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Author Topic: ACL replacement leading to CS, AF and possible ankle reconstruction or fusion  (Read 32697 times)

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Offline kcknee

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I had not looked at X-rays side by side until the other night. I checked dates I had and realized that all the major bone shifting has happened within a month's time. I am concerned about the rapid shift in bones or if big toe joint ( by ball of foot) looks like could be bones jammed together too tightly. Since the project in the garage on 3/9, my foot has just hurt to stand or walk and I only do any walking when necessary. Pain before that was one spot on the lateral side and pain from whatever was snapping. Since then pain and limitations have greatly increased and hurts just walking across kitchen. Since the garage project, snapping only happens occasionally and mostly when twisting. After recent fall on stairs, less pain in tendons.

On 3/5 I was still able to bend that big toe joint that is now frozen. Could this joint be frozen because of bones shifting too close together? If toe is jammed from scar tissue, should just be a month old and hopefully can break up. If bones, maybe if arch raised would pull apart and allow bones to move again.

1/18 X-rays prior to weight bearing.
2/3 able to put full weight on foot first time in boot
2/15 in boot could climb 2 flights of stairs one step at a time, but upright and without crutches, to get to upper gym for basketball game.
2/29 something in ankle felt like snapping over bone with each walking step
3/4 spoke to Surgeon's office about snapping. Told to try using stirrup brace. Brace too painful on outside of foot and no change in snapping while wearing brace.
3/5 St. pats party in Boston at family's house. Could walk up carpeted full staircase normally and upright, so toe joint could bend at that time.
3/9 I did project cutting and piling cardboard and straightening garage in sneakers ( snapping hard each step that day)
3/12 wondered if too swollen and inflamed to snap. Stabs in side of ankle each step. Started having to crawl up steps or put hands on stairs in front of me as I went up. Could not climb stairs upright. Extensors tendons in foot swollen and painful.
3/23 pain increases. Limiting walking to only necessary. Any walking or standing hurts entire foot.
3/25 not snapping often, but feeling unstable on lateral side
4/8 foot fell forward from bottom step. Unable to bear weight that day and only could walk on heel next day. Tendon pain has decreased since.
4/9 new X-rays showing foot less cavus.

Spoke with surgeon's office and was blown off. Told that foot will never be as good as it was before the last surgery and I would need orthotics for life. Blamed continuing problems on CS damage even though toe joint started after this surgery. Would not discuss bones in foot or why orthotics would be needed, just told needed to go to PT for now and we would discuss orthotics later. So, I guess I try to treat myself for a maybe problem that I might have. If the bones are jammed together and blocking joint, I would rather try to do something now on a month old problem and try to keep joint useable rather than wait until joint destroyed and then get orthotics to lessen pain. Trying wearing arch support sleeves to try to raise arch and separate bones. No idea if this is a good plan, but all I can think of now. Ordered surgical reports so I can try to search for new doctor.
« Last Edit: April 15, 2016, 11:20:51 PM by kcknee »
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline kcknee

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I wore an arch support sleeve on my left foot whenever weight bearing, except showering, since Friday afternoon. We had to go to my son's basketball tournament in another state and stay in a hotel. Lots of walking and standing. I do think the arch support is helping. On Saturday we had to go up several flights of stairs to get to gym at a university. I couldn't find an elevator. I was able to walk up flight of stairs normally, but then the muscles in back of calf started feeling like they were going to explode ,so half way up the second set, I switched to one step at a time. When we got home Sunday night I was able to bend the big toe joint at ball of foot, not as much as good foot, but the joint was moving. Today I was able to cautiously get up stairs in my house normally.
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline Clarkey

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  • Neil TheElephant knee packed up carrying his trunk
Hi Kristin,

I am pleased to see some improvements with your ongoing ankle problems, will it last is always going to be on the back of your mind after all the setbacks you have had to endure. The arch support seems to be benefiting for you as you are more flexible, finding it easier attending family commitments. Stairs are always a challenge if you are suffering form joint problems both pre-op and post-op.

Hopefully things will continue to improve even further for you.

[email protected]
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline Snowy

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I'm glad to hear the arch support is helping but am so disappointed that you're still getting stonewalled by doctors about symptoms, and having to do so much self-management of your recovery. You would have thought at this point that anyone willing to take your case on would be willing to acknowledge that it's not a usual history, even if they're not willing to respect how much you've researched and learned since your original injury.

