Rehab experiences after ankle arthroscopy with debridement and microfracture on talus dome

Today is 3 months and 10 days. I saw the doctor online a few days ago, and he said everything is good. There are some improvements week by week, but it is very slow. Two days ago, I carried two laptops and my lunch and water, when I walked, I felt my ankle did not like it. The ankle is still weak. Another issue is range of motion. My backyard has a slope, when I walk up, the ankle can't bend that much. Currently I am working on ROM and balance. However every time I do PT, ankle does not like it. But without PT, how do I improve ROM and balance? I need to figure it out. Sometimes I am really afraid of surgery failure.

This week is about 3.5 months after surgery, and my ankle felt a lot better all of sudden. The bad pre-surgery feeling is mostly gone. Before surgery, my ankle feels uncomfortable, and I know if I keep using it, the pain will kick in. That uncomfortable feeling prevents me from doing certain physical therapy. Now I feel my ankle is close to normal feeling. I walked 3/4 mile per day for about 5 days now. I will start more aggressive PT. And I usually swim about 30 mins a day and 4 days a week. Moreover, last week I walked uphill on my backyard for 15 mins. Walking uphill on the grass helps me improve balance and ROM. Don't give up.

It is 4 1/2 months after surgery. Saw my doctor this Monday. He did an examination and said everything is fine. I feel my ankle is like a very old battery. It takes long time to charge but it takes no time to use it up. Endurance is still an issue and I probably have 1/3 of normal endurance only. It takes a night to give my ankle a rest, a 30-minute break does not help ankle much. According to my doctor, he said it will take 9 months to one year to get my endurance back to normal. Currently I can walk 1.2 mile without break, and standing for 30 minutes is ok too. But anything longer than that is challenging. I did not do much PT because my ankle is good for either PT or walk, so I choose walking because I want to get back to "normal" life activities. Once my endurance improved, I will work on both PT and walking. My next goal is walking 1.5 miles.

Today is Christmas eve and it is almost 5 months after my surgery. Right after my last post, I saw my doctor for post-op review. The doctor said I am doing really well! The second day after saw my doctor, I experienced a setback. The ankle felt weak and uncomfortable, however after two days of rest, nothing improved, so I pushed through it with a 1 mile walk. The next day the ankle felt much better. Then I broke my daily walks into two. One is morning 20 mins (1 mile) and another one is afternoon 20 mins (1 mile). For the last few days, I have been walking 1.5 mile non-stop for a two days. My next challenge will be 2 miles non-stop. After that, I will shift my focus to physical therapy.

Today is almost 6 months post surgery. Over the last three days, the surgery area is not comfortable and weak, I don't think I can walk much. About a week ago, I did a decent 2.2 miles walk at 20 seconds/per mile speed. It was awesome. I did not know what caused the uncomfortable this time and why didn't it go away. I did not use my ankle too much since I can't walk outside, it is very cold . I have to say that the latest setback makes me worry, especially after 6-month recovery.

In terms of activities, I continue swimming, in the meantime, I am working on my butt muscles. My daughter noticed that my butt is way too soft, and I guess I lost a lot of muscles there due to inactivity. Swimming does not help butt muscle, especially freestyle. Recently I try more breaststroke kicking. I also started butt workout on YouTube. On average, my butt workout is around 10 mins, sometime 7, sometimes 15. Also do a little stretch to help piriformis.

More than 7 months after surgery, when I don't feel good about my ankle, I write something. This afternoon, my ankle does not feel good after 1.5 mile walk at 22 min per mile pace. My ankle was fine for the last three weeks. Whenever I think about surgery failure, I feel sad. I am keeping this one short, I hope today's feeling is just the new normal, and I get fewer and fewer of those bad feeling.

Yesterday I felt bad, but today it is even worse. I have to use knee scooter inside my house. Never post two days in a row. This is first time ever. It is sad because I did not use my ankle much today though. Going to bed soon, hopefully tomorrow is a new day.

