Loose Ankles?

My experience with Brostrom Surgery – Ankle Ligament Repair

In January 2018, I had ankle surgery to repair torn ligaments. There is plenty of medical information online, but I couldn't find many first-hand experiences of the problem. I put this together in the hope others in a similar situation will find it useful.

Back when I was in boy scouts, our scout troop leader had a limp. He lamented to us often about the importance of good boots. But I was young then and I figured I had nothing to worry about. In college I took up jogging, and every now and then would trip and twist my ankle. No big deal. But over the years the trips and sprains added up. The big ones stick in my mind; sprains while hiking down from overnight camping trips, trips while trail running, trips while out for a morning run.

My mother cautioned me to look after my ankle. She said I would get arthritis. But I figured arthritis was for old people, so I didn’t pay much attention.

The years passed by, the sprains kept coming. Then there were a few good sprains that put me out of running for months. Compression socks from different countries started to pile up in my drawers. I started wearing an Active Ankle brace occasionally, then all the time. Along the way, I saw a few doctors who diagnosed ‘chronic ankle instability’ and recommended ankle strengthening exercises. I did my best to improve my balance with my eyes shut while washing my teeth, but there didn’t seem to be much more that I could do; except be careful.

I wish I’d known….

Whenever I sprained my ankle, I would wrap it up with one of those ACE bandages that you get at the drugstore. They didn’t really add much support.

What would have worked better for hiking and running would have been an ASO Lace-up Ankle Brace

Eventually, I stopped running; it wasn’t worth the risk. I stopped hiking; it also wasn’t worth the risk. But by then I would sprain my ankle crossing the street or even doing laundry. The ankle started to ache… not badly, but noticeable. So, with insurance in hand, I went to get some long overdue physical therapy.

By this point the physio laughed at me, and said there was nothing she could really do. Time to talk to a surgeon.

Ankle Ligaments.

Inversion sprains are the most common types of sprain where the foot bends outwards. There are three ligaments that are designed to keep things in place, but repeated injuries will weaken and eventually tear these completely. The doctor knew right away from pulling my ankle out at a funny angle, and the MRI confirmed: Two of my ligaments, the ATFL and CFL were completely torn. Only the strength of my muscles kept me upright.

Fortunately, modern medicine has a few tricks up it’s sleeve and the Brostrom Repair is one of them. The ligaments can be sewn back together, and they’ll reattach, stronger than new apparently.

The MRI also showed other damage. With each sprain, the corners of the bone starts to grind into the cartilage. Eventually that cartilage started to rub away and the result was friction where the bone starts to grind on bone. The associated inflammation and pain is known as arthritis and it’s bad news. The arthritis damage is less easy to fix, but a technique called ‘micro-fracturing’ of the bone makes it possible for the body red blood cells to escape and regrow some insulating material where the cartilage had formerly been.

With trepidation, I signed myself up.

Brostrom Repair – The Surgery

I had my surgery done with Daniel Thuillier at UCSF. This surgery has a high degree of success, and even though my ankle started to feel better in the months before surgery, both my PT and the doctor felt this was the right decision long-term.

The morning of the surgery, I was nervous. I took a long walk down by the canal in the morning drizzle before I went in, and then I resigned myself to the professionals.

Leg shaved, colored pens to mark which ankle they were going to operate on, IV drip hooked up, sedatives infused, ultrasound to find the leg nerves and a nerve block applied, and then I was wheeled into the OR, strapped in and a couple short breaths later…

…. I woke up. It didn’t feel bad. In fact I felt fine like I’d just taken a morning nap. My foot was all nicely packaged up. The nerve block was clearly doing it’s thing as there was no pain at all. They kicked me out of the hospital soon after, and I rode home to enjoy two weeks under house arrest.

Elevation is key to reducing swelling, so I lay back on my bed, with my foot propped up on a multitude of pillows. The nerve block lasts about 12-18 hours

After the nerve block wears off, the pain kicks in. They sent me home with prescriptions for lots of ibuprofen and opioids (oxycodone). Apparently it’s important to ‘get ahead’ of the pain. It’s much harder to use the drugs to overcome the pain once it arrives. So I signed myself up for the basic dose before I went to sleep and braced myself for the pain to come.

