Ankle arthroscopy, debridement, and ligament surgery: As fun as it sounds

I referenced my pending ankle ligament surgery in my last couple travel-related posts. Well, I had the surgery yesterday at Aspen Valley Hospital; I’m back home recovering; and there’s no immediate travel in my future, thanks to the biggest, fattest cast ever and no weight-bearing on my right leg for at least a month.

Good times.

But, honestly, I’m so glad I had this surgery done. It was time. I’d sprained it pretty badly in the summer of 2018 — after having torn some ligaments with multiple sprains as a kid. I’ve always had “weak ankles,” rolling them often when tripping on the street or hiking on uneven grounds. So this ankle was in rough shape.

Three-and-a-half years ago I sought multiple doctors’ opinions on what to do about the ankle pain and instability. Three foot-and-ankle surgeons who looked at my X-rays and MRI, and examined my foot, and listened to my symptoms, all suggested I could do this surgery then to decrease my pain and stabilize my ankle.

I decided to go with the a suggested less invasive route. I did physical therapy to strengthen the muscles around the torn ligaments, thus compensating for ligaments that simply weren’t holding my ankle up straight. I got a custom-made, super-sturdy ankle brace to wear when doing any sort of activity, from a significant amount of walking and hiking to spinning and strength training. Other instructions: no jumping, no super-long hikes (they just hurt to much after about 5 miles), plus ice and elevate when I overdo it.

For more than 3 years, this has worked. But I’ve felt progressively more pain. My hips and back started hurting last October, due in part to a funky gait I’ve picked up to avoid said ankle pain (plus some poor posture habits and sitting for a long while in the RV with not enough stretching haven’t helped). I tried more physical therapy, a cortisone injection and wedge inserts in my shoes to help the recent flare in pain, but nothing really helped.

Thus I made the decision to get this surgery in mid-February 2022 after an awesome run of travel (French Polynesia, New York for Christmas, Galapagos Islands, Mexico) since early November. There was no way I was going to cancel any of these anticipated trips! And I’m so glad I didn’t.

That said, I definitely didn’t feel like myself in Mexico. I didn’t enjoy walking the beach in sneakers and orthodics as much as I did years ago when I could be barefoot in the sand and pain-free. There are a bunch of jungle trails around San Pancho and Sayulita, and I didn’t hike any of them. My hiking mojo wasn’t there, and that’s super weird and unsettling for me. I dislike not being active or wanting to be active while traveling. That’s not how my brain typically works!

So, I was glad to have this surgery scheduled 2 weeks after returning home from Mexico. Prior, I’d done a ton of Googling about the procedures my Steadman Clinic surgeon was planning. He detailed the plan thoroughly during a pre-op office appointment, but I still tried to read as much as I could about the procedures (as one does in the Internet age). I only found a couple of personal accounts of others‘ similar surgery and recovery experience (which I read multiple times!), so I figured I’d keep a bit of a diary here for anyone who might be considering or having ankle arthroscopy and debridement with ligament reconstruction (aka Brostrom repair).

I’m pretty sure I’ll need to SEO-up this post (and my blog in general!) since I’ve been writing here mostly for kicks, not for Google to display in search results (my website-owner/blogger friends will know what this means!). I’d like to be helpful for people searching for info, and also want to keep a diary of sorts just for myself. I’ll update chronologically when I’m so inspired!

Ankle ligament surgery day

My surgery was scheduled for 7:30 am in Aspen. I had to arrive at 6:05 am. I didn’t sleep well at all the night prior — so was up well before my alarm went off at 4:50 am.

Registration check-in, pre-op procedures… all that business went well. I’d had surgery before, and I know I tolerate general anesthesia well, so I wasn’t too worried about that. And I was actually excited about some new anesthetic technology that wasn’t around 11 years ago when I went under for a bunionectomy (on the same bad right foot!). For this ankle surgery, I was able to get a nerve block that numbs below my knee to the tips of my toes that should last for at least 2 days, perhaps up to 5 days. This is a total game-changer in pain management!

It felt a little weird to be lightly sedated while the anesthesiologist went into my nerves in my thigh to inject the block. He watched the needles thread into my leg via a monitor; so did Quent. I averted my eyes.

I was rolled into the operating room right at 7:30 am and found myself waking up in the recovery area at 8:45 am.