Today is Monday, the bad feeling started last Tuesday. Finally today I feel a bit close to normal. It was a tough few days, I had to use knee scooter for the first two days. Then I slowly biked about 20 mins for the next two days and a lot of hot-water foot bath. The ankle felt weak, cold, and uncomfortable, which is very similar feeling before surgery. I don't know whether it has anything to do with I had a cold-water foot bath to manage pain on the first day. During the last few days, my mind was occupied by the possible repeat surgery. The knee on my good leg had piriformis because of many years's overload/overuse. The piriformis imporoved before this ankle setback. However the setback makes piriformis more painful because I have to count on the good leg a lot. I am hoping for great come back!

Another update (8-month post op). Today is one month since I felt the recovery is NOT heading to the right direction. After three weeks of rest, my ankle felt solid again. But a one-mile slow walk set everything back to square one, very sad! Now I am seriously thinking the MF procedure is not working. This was a tough one month. I am seeing my doctor today. I really like to do a MRI to find out my recovery and current situation. But when I messaged the doctor, my doc is against doing a MRI. His response is "doc feels that an MRI of this area, for you having had surgery even when you did, will make it difficult to read and differentiate postop soft tissue changes vs anything new." Personally I don't think the doc argument is strong because I am not comparing, I am just want to check what is wrong. Today I will push for a MRI during my virtual appointment.

This is a long update. I did the MRI and I also see three doctors. According to the MRI, the edema and the cyst is getting smaller. It's around 50% of the original size, the size before surgery. But I'm not sure for the last 6-7 weeks whether the edema was getting worse or better.

1. The first doctor – the doctor who did my MF surgery: his recommendation is to wait until bone/surgery settle down. He said if the MF surgery failed, the next step is to do allograft with donor's graft. I will be put into a waiting list, and when I get notified I will have 30 days to proceed. And he said this surgery is going to be very difficult, it's going to be open surgery, one bone has to be cut (osteotomy) in order to access area. Because of the area is on the shoulder, it's very difficult to fix. The chance it's pretty low.

2. The second doctor sent his assistant to see me. His assistant is pretty knowledgeable. He recommended allograft with Biograf. Everything will be done through arthroscopy. It's a minimal invasive procedure just like the last MF. Basically they first drilled some holes, then put some powders to form a new cartridge. In three months, I'm going to have a new MRI, after that I will see the real surgeon. This surgeon is very busy, maybe a little bit too busy. He did some surgeries for Blue Jacket athletes. When I asked whether the location of the injury is important or not, this assistant sad in general it's not but the size did matter. He also challenge me with the question that MF has location issue and why you did it in the first place.

3. The third doctor (OSU) recommended allograft with Biograf as well. He said he did a lot of this kind of procedures, and in the army MRI is free, so he did a lot of MRIs. He said sometimes it took more than a year to see edema disappeared. He said location does matter, location make it more challenging. And given my age. He say the my success rate is about 70%. When I come out to sign the consent of treatment (just in case I need the surgery from him in the future), the nurse put the wrong ankle in the consent form. That really scared me, and I decided not to sign anything.

After getting all those opinions, here's what I think about. I'm not going to do a open procedure with donor's graft. Two reasons: 1. If it fails the outcome will be a lot worse than what I am right now. 2. My option in the future will be very limited because the damage already been done. However I'm open to arthroscopy with Biograft for two reasons too. 1. Still a good chance to be successful. 2. I don't use my ankle like crazy, so even the location is on the shoulder, I don't think I'm going to tear it. Even a failed again, my ankle is just back to where it was. In the future, if there's a stem treatment, I can still do it.

For the next few weeks, I am going to do two things: 1. I'm going to modify the way I walk, I'm going to put the lateral heel wedge. So basically I put less stress on medial, which is the injury side. 2. I'm going to try PRP injection, hopefully it can speed up edema healing. I will see the first doctor in six weeks, and the second doctor in 3-4 months.

The more I think about location, the more I don't think it makes sense. 1. Most of injuries should happen in the shoulder, it should be very common. 2) Shoulder is bad location for fixing, on the other side of coin, it means shoulder has less weight-bearing than the center one.

18 months after the first surgery, I am going for the second surgery on Monday Jan 09, 2023. I choose the second doctor. He will take out the bad bone, basically creates a cavity on my ankle, then take some good bones out of my heel, and use those good bones to fill the cavity. Finally he will cover the wound will biocartilage. God bless me! I am nervous.

Jim,

How did your second surgery turn out?