Surprisingly, severe pain didn’t come. The drugs did their job and I felt fine and only slightly loopy. By morning I could move my toes, and the pain level was probably at no more than a 2. If there’s one thing that I could pass on to others going through this, it’s that it wasn’t that bad… at all.

The next couple days, it’s best to remain in bed, and believe me, I had no desire to be up and about. I drank lots, and repurposed a laundry detergent container into a bedpan. The drugs stop up the rest of your system, so you don’t have to worry about #2 for a couple days. Then you have to start worrying about #2.

After a couple days in bed, I was ready to get up and move around.

Life on crutches.

Ok. So there’s a shopping list of things you need to prepare for.

1. You’ll want to shower and you can buy a waterproof covering that will go over your cast and keep everything dry. Buy it.

2. Don’t use the underarm crutches. They’re awkward, uncomfortable and can cause nerve damage even when you have them adjusted properly. Instead go buy some forearm crutches – also known as Canadian crutches, or Euro crutches, or quite frankly Rest-of-the-World crutches. It seems only America is stuck in the mid-1800’s with it’s preference for underarm crutches. Believe me, forearm crutches are the single best piece of advice I can give. You can buy a pair for $40.

After two weeks of hobbling around the house and keeping my foot elevated, the doctor took my stitches out, put me in a boot and allowed me to go out.

Note on the boot. The hospital charged my insurance over $1000 for the boot. If you bought the boot without insurance it might only be $700. If you look on Amazon, you can find the same boot for $65!!!

Be careful of those knee scooters. One friend clipped a cubicle while zipping around the office and put herself back in hospital.

The first couple weeks on crutches is hard. Hard on your hands, hard on your self-confidence. This is offset by the ample kindness and generosity exhibited by almost everyone. Buses would wait for me, people would hold open doors, carry my food, strike up random conversations. I would go so far as to describe this period of convalescence as both character-building and life affirming.

Driving with your left foot

Since I’d had surgery on my right foot, I was told I couldn’t drive for six weeks.

Right. You can’t walk, and now you can’t drive?

I refitted the car with a left-foot accelerator made out of soldered copper pipe. Now you might think this a crazy idea, and everyone warned me against it, but in reality it wasn’t much different than driving on the left side of the road. There’s a mental shift, but it happens fairly quickly. You do need to be very cautious as you get started, and you do want to keep that right foot out of the way. I swung mine over to the passenger seat, so that muscle memory would know it had no role in hitting the brake should a surprise arise. It was left foot or nothing, and the left foot rose to the challenge.

Home made left-foot accelerator modification

Rehab

The weeks passed quickly. My arms grew strong. My disabled parking placard came. I learned how to carry a cup of coffee while walking slowly on crutches. The scar healed; it healed well. The boot became comfortable, and then it was time to move on.

Six Weeks

Up until six weeks, I’d successfully managed to stay off my foot (with only a couple minor mishaps). My pain level had never been above 3. I figured I was through the worst, and would soon be able to throw away the crutches and start dancing. Wrong. The fun was only getting started.

Six weeks of non-weight bearing had left my leg a shrunken noodle. As I started to move my foot, all sorts of stuff started to feel wrong. My leg muscles started cramping up at night. The foot was bruised, tingly and uncomfortable. Pain would shoot out as I started to put partial weight on the foot while walking in crutches

But the boot came off, and it was soon time for physical therapy!

Nine Weeks

Physical therapy started with range of motion and simple exercises to bring the muscles back to life. I was soon on an exercise bike every other day, and 30mins on the bike seemed to leave me a little more mobile than before. Walking with the crutches became more natural. One day, I found I was able to stand. The next I was able to stand up. Then I could walk across the kitchen unaided. Soon I found myself able to walk up stairs, then down stairs. I’d take the crutches for longer walks. I was able to get around.