My surgeon said all went well:

• For the arthroscopic part of the surgery, he went with a tiny camera in via a tiny incision to see what was happening in my ankle. He learned what was suspected via prior imaging — that I have very little cartilage left between the bones on the anterior side (inside part of my ankle). But the cartilage on the right side of my ankle (lateral) is still mostly intact and of decent, not horrible, quality.
• For the debridement/excision part of the surgery, he removed a bone spur that was the size of a marble! He thinks this was a major cause of impingement and a lot of my pain. Delightful! He otherwise removed scar tissue and generally cleaned up the mess that sprains have caused over the years.
• For the ankle ligament reconstruction part of the surgery, otherwise known as a Brostrom repair (link is a journal article with nasty photos, be warned), he went in via a 2.5-inch incision on the anterior side and cut torn ligaments and reattached them with staples (basically) to bone — which will help a lot with stability.

I was in no pain in the recovery room. That’s namely because I couldn’t feel a thing under my big and bulky cast, which is really a thick padded splint wrapped in an ACE bandage.

I moved back to my original check-in room to finish fully waking up and eat snacks (hooray for coffee, apple juice and graham crackers; I hadn’t eaten anything since 9 pm prior, though I did have water up until 4 am). PTs came down to give me a refresher on using crutches. Then I was wheeled out the door of Aspen Valley Hospital at 10:45 am. Really, in all, a very painless (literally and figuratively) morning.

I am scheduled to go to a post-op appointment in 2 weeks, where I’ll ditch the bulky, uncomfortable splint and get to wear a removable boot, which will be most welcomed! But I believe I’ll still need to stay off the foot for another 2 weeks. I believe I’ll be in the boot for 4 weeks/month total, then move to a brace. I can start PT as soon as mid-March, and I’ll likely have twice-weekly PT work for at least 3 months. I’m not sure what I’ll be cleared to do exercise/movement-wise once I can load weight on the ankle, but that’s so far away, I’m not thinking about it. Right now my mind is just on resting, immediate recovery, keeping pain in check, eating as heathy as possible while spending most of my day in bed, and fully putting Quent to the nursing test.

Ankle ligament surgery: One day post-op

My pain continues to be a 0 on a scale of 0-10. This local nerve block is AMAZING. It’s super weird not to feel my toes, but I’ll take that over the excrutiating pain I had about 12 hours after my buinionectomy. I’m cycling acetaminophen and ibuprofen so my body’s pumped full of pain medicine once this block wears off (really hoping it lasts 4-5 days and I can avoid narcotics!). I’m just feeling uncomfortable with my foot trapped in this cast right now, with it elevated on a special wedge pillow pretty much all the time I’m in bed. Which is pretty much all the time.

So far, I’ve just hobbled to the bathroom with my crutches. I’ve yet to circle around the kitchen or work in my office — both on the ground floor of our house, thankfully. I’ve got my fab nurse-husband making and serving me meals in bed, bringing me ice as needed (I’m applying behind my knee to help with swelling), and otherwise waiting on me beck and call. I’ve got the TV remote next to me, my laptop by my side, and books on hand. I slept pretty well last night, though finding a comfortable position was challenging. My pillow game is strong. I’ve got no less than 7 different ones on the bed right now for propping and hugging and resting my head to most comfortably sleep, work, read and watch TV. I actually have been semi-productive, filing an article for some freelance work I’m doing. Overall, no significant complaints — yet!

Ankle ligament surgery: Two days post-op

I’ve reached the cranky stage of recovery. I slept well last night — thanks to swapping a Tylenol PM in for one of my regular Tylenol doses. But I feel tired (probably because of the sleeping pill) and just meh, likely from not moving around much.

A kind soul I met on our local Facebook Marketplace page (Roaring Fork Swap) is lending me a knee scooter, so I think that will help me feel more mobile around the house. I continue to be uncomfortable with the big bulky cast (which I’ve learned is literally called a “bulky Jones dressing… with plaster splint,” according to my operative report), but I’m not in pain. The nerve block holds!

Ankle ligament surgery: Six days post-op

All good things must come to an end. The freaking amazing nerve block that numbed my leg from knee to toe has worn off. The lateral side of my ankle is achey; that’s where ligaments where tightened. And I can feel my cast pressing into my shin when I use my borrowed scooter (which continues to be a godsend). I’d stopped cycling Tylenol and Advil over the last couple days, simply because I felt fine, but will start that up again likely, just to ward off the achey-ness. I like sleeping through the night!

I continue to lie low. I’ve yet to leave the confines (single floor) of my bedroom, bathroom, kitchen, office area. I tried a chair yoga video yesterday, and that went pretty well. Though sitting for a while with blood rushing to my foot just isn’t super comfortable. Sitting in bed with it elevated is most comfortable. I’m convinced that once I get this bulky cast off on March 7 I’ll just feel better all around. One more week!

