Should I get surgery for Brostrom Gould and small peroneal tendon tear?

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I broke my ankle 8 years ago but since then I have not had any problems with instability and I do just fine in running and dance. 

I started having peroneal tendon problems 6 months ago because I was recommended a pair of high arch supports at a running store that forced my foot onto the outer edges. It wasn't painful and I kept running on it for a long time. 

I recently saw an orthopaedist and got an MRI and ultrasounds but the results seem to be conflicting. The MRI shows I have a tear in the peroneal brevis and the ultrasound says it's only tenosynovitis. 

My ATFL must have been torn from my previous fracture but a physical therapist mentioned to me that there is no need for surgery unless you have chronic instability. 

I'm afraid my surgeon rushed into the decision to repair my ATFL and the peroneal tendons in one surgery even though it might not be necessary. 

I'm 25 years old and my job is fairly active so my life and source of income would be affected if I made the wrong decision.

So far the plan the surgeon has told me involved a Brostrom Gould and a peroneal tendon repair and the post-op plan would be 2 weeks NWB and 4 weeks in a boot. It doesn't sound too terrible but from what I've read online it seems like the recovery can be quite long and can cause complications that lead to more surgeries. 

Has anyone ever considered ATLF ligament repair and did you get the surgery as a preventive measure or because it was causing you problems? The doctor also mentioned if I don't get the surgery now I would have more problems later and require a more invasive surgery which scared me and now I'm leaning towards just doing it to get it over with. 

For people who have had experiences with ankle injury, do you think it would be a good idea to get ATFL repair on an ankle when I generally have full function and good balance or should I talk to the surgeon and say I only want my tendons repaired and not the ligaments?

Thanks for your help! This would be my first surgery so I'm having a lot of anxiety

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10 Replies

  • Posted

    I would recommend getting a second doctor's opinion, first and foremost.

    Second, I also just recently went through my first ever surgery and it was to repair a tear in my brevis tendon. The surgery itself wasn't bad, but recovery depends from person to person.

    I'm almost at my 2nd-week post op and I'm still on the NWB period. The pain was only bad the first 3 days and after that pretty bearable, but any bigger movement other than wiggling my toes or moving my ankle just slightly causes some pain since the overall area feels pretty sore.

    In my case, I went through with surgery since I am quite active in sports and I was struggling to run or even go on a longer walk due to pain. If this was not causing any issues I would've probably not gone through with surgery. This, because I probably had this for a while, just asymptomatic, since I've had no injuries in the last 3 years.

    I think surgery should be a last resort for this if the injury is causing problems and discomfort for you that you cannot control. Despite my belief in this, I also strongly advise to just get a second professional opinion.

    Best of luck!

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    • Posted

      Hope you are making a good recovery from the surgery! I am also quite active so if the ankle is going to cause me problems later I would rather take care of it now. The MRI and ultrasound shows my peroneal brevis is torn, thickened, and frayed but somehow I don't feel that much pain. My main symptom is stiffness on the bottom of the foot. If it wasn't that I was told not to I could probably run and jump. 

      In January I did physical therapy and then I tried acupuncture. I also saw a sports med guy for graston and ART. Eventually when all that didn't work I tried shockwave and did 10 sessions of it. All with no improvement so it seems to be chronic. 

      Before I went to the orthopaedist I saw a doctor at a pain management clinic who recommends stem cell injections but they are extremely expensive. If that doesn't work I would lose a lot of money and several more months I could have had to recover from surgery. 

      I guess my next step will be to meet with another doctor. To me my symptoms feel pretty mild but the imaging results and doctors seem to think it is more serious.

      Do you have to be NWB for a few more weeks or will you be able to start walking with a boot soon? Did your doctor give you a plan for when you could start PT and when you would be back to walking and running?

      Thanks for sharing your experience! I feel like peroneal problems are more rare and it's been hard to find info on it! 

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    • Posted

      Thanks and recovery is being alright in my opinion.

      As NWB my doctor told me that it had to stay like that while I have stitches, but once they are off to start trying to put some weight on my ankle (as much as I can tolerate) and walk around in bits. Of course, in the beginning, a few minutes at a time with plenty of rest in between, but even then it's already something.

      I'm on a sort of rush to recover enough that I can at least move around without problems until the end of August because I live abroad and need to be walking by then. My doctor seems to think because I'm so young (22 y.o.) and with a sports background that I should be able to achieve at least that much by then if I am proactive enough during recovery time. This means handling some discomfort (not pain) and work through it. Also, running and jumping, due to the high impact, is not advisable for at least a good 4 to 5 months if recovery goes really well. Usually, full recovery can take as long as a year, so most doctors seem to advise avoid any major sports of physical activity for 6 months. PT should start as soon as 4th week or so? I'm supposed to be called back for it soon I believe.

      I can tell you that within the first 24h I could already move my toes and I found that I could move my ankle a bit without pain by the third day. Anything a bit outside the pain-free range movement at the moment hurts quite a bit. The peroneal tendon issue is not super common indeed, you'll see it most often in people who got injuries from twisting their ankle or had accidents. That and among the sports community becomes also more common due to just how generally prone to injuries most athletes are.