Friends came to visit, and I took them to Yosemite. I managed to walk the Vernal Falls circuit partially weight bearing with the underarm crutches, up slippy rocks, and through snow. My physical therapist was not amused. But I think I will use forearm crutches for all hiking in the future. It’s fast and easy, and everyone seems delighted to see a cripple with determination.

Twelve Weeks

After three months, the crutches are in the basement, but my ankle is still sore and stiff. Every day is better though and I’m back on my bicycle, and back to swimming. I’m able to walk to the store, and every week the limp seems to be less. Doctor says this is completely to be expected at this stage.

Six Months

Recovery is definitely plateau-ing. My ankle is much more stable, and I am comfortably getting around on it, but it still aches and it doesn’t feel good to run on it. I can make it maybe a half mile, but after that it lets me know that it definitely isn’t happy. I saw the doc, and he recommended I go easy on it and see where we’re at after a year. That feels right. I’m still hopeful for a full recovery, although a little fearful that my running days are over.

Twelve Months

I’m back to running again. Not a lot, but I can comfortably trot out four or five miles now, which is all I’m after really. After a longer run, my ankle will ache for the next 24 hours, which I assume is from scar tissue and inflammation around the damaged cartilage. Nothing that a little ibuprofen and a bit of ice doesn’t take care of. I only run once a week or so as part of a a varied exercise routine, so perhaps I should push it more and see if it sorts itself out. The biggest improvement is that my ankle now feels much, much, more stable. I’m more confident on my feet, and that cloud of worry on uneven ground seems a lot less heavy.

Eighteen Months

Running a couple times a week now, without any noticeable problems from the surgery. My foot feels strong and stable. So, at this point, I’m pretty happy. It was a slow recovery, but well worth doing.

Good Links

29 Comments

  1. Beth on February 19, 2019 at 2:28 pm

    Dear James,
    I also had the same procedure, but it was 5 years ago. Have you had any complications from it? I was just wondering because unfortunately I have had some issues following surgery. Though, unlike most people, I had about 6 ankle sprains prior to tearing them completely. I was so excited to see someone write about the recovery process. Thank you. It was a very difficult time for me. Even though it is5 years later, it is nice to know that someone else went through a similar situation. Thank you.

  2. Joe on March 28, 2019 at 10:13 pm

    Thanks for this awesome post (especially that sweet job with the pipes). It’s so hard to find information on the week to week recovery process and expectations.

  3. Heather Belling on April 9, 2019 at 4:30 am

    Thanks for writing this And putting it up online to share with everyone. It really does help to hear from somebody who’s already gone through it and I don’t know many who have. Personally I don’t know anybody who has, and even my online searching has proved fruitless before. I appreciate that you were able to document how you felt at different stages of your recovery. It was good to know that you were feeling stuck at six months to, as I am at the six-month mark and frustrated that I have not made more progress. I’m still having difficulty walking/Weight-bearing so I keep questioning whether something is still wrong or not it’s hard to tell when everybody just keeps saying “yeah it’s normal stay patient”, I’d like to know some specifics of what I can expect LOL so thank you again for writing this out.

  4. Lisa Jurado on June 1, 2019 at 4:18 am

    I’m so happy to come across your article. I had right ankle lateral ligament reconstruction surgery yesterday. I too was diagnosed with chronic ankle instability a few weeks ago after 3 months of physical therapy. I played sports in high school so I’ve had 3 sprains during that time. As I got older, wearing heels I remember my ankle giving out for no reason. I’ve managed to stay ahead of the pain as you mentioned. I feel like the tens unit has also helped with pain. I’m praying for a full recovery. I know I have a long road ahead of me 6-12 months. My goal is to feel comfortable walking without fear of twisting my ankle and falling. Most importantly i hope one day I can resume wearing heels to work. I’ll keep you posted!

  5. Tonya on June 1, 2019 at 11:01 am

    Thank you for sharing your story. I am 11 days post OP. A knee scooter is my new best friend. I have started stretching and strengthening PT. Hoping to be full weight baring in 3 weeks but know it could be longer.

