UKC

Hello,

I am in a bit of a quandry on whether to go ahead with an operation to remove a bone spur, at what I think from the MRI, is the front of my talus bone, and perform microfracture.

As I'm quite indecisive at the best of times, I thought it would be a plan to ask for the opinions of fellow climbers who may have had a similar operation, be living with bone spurs in the ankle, or anyone in the medical profession. After being on the waiting list for ages, I got a letter in the post with the consultation, confirmation, and surgery appointments all in a short space of time, and have to decide whether to go for it in the next couple of days.

The injury stems from a decent sized fall I had a couple of years ago. Having had quite swollen ankles from skateboarding in the past, I sucked up the pain (which was probably the worst I have ever experienced), and took longer than I should have to get it seen to. I found out a month or so later from an x-ray that I had a tiny fracture in the front of the ankle, so I took it easy for most of the summer. The swelling took around 6 months, probably longer, to get back to a normal size, and I am left with less flexibility at the front. It has taken a lot longer to get back to activities with higher impact such as hillwalking and skateboarding, which will often result in it being achy if I'm not careful, or carry on for too long. There is rarely any acute pain, the main symptom is of discomfort.

When speaking to the surgeon last week, his advice was to only operate if the patient is experiencing significant pain, which I am not. My thoughts are that surely by removing a bone spur, some of the more durable hyaline cartiledge it may be poking into may get eroded less quickly? I guess I could start the process in the future, when it will probably flare up more, but would it be wiser to get it seen to now?

Any helpful thoughts and opinions are welcome,

Thanks,
Martin

In reply to Martin Bagshaw:

Hi Martin,

I had this procedure (arthroscopy and debridement) on my right ankle in early March. I was in a similar situation to you - rarely experiencing acute pain but regular discomfort and stiffness in the ankle. I was advised that without the surgery there was little chance of improvement, so decided to get it done as soon as possible.

The surgery itself went well, and initial recovery was promising. I aggressively followed the prescribed exercises post-op, as I was keen to regain ROM and prevent unnecessary scar tissue. The first three weeks went well and despite catching the foot it a lot – proprioception takes a while to regain - the ankle improved significantly. Unfortunately I sprained the same ankle three weeks post-op, which has put progress back a lot. I was unable to do any rehab exercises for two weeks, and I would say the condition of the ankle is roughly where it was just prior to the sprain. I’m unsure of the long-term prospects of the ankle, and haven’t yet returned to climbing, running etc.

This is obviously a fairly uncommon situation, so take my experience with a pinch of salt. I don’t regret undergoing the procedure and would do so again in the same circumstances. As I understand it, the op is relatively straightforward and low risk. Of course, only you can decide what’s best for you in your circumstances.

If you have any questions feel free to PM me.

In reply to Martin Bagshaw:

I had an arthroscopic debridement of my ankle in 2010 after a climbing fall a few years previously. I developed a bone spur in the joint due to bone shards floating around in the joint after my accident that weren't seen on the x-rays. Prior to the surgery I had very limited dorsiflexion in my ankle and I struggled to do long walks and would suffer a lot of pain afterwards. The removal of the bone spur made a significant difference to both immediately and I was very happy with the result. I was back on the bike in 3 weeks and climbing after 5-6, though not pain free for a few more after that.

Unfortunately by 2015 my ankle had deteriorated again and I've now been diagnosed with osteoarthritis. It's still better than it was pre-op though. I don't think the surgery was to blame - I think it was the presence of foreign bodies in the joint for 18 months that caused the cartilage damage and really regret not pushing for a second opinion much earlier and allowing myself to be fobbed off when I knew something wasn't right with the recovery process.

Anyway this is a very long winded way of saying that doctors sometimes don't fully appreciate quality of life issues, especially for active people and when they're being pushed to keep costs down, which can sometimes mean they'd rather treat injuries conservatively. Not saying that's why they're suggesting to wait but it's something to be conscious of. But a bone spur isn't ever going to go away without treatment and like you, I'd be wary of the long term damage it might be doing to the joint.

In reply to Sam Hockley:

Have the op. I knackered mine bouldering a couple of years ago and had it diagnosed as a really bad sprain. A year or so later a doctor friend told me to ask for another opinion as it was still bad and kept sticking/locking up . Turned out it had been broken and now had spurs and all the associated problems with it. I had the op and I can only wish I had done it earlier as it is now so much better than even the "good" one. Have it, do the Physio exercises afterwards and get back to normal life again

In reply to Martin Bagshaw:

I had the same operation two years ago; it has caused me pain ever since. At the same time as the ankle arthroscopy the surgeon performed a Brostrom repair. This repair strengthened the ankle significantly but I have more pain at the front of the ankle (where the arthroscopy was) that ever before.

Thanks guys, it is useful to find out what others have been through.

Though it hasn't made me much more decisive, some of your injuries and symptoms seem to be a bit more severe than mine, and so I am tempted to act conservatively, even though a bone spur aint going nowhere without an op.

The lack of depth of information I have recieved during the whole process, not to mention the amount of time it's gone on for has proved pretty frustrating. Either option feels like a bit of a gamble, and I have found the 'we only operate on people who are in pain' line incredibily hard to swallow.

Anyway, thanks again for all your feedback.

In reply to Martin Bagshaw:
Hi,

Probably won't be very useful, but I'm 4 weeks post ankle arthroscopy due to injuries sustained in a climbing accident. Post op, the ankle is a bit sore for a week or two and don't expect to be driving or doing much walking for a week or so which is a real pain! Four weeks on, other than being swollen it's feeling an awful lot better than before, and my surgeon is happy for me to go to the alps in June! I'd highly recommend getting it done!

P.S. ask your surgeon for the endoscope photos from the op, well worth a look!

Hope it all works out in the end,

Ross