I really hope that you're able to get to a point of better mobility and less pain from here. I don't check in to KG as often as I used to, but I do watch your thread because I'm always keeping my fingers crossed and thinking of you as you continue on this journey.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline kcknee

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Thanks Snowy and Nick. Sorry for delay in responding. I called my surgeon after my last post to tell him what was going on, the effect of raising arch and asked for help. I was blown off and told by his assistant that he would not help even with arch support until 6 months. I go back to see him in 2 weeks. It has been stressful and depressing watching my foot be damaged and not being able to do much to stop it. I bought walking sneakers that have a slight rocking bar to assist with moving my foot while limiting pain. I also still wear an arch support. My ankle has rolled many times and my peroneal tendons just feel constantly sprained. My left knee now aches from the ankle collapses. I have found that I have started walking only on the outside of my left heel and avoiding the painful joint altogether when walking. I'm sure that is having a horrible effect on the rest of my reconstructed foot as it is getting twisted looking. I wish I never had this surgery. I have the start of hallux rigidus (limitus), similar to turf toe, but my condition is caused by a surgical miscalculation in cutting my bone angles and is leading to arthritis and not being caused by arthritis.  I hope that I can find someone to correct the osteotomy that left me in this mess, I'm not expecting my surgeon to do more than offer me orthotics or steroid injection to reduce pain from my deteriorating joint.
« Last Edit: May 28, 2016, 07:23:14 PM by kcknee »
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline kcknee

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I feel a little bad for my surgeon today during my appointment, but not that bad since he was trying to bs me. He did get the full wrath for every time i walked away quietly after getting a bs line before. I got the typical lines when surgery doesn't go as expected - not a new symptom but pre-existing, always was like that but only notice now after such a great surgery, if you don't move joint there will be no problem. Ugh. I called him out on every line and rejected his offer of cortisone shot and orthotic that would guarantee condition continues to deteriorate. He finally, after accusing me of knowing too much,  admitted that it would not be a big deal to either shorten bone or redo his osteotomy cut and that if either was done my problem would stop. I need to get standing xrays. He was laughing by end of appointment.
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline kcknee

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Saw My surgeon today. He reviewed my recent x-rays and said I need surgery. I now have arthritis in the joint so he wants to do a cheilectomy to remove the arthritic bone spurs that have developed and he said both of the sesamoid bones in the joint are wildly subluxed, arthritic and enlarged and he wants to get those back in place with the possibility of having to remove one if the arthritis is too bad to make it still functional. Finally, if after getting out the arthritis, joint still can not move, he agrees the bone alignment from the osteotomy surgery is off and he will do another osteotomy.

His office will call with a surgery date - surgery center just bought by new owner and have to renew certifications so not sure if this is weeks or months away. Not as major a surgery as last surgery and I will be able to walk in surgical shoe after surgery.

Not that it matters, because regardless of the reason, the joint is now filled with arthritis, but I wonder if this has all happened since April when I begged him for help because joint was getting stuck bone on bone and I was afraid becoming arthritic. It could also be some damage from when foot was cavus after the CS, and the shape of my foot made all weight be carried on heel and ball of foot.

8/17 - i have a surgery date of 9/14 and see the surgeon on 8/31 to discuss the surgery.

9/1 - When I saw surgeon in July to go over xrays, he agreed based on xray that the angle of the osteotomy he did on the metatarsal was off and was stopping the joint from moving. When I saw him yesterday he forgot the last appointment and is approaching the surgery with the idea that I somehow developed severe arthritis out of nowhere which caused my sesamoids to dislocate and block my joint; he believed his prior osteotomy is doing great. Ugh!! I tried my best to try to convince him not to approach my issues backwards, but when I left he was still saying he must follow his sequence of cheilectomy, relocating sesamoids, removing medial sesamoid, and only then test to see if bone angle could possibly be the problem. If he only cleans out joint, the bones which hit when joint is moved will just cause the arthritis to come back and damage more bone. I asked him to please try to simulate weight bearing in surgery by pressing against foot, to see if joint still blocked after cleaned out. Didn't get a promise, but I hope he will think about it. I don't want any more surgeries.
« Last Edit: September 01, 2016, 06:07:40 PM by kcknee »
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline kcknee