But, overall, since my pain level has been 0 on a 0-10 scale, and even now maybe it’s a 2 tops with the nerve block worn off, I’m not complaining.

P.S. If you’re getting any kind of surgery, ask if your surgeon uses the nerve block I got: “long-lasting, non-opioid Exparel.” It is freaking amazing, and in the future I will seriously consider only being worked on a surgeon that uses this product for local anesthesia. Apparently not all do. It’s a game-changer and I am HUGE fan. (Though, disclaimer, I am also not a medical professional, so this is my opinion only!)

Ankle ligament surgery: Two weeks post-op

What a difference a boot makes!!

I had my 2-week post-op visit at my surgeon’s office yesterday and had that BEAST of a cast removed — hooray! My foot was all tingly and felt a bit numb in places, but that was to be expected, since it hadn’t gotten any stimulation for 2 weeks. My two incisions are healing nicely. I had the stitches removed and some Steri-strips put on for a week or so until the adhesive strips wear off. I’m now able to shower (seated) and soap, rinse and shave my lower leg. Glorious!

Best of all, I’m in a removable boot AND I can be partial weightbearing in it! This is *not* what I was expecting, as my (very conservative, realistic) surgeon said in my operative notes that I’d be non-weightbearing for 4 weeks. Instead, I can now put 50% of my weight on my right foot in the boot while walking with crutches. A week from now I can put an additional 75% of my weight on the boot while walking with crutches. Then in 2 weeks, I’m free to walk on it fully, sans crutches.

For now, just being able to put my foot down in the boot is great. I even went out to eat at a restaurant last night! After 2 weeks at home, that was most welcome. In the picture above, that’s an “even-up” YaxTrax-like contraption on my left shoe, so my “good leg” is more even with the boot, which helps me from torquing my hips, back, and pelvis when walking (something I’ve been prone to do, with my unstable ankle weird gait). I’m hoping this ankle surgery will ultimately help eliminate pain in my back and hips, too.

I’d say my only (minimal, given the state of the world right now) complaint is that sleeping in the boot is not fun. I took it off in the middle of the night, and cushioned my ankle on a pillow. Much better.

I’ll start PT March 15 (sounds like gentle mobility exercises and desensitization to start), and then I’m due to be out of the boot, transitioning to a brace, April 18.

Ankle ligament surgery: Four weeks post-op

Recovery and rehab continue to go well! Here are the highlights, 4 weeks after my ankle arthroscopy and ligament repair:

• I’m fully weightbearing in my boot. I’ve ditched the crutches!
• I can soak my foot in a tub. That’s most welcome! Previously, I’d worn the giant leg condom, and then later, once out of the cast, I propped my foot up on the side of the tub in order to take a soothing bath. Now I fully emerge my body, and then I get out and wheel on the knee scooter over to my shower to sit down on a chair and rinse off. It’s not graceful, but it works. And I can do it all independently, safely.
• My one lateral scar is healing very well. It’s all scabbed off. The smaller incision on the inside/top of my foot is taking longer to heal. Maybe because it’s sort of in the crease of my foot, where the boot hits it? Not sure. But it’s still a little scabby and I can’t go in a public pool until that’s all healed over. I’m using Scar-Away and vitamin E on the parts where the skin is healed over, but still very pink.
• I’ve gone to three sessions of physical therapy, where I get my foot and calf rubbed, I practice pointing and flexing my foot, and I otherwise learn some lower-body strengthening and stretching exercises. I’ve also started balancing on my one boot foot — with counter support. The idea is to keep the abs, hips, butt strong to best support my healing ankle. And start working on some balance that will be needed once I ditch the boot and I move into the brace.
• I’ve been cleared to start some cardio, too! I spent 20 minutes on my Peloton bike, in the boot. So I’ve got one good foot strapped into a pedal (I use toe clips) and one foot in the boot just resting on the pedal. No classes yet, but slow and steady for 20 minutes felt GREAT.

In all, no big complaints, 4 weeks after surgery. Sometimes, if I’ve had a big day (PT, moved around the house a lot, maybe sat at my desk a lot), I’ll feel like I want to elevate and ice it to take away some soreness. Or I might have a hard time getting comfortably to sleep. After I introduced some quad/hamstring exercises, I definitely had super sore muscles. But, overall it’s fine.

