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The response to the question below was authored by Marc Mitnick DPM
pain, clicking , swelling of ankle
by Andrea
(metamora , IN. U.S.A)
talar dome fracture
I had a break in my talar dome. I have had 4 surgeries. 1st was a graft that was stem cells and bone mix? Like a paste I was told. 2nd was because malunion of Talus? Where he had to cut thru to get to where the graft. 3rd was to remove hardware, the wire had came loose and was slicing the tendon .The 4th was because the graft broke and this time they tried a bone plug from a cadaver. It did not work. I go to get a MRI today . I have been thru it before and I know what it feels like.My Dr. tends to agree as each time I have told him something is wrong has resulted in surgery. My question is , when is it time to say enough? I have limped around for 2 years and have learned to compensate with my other leg quite well. I really do not want to face another surgery, when I know it may not work.Can it get worse if I just leave it alone ? I do not take pain meds other than 800mg IB . I would ask my surgeon, but I know he is determined to fix this. He is really a great Dr. And I do not doubt that he has done his best to fix this, and his success rate is great with other patients. He actually teaches this surgery to other doctors. But I am just so tired of being laid up. After each surgery, the MRI's get worse with more tissue and tendon damage . I have bone cists from the screw holes that got big from the screws moving , and he pt a graft in there as well. I injured it in may of 2011 and I am worse off now than I was then. The top wound you see was due to the bandage getting too tight due to swelling. At my 7 day post op visit, my foot was numb and I could not move my toes. This went away after a few weeks. I just get a little tingling now and then as
RESPONSE
Hi Andrea,
When you continually have surgery in the same location you eventually reach a point of diminishing returns. Essentially because of all the scarring and other stuff that has taken place in a small area due to the original trauma and subsequent surgeries, your chances of achieving a pain free existence with further surgery is dramatically reduced.
I am not questioning the competency of your surgeon, but a good surgeon also knows when "enough is enough". In his desire to help you he may not see the forest thru the trees.
In my way of thinking you have a couple of options here.
Since you state you are not in a tremendous amount of pain and since you have learned to walk differently to keep pressure off the foot, you might speak to your surgeon about an ankle-foot orthosis (AFO). This is a device that not only supports your foot in a certain position but also reduces motion in the ankle joint. This combination may be enough to allow you to bear some degree of weight on the foot without creating too much pressure on the talar dome which as you know makes up the floor of the ankle joint.
If that did not work out for you, I am not sure the option of doing nothing would end up serving you well. I do not know how old you are, but as times goes on, it would probably become more difficult to walk on the foot if you have nothing but a non-union.
So, if the AFO did not work out for you, my opinion would be to have a screw placed through the talus and then have an ankle fusion. An ankle fusion is something your surgeon has been trying to avoid and that is to his credit, but at this point I can only imagine what your talus looks like and as I said earlier, the chances of "fixing" it have diminished.
Marc Mitnick DPM
DISCLAIMER
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ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
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