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Re: ACL replacement leading to CS, AF and possible ankle reconstruction or fusion
« Reply #157 on: September 22, 2016, 12:56:00 PM »
I had my first post-op appointment yesterday; surgery was last Wednesday. The surgeon said he was happy to find that my two sesamoid bones were enlarged, but not arthritic. He released both and relocated them to the correct position under the ball of my foot. He said my joint space was still good and not arthritic, so he filed off several bone spurs and a hook shaped piece at the end of metatarsal bone. He said I had much more movement than before in the joint on the surgical table. He did not re-angle or shorten the metatarsal bone as he had discussed doing. I am allowed to walk on foot in surgical shoe and get stitches out next week. I now wait to see if he did enough to stop the bones in joint from hitting. If not, this surgery will be all for nothing and the bone spurs and dislocations will all happen again. Articles say up to 30% of top of metatarsal can be filed off if arthritic, but not sure if would be done if bone is normal but at wrong angle for joint movement. Last time it only took about 4-5 weeks for damage to occur, so I will know soon if surgery helped more than temporarily. Right now I can walk with less pain than before surgery and can put weight on front of foot.
9/27 - not sure if surgery helped or not. There are times i can put full weight on front of foot when I walk and other times I can barely put weight on it - not dependent on time of day or activity level, so I think the sesamoid bones are floating around in and out of place. If i do too much, I wake in middle of night to deep bone pain - just regular healing or arthritus starting from bones hitting? Just not sure. I see surgeon tomorrow to get stitches out.
10/15-i am able to put full weight on foot and walk in sneakers. Joint is still very bruised. There are times I am hopeful surgery has made me good enough to just start living again, although with so much muscle death from cs I will always be somewhat limited. I have had some nights of deep bone pain so fear of arthritis returning still there. Better than before last surgery overall.
11/11 - unfortunately since surgery didn't address the cause, the arthritis has once again returned and sesamoids dislocate ( although so far not trapped in joint). My surgeon has signed off, so this is it until pain gets unbearable. At that point may have to fuse joint although joint space is good and no arthritis in joint, because the osteotomy fix is harder to find a qualified surgeon to do.
3/4/18- i haven't posted in this diary since 2016 when surgeon told me he did not perform the needed surgical procedure and would not. My husband had made me promise before that surgery that no matter what the outcome I would not seek further surgery. I have been walking on the outside corner of my left heel since if I try to walk using the ball of my foot, the sesamoid bones dislocate and press on a nerve causing excruciating pain until they eventually migrate back into position. This altered gait/weight distribution has caused my heel to feel like the screw inside is shifting; my peroneal tendons are strained and painful with hardware from their repair piercing internal tissue causing blood bruising; I have had repeated incidences of compartment syndrome that have destroyed more muscles in lower outside of calf causing weakness, pain and indentation; my opposite hip keeps me awake at night with hollow aching pain, the failed osteotomy site in foot throbs in pain with sharp pain at damaged joint. A recent herniated disc with severe pain landed my husband in emergency room and made him understand how much life sucks with chronic crippling pain. He has agreed that I can see a foot surgeon to get the osteotomy corrected. I have an appointment on Tuesday.

3/6/18 - Surgeon is sending me for a CT scan to get better view of issues in foot and to see if my heel is still fractured from the surgery in 2015 when heel was cut in half and the bottom half shifted over and screwed back on. He agrees completely with me that the dorsiflexion osteotomy (bone on top of foot heading into big toe joint) was done at the wrong angle and it needs to be redone. He said he would cut into same incision, take out screw and a v shaped piece of bone and then screw bone back together to raise bone angle. He said foot is still too cavus- high arch, but he would not fix anything besides the one bone. I hope if that bone is recut then most of the other pain will settle or at least not get worse.

