Is ankle surgery helpful?

In cases of severe injury and sportmen, surgery is recommended.  the link below shows pictures of a ankle surgery (cadaver tendon used to replace the torn ligament) 
http://www.footankleinstitute.com/ankle-instability/

The complications which may occur after a ligament reconstruction operation include:
· pain in the ankle, either because of damage at the time of the original injury or
because the ankle is now tighter than before
· numbness or tingling down the side of the foot due to stretching of one of the
nerves either at the time of the original injury or the operation
· persistent swelling of the ankle
· Stiffness of the ankle, restricting the range of movement
· In 5 to 10% of people the surgery does not work, and the ankle remains
unstable

http://alexwee.com/en/information/Ankle_Ligaments_AW.pdf

Remember - Surgery related infections are always a risk!

Week 10: Removing the cast - Its not over.

Finally, I got my cast removed in a small clinic in Delhi. Removing the cast is an experience in itself. My cast was a fibre cast - quite tough. A scissors or something sharp won't do. You need something sharp PLUS high frequency, about 1000 Hz (just a guess).
http://www.youtube.com/watch?v=BACimEbps8k

You need to drill through the cast, make a clean cut. When the drill is going through your cast, its better to keep still. And it feels like an earth quake centered in your bones.

Once a single cut was made, the dude in the clinic just used his bare hands to rip apart the cast (not the most elegant way to do it - also painful, like Lord Narashimha).

What I then saw was quite ugly - my leg looked like the Rann of Kutch

the skin was completely broken and I could peel out layers at will (very itchy). Good idea to use 

- Lots of cold cream 

- Famous coconut oil from Kerala (India) (solves all problems Malayalees ever faced)

Everything feels weird on the 1st day. Basically the muscles feel quite weak and need to be strengthened. 

Also, there might be some swelling - which will persist ON/OFF for about 2-3 weeks. 

Time for physio. 

Will I keep having trouble with my ankle?-The majority of ankle injuries get better completely and cause no longterm problems.

 -Unfortunately occasionally there is permanent damage to the ankle. The ligaments may fail to heal properly and become weak – leading to ankle instability, or there may be damage to the joint itself or some other structure nearby leading to ankle pain and swelling.

Week 9 : Some tips on home physiotherapy

6-8 weeks of immobilization can mask many things that you taken for granted.

• Dunno why, I cannot get myself to put any weight on my left leg (with the damaged ankle). Everytime I try to put some weight on my leg, I automatically start limping, jumping, skipping - basically anything to avoid putting weight on my left leg.

After you remove the cast

http://physicaltherapy.about.com/od/orthopedicsandpt/ss/anklerehab_2.htm

http://www.thechildren.com/trauma/_pdf/en/leg.pdf

Week 8: Some useful links

About ankle sprain recovery/rehab
http://sprainedanklerehab.blogspot.com/

My favorite one, about a guy who ruptured his Achilles tendon - the whole process
http://www.achillestendonblog.com/

Another blog about ruptured Achilles tendon, with the writer desperate for a quick recovery (me too!)
http://rupturedachillestendon.blogspot.com/

Week 7 : Wheel-trans and Cast Shoes

Ok, 1 week with the fibre cast I travelled from Bangalore to Toronto. It wasn't too difficult, except probably at Chennai airport

(definitely needs to get refurbished soon, else Chennai is going to disappear from the map).

(I travelled in business class, so could keep my feet raised all along. Not sure it would have been comfortable in economy, but would have definitely been a chance for a sympathy upgrade). 

Toronto is an awesome place for 2 reasons 

1. I haven't climbed a single step in the past 3 weeks here

2. there is wheel-trans 

Awesome facility. Public transport that picks you up from home and drops you to your destination. Cost 2-3$ per trip. You can take 1 escort with you. Only catch, it takes about 10 days to get yourself registered with them. But it is the most convenient and cost-effective means to travel when you're handicap.

Look for something like this in your city. Good chance of something being there if you're in a developed country. 

I was getting itchy to walk. So I started looking for cast shoes. It was too early to bear weight on my left leg, but I bought the cast shoes anyways. Costs about 10-50 dollars. 

here is the one i got (17$)

http://www.darcointernational.com/slimline

but you'll find many more online

http://www.nextag.com/walking-cast-shoe/shop-html

Cast shoes are useful

• you can rest your leg on the ground without putting too much weight
• Protects cast from the getting dirty/moist
• Serves as a smooth transition from complete rest to physiotherapy
• Aesthetically  presentable

Also, if you are pro-German, check this out

http://www.vacocast.com/standard/

Its pretty awesome, costs about 200-300$

Day 18 : Finally, the elegant fibre cast

The swelling on my feet has completely come down by now. Small bump still around the ankle, which the doc believes will take longer to disappear.

Good thing about bone/ligament injuries - Treatment is just the same. Pack you injury in an immobile cast and wait for the body to figure its solution. Works everytime. Kudos to orthopedics!

Doc does me a favor - Time to put on the more elegant, light weight fibre cast. Available in all your favorite colors!

for whatever reason, art flourishes on casts.

