreeing that in two years something more may be available to her. He waved most of his fees, and got a surgical hospital to wave most of it's fees, we pay for the halo-frame, and the cartilage injections will be donated free from the company. Friday he will go into surgery and take the plate and screws that were left in the ankle and prepare the ankle bones and area for injection room. He will pin and screw the halo-frame to her foot and calf and she will undergo several weeks of injections (we love chickens now) the frame should remain on for 2 to 3 months, the later part slowly releasing movement for her ankle and then slow therapy to see how it all went. We are crossing our fingers and ankles on this one. She is cautiously excited. I will keep you posted if you have interest on how this goes. The surgery will be done in Miami, Florida. Good luck to you all as well.
                      Last edited by CudjoeKrew; 28-04-2005, 12:57 AM.

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                      • #12
                        Ankle Fusion

                        The forum is interesting and should be made available to more people looking into surgery.
                        I had my left ankle fused on 27 January 2005, I am now walking using a walking stick, a fair bit slower than before but the nail driving into my nerves with every step has gone at last. It had reached the point that every step was agony and pain-killing injections stopped working.
                        In 1997, the specialist warned me that fusion was a last resort and I reached it.
                        I am happy to be pain free, am surprised at how much movement I have in the ankle.
                        I am frustrated that I was unaware of how long recovery would be, and not having clearly explained that getting up too early would delay recovery. As a workaholic, I went back far too soon and wound up with an infection that required further surgery to clean out properly (after I discovered the hard way I am allergic to penicillin)
                        Was it worth it - YES

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                        • #13
                          Geoffa, I'd be interested to know more about your experience. I asume you are now out of plaster. I had my fusion in Feb which was done through key hole surgery. Next week it wiil be 12 weeks and i'm hopeing the plaster can come off. Since starting to weight-bear with crutches I've been surprised that I've had a lot of pain in my mid foot and fore foot. It varies a lot depending on what i've been doing. I have a number of theories about it... Swelling inside the plaster may put pressure on joints and nerves.. Other joints are having to move more now that the ankle is fused.... Anyway my consultant doesn't seem worried about it but I sure hope it goes away.

                          I wondered what your experience was during the first 12 weeks. As I said in a previous entry, I know a man who's had a fused ankle for 5 years. He is now training for a triathlon! It shows what can be done if you've no other problems and you arte determined.

                          Best wishes

                          James

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                          • #14
                            Hi James,

                            Yes I am out of plaster, unfortunately I am a disaster in plaster, I had a reaction to the cast so only had 2 weeks in a walking cast, then wound up slowly weight bearing on crutches with no cast. Yes I had a sore forefoot too at first but now that has gone completely and I have soreness in the Achilles tendon as my body adjusts.
                            The first 8 weeks were in a back slab and only the two weeks in a walking plaster. When I first took weight on the leg, I thought they had stuffed up because it hurt so much. I rang the physio who said a small amount of pain was normal. NORMAL, I spent three days on Panadine Forte but then it calmed down and now almost 15 weeks later my left foot and ankle are fine the left knee is a little sore but for the first time in 30 years I am walking with almost no limp!
                            Expect some tenderness in the ankle when the cast comes off and take it slowly but I recommend swimming as soon as you can as it will help rebuild the calf and ankle muscles that will have deteroriated in the cast.
                            Good luck.

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                            • #15
                              I suggest the ankle fusion

                              Rebecca,
                              I saw your post about your ankle injury and read most of the replies. I had severe trauma to both ankles in a car accident in 1975- I was 24 at the time and am now in my early 50's. Both my ankles were fused and I can do a lot of things and never regretted the surgeries.. One thing I did though was go through over 10 orthopaedic surgeons until I found a Doctor I felt was capable to treat me. If a doctor tells me that "I am either a surgeons nightmare or a surgeons dream" I know I am in the wrong place. Spend all of your efforts in finding the RIGHT DOCTOR. Make sure the surgeon is the BEST one you can find.
                              I was really bothered by the post from unjuryupdate administrator that told you that you would be better off with an amputation. Why is he deciding that you need to, or want to run in a marathon--he was putting his own criteria for life in his response.

                              What I Can't Do: can't run or jump--too bad, can't wear high heals anymore but that's ok too. I could however run if a moving train were headed toward me!

                              What I Can Do: ride a bike long distances, go hiking in the mountains, I ski ( not great but good enough for me--don't rent ski equipment--buy the best boots you can find). Ride a horse.
                              Last summer I painted the whole outside of my house (1500 sq ft) all by myself. Just finished wallpapering my kitchen and bathroom all by myself.

                              As far as pain goes - I do have some now and after 4- 5 hours on my feet I am having pain which has gotten worse lately because I let myself get overweight in the last few years. Bad thing to do with bad ankles. But I take naproxyn (over the counter)on a regular basis and it is very effective. I don't take anything else for pain. Sorry to tell you that the surgery is painfull but just tell your doctor to make sure you have lots of pain medication.

                              Ankle replacement had been mentioned to me and there is no way I would do it based on the high percentage of failures and sometimes last only a few years and not long term at all. And as far as amputation-- there's no way I would do that -- I can do alot of things and I don't need to run a marathon!! Hope this helps. Take care. Cindy

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