4/25/18- my CT showed that my heel osteotomy is healed. Pain in heel I guess is just from the screw and walking on the side of it for the past few years. I have next surgery scheduled for 5/9 to take out osteotomy screws from first metatarsal on top of foot. Surgeon will then cut wedges of bone out to reangle the bone at the same level of my other metatarsal bones. He will then screw it back together and I will have 6 weeks non weightbearing as bone heals. I had to sign that he has permission to harvest bone from my heel if needed during the metatarsal surgery. I should be able to walk on a flat foot once healed completely.
5/6/18- i saw the CT report and it gives me hope that I might be not great, but maybe okay after surgery. My sesamoid bones are mildly arthritic, I have mild arthritis in 2 different spots on ankle from walking on side of heel and I have heel spurs by plantar fascia/achilles insertion so not pain from the screw. Hopefully if I can walk flat on foot after surgery these arthritic changes won't hurt as much along with the tendon and cs issues from walking on side of heel. Only a few more days.
5/9/18-the surgeon told my husband that he thinks surgery went well. ( i guess he talked to me, but again why do they talk to unconscoius patient) He removed screws from prior osteotomy and put in a metal plate as he reangled bones to match other metatarsals in foot. He did take a bone graph from my heal to use. The anesthesiologist gave me multiple nerve blocks prior to surgery. I have never felt this good after - probably combo of lighter anesthesia dose needed and they did not give me any opiods during or immediately after. They gave pain drugs in iv, but toradol is the only one I remember. I still have no pain, but am just starting to feel pressure at bottom of foot. I hope nerve blocks last up to the max 36 hours. It's nice to have a clear nonopiod heaf and no pain.
« Last Edit: May 10, 2018, 02:57:52 AM by kcknee »
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline Snowy

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How strange - I visit KG sporadically at best these days, but for some reason today I thought to check your thread and discovered the latest updates on your last post. I am sorry that after everything you ended up in surgery yet again, but so relieved that your husband had a change of heart and that you found a surgeon who was willing to deal with the mistakes from last time. I am hoping for the best outcome possible for you, and that this is the last surgery your foot needs.
Mar 11: R Biceps femoris tear (skiing)
Jul 10: ACLr (hamstring autograft)
Mar 10: L ACL rupture (skiing)
Feb 06: L partial ACL tear (kickboxing)
Dec 03: R bone edema (motorbike)
Jan 01: R patellar chip (motorbike)
May 93: R ACL sprain (hockey)
Ongoing: bilateral PFS and OA

Offline kcknee

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Thanks Snowy. I figured most of current users wouldn't get why I was posting about a foot reconstruction on a knee forum, so just added info on my most recent surgery to an old post. I still can't fully grasp how a simple ACL tear from skiing could have had so many untreated complications that I ended up losing many leg muscles with a crippled deformed foot. I'm hoping this surgery takes away some of the pain. I am still nonweight bearing so won't know how surgery worked until near the end of June.

At least one of the doctors who treated me learned something from my mess to try to help other patients. Not suprisingly, it is my sports med doc. He has become a go to doctor in the NYC area for compartment pressure testing and is offering to try botox injections in an attempt to assist patients who continue to have compartment syndrome pressures despite having had  Fasciotomies. My last compartment syndrome surgeon now lists himself as being an expert on the surgical treatment of the disorder and recruits patients. I am more hesitant to believe that he learned to listen to his patients and believe what they are saying to him, but I sincerely hope that he will take his patients concerns seriously.
12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy

Offline kcknee

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6/19- I saw my surgeon for my 6 week follow-up and found out my idea of starting weight bearing does not match his. I had hoped for weight bearing as tolerated so walking by next week at latest, but unfortunately it is 25% for this first week, 50% for next week, 75% for next week and then 100% all while wearing a surgical boot. In a month I see surgeon again to see if I can get off crutches fully and can start wearing a normal shoe. He will decide if I need PT then. Ugh, 25% weight bearing on crutches is harder to live with than using a knee scooter where I had use of at least one hand to carry stuff. It does make sense as he explained, he took a wedge of bone out of my foot and the screwed it back together at new angle. The gradually increasing pressure from weight bearing will help the bone to strengthen and strongly heal internally. At least I can sleep without the boot on now.

12/31/08 - Skiing injury L knee
6/1/09 - ACL stump removed from joint
8/31/09 - ACLr - Hamstring Graft
12/21/09 - Ant Fasciotomy 
8/26/10 - Anterior Interval Release
12/6/10, 5/5/11, 12/22/11 - Fasciotomy
12/7/12 - Nerve Decompression
6/3/13(m), 7/29/13(l), 12/13/13(m & foot) 2/3/14(l) Fasciotomy















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