• So 3 weeks after my injury, I finally get my ankle into a cast. By ankle I mean, tip of my toes to my knee. "From one joint to the next, to ensure complete immobility" - as the doctor ordered. 
• Make sure that a teeny bit of your toes peep out. This will ensure if some bad happens inside the cast, we will know it. 
• Move the toes every once in a while. Again to ensure 'all is well'.
• Its not a good idea to get water inside the cast. Taking bath is whole new challenge now. 
• First 2-3 weeks in the cast, continue to take rest/elevate. This allows the injury to start the healing process.
• the next 2 weeks, healing will accelerate if we can pump some blood to the injured area. So some movement is advisable.  

Day 15 : All about crutches

My swelling has come quite a bit. I have been trying google for alternatives for easier locomotion. Here are some options.

1. Conservative crutches

2. Forearm crutches

3. i-walk-free (http://iwalk-free.com/index.html)

4. Wheelchair / Wheelchair scooters - costs 100-500$

Day 8 : Still no reprive

Swelling reduced a bit from my feet, but the ankle was still monstrous. I had travel to Toronto coming up in a few days and things were not looking good.

Doc suggests an MRI. He is not sure why the swelling hasn't been coming down. So we took an MRI.

PS - MRI room is freezing!

and this is what the findings looked like

deadly report! Going into the details,

1. complete tear of anterior talo-fibular ligament + Partial tear of tibio-fibular ligament

This is what i probably did

http://omurtlak.bloguez.com/omurtlak/page1106/?googleimage

this is what probably happened

http://www.footdoc.ca/www.FootDoc.ca/Website%20Ankle%

20Injuries%2025.htm

2. Bone contusion caused by the ligament tear resulted in a hairline fracture

Probably something like the image below. Unbelievable what the cascading effects can be.

http://www.arthroscopy.com/sp09017.htm

3. Lateral ankle hematoma

hematoma is a fancy word which means 'localized collection of blood'

And thats the reason why the swelling won't just go.

The big question -

Did me working the first few days after injury cause the bone contusion and hematoma or was the hematoma the reason swelling won't just go down?

No idea! But its always better to take rest and avoid taking a chance.

Day 4 : No luck!

I made a grave error after the injury.

• I did not take complete rest. I went to work (with a lot of care, but that doesn't matter!)
• I did not ELEVATE my feet above heart level except while sleeping
• I did not put ICE

Result,

• the swelling did not come down when we removed the cast
• in fast my whole feet was now swollen

Doctor

• was worried and annoyed
• he suggested complete rest for another couple of days
• increase the dosage of chymotrypsin

Day 1 : Browse the web

Yep, thats pretty much all I did on the day after my injury.

not an elegant soft cast

• I was using a single crutch then. Not sure how i managed, because its tough. Sure had many close falls. Teaching your arms to bear your weight is most important. At the end of the whole 8 week exercise, you will have the arms of a boxing champion with the feet of a 100 year old!
• 
  
• Browse the web and you will find RICE.
• R=REST, lots of it
• I= ICE, helps feel no pain and reduced swelling
• C=COMPRESSION, the cast should help, otherwise it is a good idea to wear something to restrain the muscles, bones and ligaments.
• E=ELEVATION, necessity to reduce the swelling. Keep you atleast a good feet or two above your heart level. Especially in my case, the swelling was huge. Elevation was probably the only way out.

Day 0 : Ligament rips

In my case, I was playing a game of squash - went for a stretch with my right leg - and my left ankle gave in!

What then happened,

• the first minute was just pain. I couldn't put any weight on my ankle
• use my squash racquet as a mini-crutch and limp to seat nearby
• surprise! the ankle joint is the size of a coconut. that can't be good!

Then, I get a bag of ice immediately to try and reduce the swelling.

My mind reads,

• how bad can this be! In the worst case it must be a fracture
• but i didn't really stress my ankle badly
• did i put too much weight since i was moving?
• do I need to go a hospital?
• maybe I can walk in 15 minutes
• this cannot be happening to me!

Reality

there was no way, I could not even walk 5 meters. I got wheel-chaired to a taxi and went to the hospital.

IT IS A GOOD IDEA TO RUSH TO A HOSPITAL WHEN,
· your ankle is so painful that you cannot walk on it all
· the ankle looks deformed
· the skin over the ankle is broken
· the injury was caused by a severe force such as a fall from a height or a blow
from a heavy object
· the pain and swelling seem to get worse rather than better over the first 34
days (the bruising often gets worse for a week or more before it starts to fade)
(http://alexwee.com/en/information/Ankle_Ligaments_AW.pdf)

At the hospital

• the doctor looks at the huge lump on my ankle and suspects a fracture
• there is some soft tissue damage, as inferred from the redness of the wound
• i immediately get an x-ray done - clean as a whistle. all bones look intact
• doc says, but there is a ligament shadow which is missing! (Ligaments cannot be imaged on a X-RAY).
• Doc concludes - this is a ligament tear. The severity will be known only few days down the line. Meanwhile, I'm supposed to take complete rest.

I definitely didn't see that coming. the swelling hasn't come down yet.

Short-term solution

• So they put a soft cast - with the top half being open.
• Once the swelling reduces they will upgrade me to a hard and more elegant cast.

Medication

• chymotrypsin - to reduce the redness and swelling (obviously, check with your doc)
• pain-killers