      But, just try asking another doctor and if this is indeed an issue that will eventually give you issues easily than you might benefit taking care of it while you are so young because recovery should be much easier and faster.

      Good luck and get better soon!

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    • Posted

      Being young definitely helps! When I injured my ankle before I was back to normal pretty quickly even after being on crutches for 8 weeks. My main problem with the ankle limited dorsiflexion and tight calves which seemed to gradually resolve the more I was active. 

      I think by the end of August you will definitely be walking normally! My doctor told me running and high impact could start around the 12 week post-op mark but usually waiting a bit longer is safe. 

      I've been so stressed about this injury for so long that if I did end up getting surgery it would just be a huge relief and I could just focus on recovery instead of constantly weighing my options. 

      When you used to be active and played sports I think balance and strength will come back pretty quickly and muscle memory will kind of kick in once you get back to sports. The doctor also told me Alter-G treadmills are great for getting back to running so if you have access it could help your recovery and strengthening once the boot comes off. 

      If I did get surgery it would probably be around the first week of July based on availability. I have a similar goal to you in that I need to be up on my feet at least by the end of September. If I get the surgery I guess I should just prepare for a long wait and make it my 2019 resolution to start my previous level of activity. 

      Last time I was on crutches I did a lot of floor barre, ab exercises, and pilates so I'll try and do the same this time to stay sane and keep in shape somewhat while I'm not walking. 

      Hopefully I can see another doctor next week and make a decision by next Sunday so my mind can rest. Good luck to you too!

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  • Posted

    I've had this procedure done on both ankles. I also had an extra surgery to repair my peroneal tendons (on both ankles).

    I agree with getting another doctor's opinion. If it's not causing you problems, you shouldn't need surgery. In general it should be a last resort. Even if the surgery goes well, etc your ankle will never be the same. In my experience it takes about a year to get used to it

    In all cases I was NWB for 4-6 weeks, then took another 2-4 weeks to get out of the fracture walker. Then you work on your rom and strength. Takes another month before you're not limping .

    I think nowadays the doctors believe in a walk-sooner approach where the recovery is easier. My ankles were bothering me which is why I went for surgery. Having said that, if you're gonna go for surgery, I'd have them look at the ligament as well as the tendon. I've been very happy with my surgeries in terms of improving my stability, fixing the peroneal subluxation, and fixing the tendon tears.

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    • Posted

      What my doctor told me was 2 weeks NWB and 4 weeks in a boot. They said at 6 weeks I will be fully mobile but like you said I do think it takes a while to regain enough muscle and strength to walk normally. When I broke my ankle and got out of the cast my calf was super skinny and I walked awkwardly for a long time. I was younger back then so even without PT I seemed to gradually go back to normal. I think within a year I resumed pretty intensive dance training and even got back on pointe with no problems. With surgery it might be a different story though. 

      I feel my ankle is fine but I seem to always notice my injuries too late and when I not really notice any pain until I have a serious problem so perhaps the MRI and ultrasound are more accurate for making decisions than how I feel. I definitely don't want to keep being active on a bad ankle and suddenly rupture the tendons or cause damage that would be harder to fix. 

      Since the surgeries have you been able to walk or maybe even run without any problems? And for recovery did you go to a PT or do exercises on your own? Glad your surgeries went well and hopefully your ankles aren't giving you problems anymore! 

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  • Posted

    I certainly don't claim to be an authority on orthopedics, nor am I a doctor. However, I have been a nurse on an ortho and surgical unit in a hospital for 11 years. It has been my experience that these types of decisions are all about how the problem affects (or will affect) your quality of life. In your case, you are young and active with a lot of years of physical activity ahead of you. If I were you, I would read as much as I can about outcomes from both surgical options. There are lots of medical studies and articles on the internet. Second, I would research the surgeon, i.e. how many of these procedures has he/she done, what have been the outcomes, what kind of patient reviews they have. At the end of the day it is all about being able to do the things you want to do in life. I can tell you this, I am 57 and recovery from surgery like yours would certainly be more difficult for me. So I would think if you are going to do it, do it while you are young and fit.

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    • Posted

      Thanks! I will definitely try to do research and think about the risks and benefits of each option. In your experience at work do you know if the patient usually meets with the doctor again before the surgery or is the initial consultation the only time you meet with the surgeon?

      So far I've researched the surgeon and the hospital and the reviews online seem pretty positive. I'm also a bit worried that the recovery time and success rate they provided may be too optimistic since from these forums and googling it does seem it will be 6 months before you feel normal and maybe longer to do intense physical activity. 

      Once offices open Monday I will call up and try to see another doctor to see if they recommend the same thing or have a more conservative approach. 

      Thank! 

       

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  • Posted

    I would get a second opinion. Definitely take care of your feet/ankle. You will regret it latter.
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    • Posted

      Thank you! I am searching for other doctors in my area right now. As much I want to get surgery with if I need it I will try to research and ask for other possible options. 
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