Longitudinal split tear with tons of scar tissue in a peroneal tendon

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When I had my last surgery last May, my surgeon refused to touch the tendon due to the amount of scar tissue. Said he'd do more harm than good if he did.

I've been getting ketamine infusions for the pain, but they have not been helping at all.

Back in November I had a bizzare accident at home, fractured the talus and possibly tore the repaired atfl ligament and the extensor tendon in the process.

Almost 2 months later I'm still in a lot of pain from those 2 injuries, I find out on Thursday how bad the damage is.

But my concern is the peroneal tendon, not sure which one honestly, but it has a longitudinal split tear in it. It's also encased in scar tissue.

The pain in the upper part of the tendon by the ankle joint is getting worse. It gets difficult to walk when the pain flares up.

I've been trying to research any procedure that could be done to fix this problem. I come up with a tendon graft. That was supposed to have been done during the first surgery, but that surgeon failed to do it.

So replacing the tendon with one that's undamaged I think would work, would probably help decrease the pain I'm in.

Thoughts?

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9 Replies

  • Posted

    Kristina did you get a 2nd opinion on your first surgery? Most insurance plans will cover one. I would definitely seek one next time around. Every surgeon does the surgery his own way. Sometimes it takes a second opinion not because the surgeon is “better” but she/he might have a different way to do the same thing or just be more confident in the way your case presents itself. I have no idea where you live or what medical facility you have access to, but with the level of pain and dysfunction you have I strongly suggest you seek out an orthopedic surgeon that specializes in ankles, probably only does ankles. All orthopedic surgeons are not the same even though they might all do joints, tendons etc. I personally like teaching hospitals because of their team approach and that they keep up with the studies and changing ways to do things. Having said that I’m careful to weigh the surgeons age and experience carefully. I don’t want the newest kid on the block and I definitely don’t want the surgeon pushing retirement that has done hundreds of procedures the same way for the last 30-40 years. I have had a hip replacement, knee replacement, and now ankle reconstruction. Through my hard earned experience I was shocked  to find out how different their approachs are to the same surgery. Somehow I thought there was one best way, you learned it, updated it over the years but basically all the surgeons did it the same. So my theory was find the surgeon that had done the most surgeries thus had the most experience. 

    For instance the first surgeon I scheduled with for hip replacement was the head of orthopedics department . Wow he was so experienced what could be better. Luckily I found out before the surgery that he did all his hip replacements from the front not the back. That’s the way they used to do them. But the difference in pain and recuperating is major! With a front incision you have many restrictions of how you can move with your leg/hip and significantly longer down time.

    Last of all, I had a similar situation to yours with a torn hamstring that was misdiagnosed so it wasn’t repaired quickly. I had tons of scar tissue wrapped around the sciatic nerve, tendon, hamstring etc. The surgery could be done but would require the surgeon to spend an additional 2+ hours to carefully and tediously separate everything.  The first surgeon didn’t want to spend that kind of extra time that he wouldn’t get paid for. Luckily, because I had no idea that was the case, my second opinion doctor carefully listened and explained what the whole procedure consisted of. Together we decided that I was very motivated to continue to be active and needed this surgery to be done the more complicated way to be successful. He became willingly to do the tedious front end work because he saw my determination, he saw me as a person not just a case. He told me several times although he was completely confident in doing the procedure and had done it many times he wasn’t willing to do it on a regular basis.

    Sorry this is so long, I didn’t mean to preach at you. My main point is don’t give up, keep trying to find the right doctor/surgeon for you. It’s a quality of life issue!

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    • Posted

      The 2nd surgery was from the 2nd opinion. He did both of my shoulder surgeries in 2015 and 2016. He knows what he's doing and I trust him.

      He predicted the outcome of his surgery and he was spot on.

      When I see him on Thursday, I will be asking if he's willing to do something. The pain getting worse is not a good sign. He might think about something for the next surgery if he has to do one to fix the ligament and other tendon.

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    • Posted

      Oh and the wait to see another surgeon could be upwards of a year, not something I really want to do.
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    • Posted

      Kristina,  Nancy provided you with great advice. There is something terribly wrong when you need to get ketamine infusions for peroneal tendon problems. I hate to put it this way but I would not let the surgeon who operated my shoulders to perform surgery on my ankle. It does sound like you need a third opinion! Please reread Nancy's comment. Wishing you all the best and keep us posted.

       

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    • Posted

      He is actually the best ankle surgeon in the city. The first one caused the damage to begin with that this surgeon was left to fix.

      The first surgeon ignored all of my concerns, refused to investigate them, said they were nothing and that the pain I was in was normal.

      The current surgeon said my concerns were valid, sent me to other specialists where other issues were ruled out.

      He was working blind for the surgery, only had the MRI report, no imaging as the MRI was done at other hospital.

      He referred me to pain management, it was the dr there who decided on the ketamine infusions. Apparently he thinks I'm having nerve pain when I'm clearly not.

      The focus has been on the ligament repair as the accident I had probably tore the repair.

      My surgeon will listen to me on Thursday about my concern with the tendon, fortunately he does not ignore concerns, never has, never will.

      He did a good job with my shoulders, I recovered within 2 weeks from the first one. The second one was more complicated, and me being diabetic doesn't help anything.

      I was diagnosed between my first and 2nd shoulder surgeries, diabetics are more prone to scar tissue.

      If I suggest a graft, he will consider it, but he's focusing on the fact that I've already gone through so much, and he'd rather not put me through any more than is needed.

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  • Posted

    Kristina, you know your body better than anyone else and I’m sure you will make the decision that’s best for you.

    You reached out on a forum and asked for advice-some advice was given to you. Please don’t get defensive. We shared our advice because we cared enough to respond, no one is judging your decision-it’s your decision to make. 

    I wish you you all the best!

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    • Posted

      I ub, unfortunately that's the way I am, I don't always take the advice given to me. Often I find myself needing to be right instead of wrong. That's just me.

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    • Posted

      I saw my surgeon and have been letting reality set in since I did.

      He looked at the ultrasound report, it was discovered that the atfl ligament cannot be seen, which means it did indeed tear.

      Surgery is on April 27th, and will be 3 procedures. I did suggest the allograft, and he said that he wanted to do that for the tendon, but as well for the ligament.

      He is going to do an atfl reconstruction, and will also install an internal brace. All of this should make my ankle stronger.

      It's going to be hard.

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    • Posted

      I see him tomorrow about a potential glenohumeral retear in my right shoulder, but will be bringing up an incident from last week.

      I was up in a step stool when it suddenly collapsed under me, injuring my ankle more. I'm concerned about the tendon that I thought was damaged after my accident in November.

      Hopefully it's nothing serious, otherwise it will just mean more work during surgery.

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