Oh, and I did get a chiropractic adjustment today, in the boot, which was much needed and resulted in me feeling great! As I said above, I am prone to my pelvis and hip getting out of sorts, because of my longtime uneven/unsteady gait due to the unstable ankle. And that’s not helped any with my walking in a boot, so I definitely needed an adjustment. Hopefully once I’m walking without the boot, steadily and strongly, I won’t have as many hip/lower back issues. Here’s hoping!

Ankle ligament surgery: Six weeks post-op

Lots of good stuff happening this week!

• I’m out of the boot! I’ve transitioned to an ankle brace. I was given a lace-up/Velcro one by my orthopedic surgeon’s office, but my custom-made Richie brace (that I’d been wearing during exercise for the past 3 years prior to surgery) is infinitely more comfortable, and it allows for more plantar/dorsiflexion, so I’m walking around in that one. I’ve got a message into the surgeon’s office to confirm this is cool. (And reallllly hoping he says it’s okay. Given he said I didn’t need to wear a brace at all at home, I’m thinking anything that will prevent my ankle from rolling when I’m out and about is okay.)
• I’m driving! I drove to PT this morning, then spent a couple hours in Starbucks doing some work, then got the car washed and was BEYOND HAPPY to be on my own and independent. (I love my husband Quent, but we’ve been attached at the hip for the past 6 weeks. I was due for some away-from-the-house alone time.)
• I went swimming! I’ve been cleared to swim laps (no push turns), so I headed down to the Glenwood Hot Springs, where Quent and I have a value season’s pass (Labor Day to Memorial Day) and swam a half-mile (26 lengths) both Wednesday and Thursday this week. Yay!
• The scab on my second incision finally fell off. That sucker was stubborn. Glad I can start treating it with Scar-Away and Vitamin E oil. 

I feel like things are moving along in the rehab department. I’m walking, with plenty of discomfort, so it’s slow-going and still awkward, as much as I’m trying to keep a steady gait. I’ve got to be patient there. I’m still resting plenty and icing and elevating most afternoons. 

Also, my lower-back pain (really, my side/QL muscle/hip) continues to flare some since increasing my activity. While I’m confident (hoping) this will resolve once I’m walking with steady/normal gait, I’m trying to mitigate this discomfort as much as possible. This week I had a full-body massage (sublime), acupuncture (helpful), and a sensory deprivation float experience (trippy). I’m throwing everything at it, while I have this time dedicated to rest, recovery, and rehab. I hope to be MUCH more active and on-the-go this summer.

Ankle ligament surgery: Nine weeks post-op

I’ve made some big strides in recent weeks! (Literally and figuratively!)

I traveled by myself to Orlando for a quick 3-night vacation with my mom, brother, and nephew, and then met up with a girlfriend for a couple nights. I walked a LOT — upwards of 8,300 steps on one day at Universal’s Volcano Bay water park. I even went in the wave pool and the lazy (aggressive) river. Was my ankle sore? Yes. Did I have to ice it most nights? Yes. Am I taking anti-inflammatories all the time? Yes. But I CAN TRAVEL and enjoy it. So that was huge.

I rode a bike! One afternoon in Orlando, I biked for 6 miles on a paved recreation trail, walked for at least a mile on a nature trail and on neighborhood sidewalks, and then swam laps for 30 minutes at the hotel’s fitness center. A triathlon of sorts! Very proud of myself. Was it pain-free? Nope. But I was so happy to sweat and move my body.

I’m ditching the ankle brace at times. On my exercise walks and bike rides, I’m wearing my brace like a security blanket. I do not want to trip and invert my ankle and rip out ligament stitches, so it’s sort of important. BUT at home, and admittedly, a couple of times when I had to drive to an appointment, I did not wear the brace. It’s freeing, and sometimes I think that the brace could be causing more pain than helping. My shin and calf muscles are at times quite sore. I know that muscles are still waking up after inactivity, so I’m trying to be patient.

I’m trying dry needling for my hip/QL/lower back issue. I’ve now had a hip x-ray and have learned I have some calcium deposits on my greater trochanter, which could be indicative of calcific gluteal tendinitis. Oy. Following up with an MD next week, and I’m ultimately thinking this issue will only truly be solved when I can get into the only physiatrist in my rural corner of the world — in another month (I booked the appointment a month ago).

I’m increasingly eating more anti-inflammatory foods. I’m following Dr. Andrew Weil’s food pyramid for reduced pain in my arthritic joints and old-lady muscles and the continued desire to age healthfully and gracefully!