Ankle pain, two triple arthrodesis done.

by Mike
(Texas)

Hello, I'm 38 yrs old. I had my original triple done almost 22 years ago (severe arthritic ankle). Then a revision about 12 years ago. Went through all my PT after last surgery. 90% of the time I'm still pain but I bear it and used to it unfortunately. Sometimes though it gets really bad. These past couple of week have been horrible. Went to a podiatrist earlier this week and X-rays showed the fusion was fine. Meds he prescribed have done nothing. Waiting to see pain specialist in a few weeks. Would you have any ideas on what could be causing this pain? Thank you

RESPONSE

Hi Mike,

The thing that caught my attention in your post is the fact that you had a triple arthrodesis at age sixteen (if my math is correct), due to severe arthritis. You do not mention any history of trauma to the foot and ankle and unless you had some sort of trauma, I do not know how a sixteen year old has that much arthritis to necessitate a triple. The other possibility is that you have some type of collagen disease, where your bones and joints wear out sooner, but again, you do not mention any such disease.

So because of those factors and the fact that I have not examined you or even seen x-rays, it makes my statements nothing but educated guesses.

The problem with fused joints, is that they tend to put additional stress on the adjacent joints, which in turn may cause pain. You are 38 years old and I therefore assume you are fairly active even if you no longer participate in any sports. I do not know if you are overweight or not and of course that would also stress the joints of the foot and ankle as well.

The other problem is that an x-ray may not be telling the whole story. If your pain can be isolated to the part of the foot where the arthrodesis occurred, then an MRI or CT scan might give you a more complete picture of what is actually going on.

Before you go running to a pain specialist, I would recommend you have more imaging done on your foot to get a better idea of what might actually be going on.

Besides anti-inflammatory medication which appear to be not working, you might consider going into a cam walker (a walking cast) for a couple of weeks to "calm" down the whole area and see if that reduces your pain to the levels that you are accustomed to.

You might also consider a round of physical therapy to quiet down the foot,

If an MRI or CT scan show no abnormal pathology, a cortisone injection into the painful area may also prove to be helpful.

The unfortunate thing is that you had this fusion at a young age and you will be spending a good many years walking on the affected foot. The problem with fusions and implants is that they do not last forever.

Every time you take a step, you are stressing the fused joints and at some point recurrence of pain is a possibility. Does that mean you are looking at revision surgery every decade? Hopefully not because at some point you reach a point of diminishing returns where revisions will not longer help simply because of the introduction of scarring every time you have a procedure on the foot

I assume you wear some kind of orthotic. If not that would be something else you might want to consider.

In summary, I would suggest an MRI or CT scan first. With the knowledge that those tests reveal, you will be able to make better decisions on what to do for your foot. If all fusions are intact you might want to consider some of the suggestions that I have made.

Good luck,

Marc Mitnick DPM
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