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Author Topic: 2 surgeries and paralyzed foot HELP!  (Read 1146 times)

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Offline shiningwaters

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2 surgeries and paralyzed foot HELP!
« on: July 26, 2005, 06:08:33 PM »
Greetings All,

Knees are complex and so are my questions.  Back in February I dislocated my right knee in a fall.  I had an ACL/PCL reconstruction with removal of parts(??) of a ruptured Medial Meniscus.  There was also a tear in my left lateral ligament (the one that runs vertically on outside of joint).

PT was very slow, but progressive.  From the start I had great difficulty getting my leg to lift up behind me when standing or from reclining position w/ball under knee. I experienced the sensation of muscle and bone/cartilidge getting hung up on each other. My PT kept insisting that this would go away as the muscles strengthened.  As I gained flexibility I started to experience back and forth movement and instability in my knee on the outside of my knee below the knee cap,  in the area where things were previously hung up.

In the meantime my PT guided me back into squat position, despite my loud and tearful complaints that there was incorrect movement occuring.  I'm not sure if damage occured, but it's the only potential trauma incident that I experienced in post op recovery. The instability in my knee increased after this event. The orthopedic doc keeps asking me if I slept with my immobilizer every night, which I did for the most part, except a few times when it became maddening and I pulled it off while half asleep.  I used to pull off my braces headgear at night and throw it behind furniture in my sleep.

Surgery for reconstruction of the Posterior Cruciate Corner was performed.  During the surgery a nerve or tendon to my foot was severed, or not included in the reconstruction. I can point the toes of my right foot and wiggle them, but I am unable to raise my toes up with my heels on the floor, or move them back toward my knee in resting position.  It's a significant loss. 

I'm seeing my surgeon this week to discuss the surgery performed  and any suggestions he may have regarding paralysis in my foot.  This surgeoin is one of those who DOES NOT like to talk or reveal information.  He also happens to be closely connected financially with the PT office he recommended that I use....and where the PT pushed my joint beyond what I believe to be a reasonable limit, while ignoring my clearly stated, and repeated concerns and pain.  It's a ball of wax.

  I am taking an advocate along with me for the appointment with the surgeon to keep me from blowing my top and as a secondary observer should I run into major communication failure.  I'm trying to cover my bases, without anticipating the worst. 
I want answers to my questions, and explainations of why I cannot move my foot.  I want to understand options in treatment, and address the problems I have had with PT services received thus far.

Does this scenario ring a bell with anyone?  What's involved in getting a foot reattatched to the rest of the leg?  How to deal with a secretive surgeon who wants maximum control, and admiration?  Where can I find recommendations for orthopeadic surgeons who could give me a second opinion, and review my case thus far? 

Thanks for any comments and ideas, support is greatly appreciated.

Annie
Duluth MN
[email protected]
2/05 Dislocated rt knee in fall
3/11 ACL/PCL, medial meniscus rupture removed
7/11 Posterior Corner Reconstruction, post op foot drop, ACL disintegrated.
Regain motion in right foot
2/06 Medial Collateral reconstruction---3/24 Failed
5/12 ACL MCL reconstruction (second round for both)

Offline clueless

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Re: 2 surgeries and paralyzed foot HELP!
« Reply #1 on: July 27, 2005, 03:36:29 AM »
Hey Annie,

I'm sorry for what you are going through. I can somewhat relate to the secretive doctor and questionable physio. When my knee ended up being a thousand times worse after surgery then before, I asked for the operating room report. It had two words: pricing - chondromalacia. As for physio, I have since discovered that the therapist I saw gave me the absolutely wrong exercises to do, which led to considerable more damage to me knee. It has now been almost a year since my surgery and I am still pretty much disabled.  My advice to you is (1) trust your instincts, and (2) seek out a good doctor, and also seek out a good physiotherapist. They are definitely worth their weight in gold. I am fortunate now to be in the care of a good sports medicine specialist and physiotherapist. They are out there, you just have to keep on looking. Don't lose hope.

Clueless

Offline shiningwaters

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Re: 2 surgeries and paralyzed foot HELP!
« Reply #2 on: July 29, 2005, 08:03:30 PM »
I can tell how much I am sick of dealing with doctors by how many times I miss scheduled appointments before I see them.  I missed the first post-op surgery on Wednesday. I went in on Thursday to have staples out with the assisting surgeon.  Low and behold, there was a good reason for me to miss this appointment.

The primary surgeon did a scope of my ACL/PCL reconstruction that was done in early March.  The ACL has deteriorated.  Why would an allograft from the same source deteriorate on one repair and not the other?  The assisting surgeon did the ACL while the primary surgeon did the PCL.  Did I want to scream?  Yes.  Did I want to kick the doc in the shins?  yes.  Did I? no.

In the meantime my partially paralyzed right foot is getting worse. I can no longer wiggle my toes like to could post op.  The assisting surgeon told me that movement often returns, but the pause at the end of his statement, and the look he gave my foot leads me to believe there could be other outcomes.  This guy should not play poker.

I will see the primary surgeon next week---I noticed that they are not making me wait 3-4 weeks this time.  The advocate (from social services who supplies my medical insurance) didn't show up for the appointment this week, I really need her there next week. 

Thanks for tips, support, and ideas from all. I feel like I am in a vacumn dealing with complex questions that I can't understand.  I'm glad to find you all with some pointers in the right direction...

This really sucks, but I am not going to lose my cool with the docs.  I've got a whirling dervish inside that would love to rant rave and reak havoc.  It will have to be happy with going outside and trimming the garden....

one day at a time---*deep deep deeeeeep breath*---*body goes flying around the room like an untied ballon*---

Annie
2/05 Dislocated rt knee in fall
3/11 ACL/PCL, medial meniscus rupture removed
7/11 Posterior Corner Reconstruction, post op foot drop, ACL disintegrated.
Regain motion in right foot
2/06 Medial Collateral reconstruction---3/24 Failed
5/12 ACL MCL reconstruction (second round for both)

Offline The KNEEguru

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Re: 2 surgeries and paralyzed foot HELP!
« Reply #3 on: July 30, 2005, 06:27:53 PM »
Quote from an e-medicine article -
"Peroneal neuropathy caused by compression at the fibular head is the most common compressive neuropathy in the lower extremity. Foot drop is its most notable symptom. All age groups are affected equally, but it is more common in males (male-to-female ratio 2.8:1). Ninety percent of peroneal lesions are unilateral, and they can affect the right or left side with equal frequency.

A foot drop of particular concern to orthopedic surgeons is a peroneal nerve palsy seen after total knee arthroplasty or proximal tibial osteotomy. Foot drop has an estimated prevalence of 0.3-4% after total knee arthroplasty and a 3-13% occurrence rate after proximal tibial osteotomy. Ischemia, mechanical irritation, traction, crush injury, and laceration can cause intraoperative injury to the peroneal nerve. Correction of a severe valgus or flexion deformity also has been suggested to stretch the peroneal nerve and lead to palsy. Postoperative causes of peroneal nerve palsy include hematoma or constrictive dressings. ref http://www.emedicine.com/orthoped/topic389.htm
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KNEEguru