  6. Fioba on June 6, 2019 at 5:36 am

    I am booked in for surgery on June 27th and your article is really helpful. I travel for work and am now worried about the few week or so I the bootassoubds like I will still need to take it easy? The time it takes to recover fully is depressing

  7. Andy on June 26, 2019 at 8:45 am

    Hey James! I was curious if you had anymore updates being a year and a half out? I just saw a surgeon today and am slated for surgery on my rank ankles to start with but will also need the left down a year of so later. Thanks for any info!

  8. Danielle on June 28, 2019 at 2:13 am

    Thanks for this! I am getting ready to have this same surgery myself and am totally scared

  9. Cori on July 7, 2019 at 6:59 am

    Hi James and Beth! I’m Cori. I had the same surgery on April 18. I’m in Mexico now, and I am so incredibly sore that I had to look this up and try to figure out if I’m just being a baby or if this is normal. The streets here are mostly uneven, and I think I’m probably just not quite ready for beach walks, either. I was doing SO well until the BOOT came off two weeks ago and I left the country; now I feel almost like I’ve reinjured myself, although thankfully my ankle does feel very stable now.
    If you’ve seen this, thank you for reading. Nobody understands…my kids are extremely tired of hearing about my ankle! I think I just needed to see that I’m not the only person going through this process. Again, thank you for listening and for sharing your stories too.
    Sincerely,

    Cori

  10. Hali Hatt on July 15, 2019 at 4:14 pm

    Thank you so much for your story. In less than a month I am on my way to get my ankle sliced and diced. I am nervous because I have never had surgery (minus my wisdom teeth but I don’t count that) and I am nervous about how the surgery will go. I have many questions and thoughts. One being how badly did you want to hit your therapist? How did you build the left foot pedal thing? I’m also having surgery on my right foot so I forsee a difficulty driving.On top of all that I’m supposd to be leaving for a trip a week after the surgery so again very nervous and wondering how difficult everything will be from the surgery on.

  11. Rebecca on July 20, 2019 at 10:25 am

    I had the same thing done about a year ago. I’d torn the ligaments in my ankle when I was a kid (did it when I was sliding to a base in t-ball, of all things) and since then I kept injuring it left and right. Normally when people see someone in a boot they’re concerned, but it was so common for me nobody even had to ask. When I was in my teens I finally started really talking to doctors about it and they all recommended the same thing: physical therapy. At that point daily pain was a norm for me, so much so it often had me in tears, and it takes a LOT for me to get to that point. I tried therapy for years and it did nothing, until I finally went to a doc who recommended this procedure. He finally explained to me why PT wasn’t working, and why this was really the only thing that would fix it. I actually started crying because I was so happy I had both an answer and a fix; by that time I’d been dealing with this for over ten years. I will add I had a gastroc recession on the same leg (R) when I went in for this procedure, and on the other leg about four months later. A year later and I can finally run without pain, something I’ve never been able to do. The brace I wore almost daily for so many years has been ditched, and I haven’t rolled my ankle once. The only complication is nerve pain at the incision site on my ankle. Even barely touching it sends a weird numbness/pain down my foot, and it’s gotten to the point it hurts without manipulation. Walking hasn’t been affected, I mean at least I’m not limping like I was, but I was recently given lidocaine patches and recommended to try desensitizing it. I’ll have to wait and see how it works. My calves are also often very stiff in the mornings or when I’ve been sitting for a while, but I suspect that just needs more PT. Overall I’m walking much better, I haven’t rolled my ankle once since surgery, and I can actually run without pain or such a great risk of injury. All surgery comes with a risk, but I would definitely recommend this procedure. Not everybody experiences nerve pain, but even with it it’s certainly improved my life.

  12. Christie J Priem on August 1, 2019 at 8:00 am

    Thank you very much for posting all this. I injured myself during a running fall and my ligaments are permanently torn, so my doctor has recommended a similar surgery. I’m nervous about the recovery, but seeing that you’ve moved in the right direction, I’m slightly reassured. Hope you continue to improve!

  13. Mike on August 13, 2019 at 3:13 pm

    Well, as I lay here post OP I can only pray that this procedure improves my quality of life. After numerous left ankle sprains I finally gave in to the Surgeons recommendation. Much like James, I also enjoyed running, as career Marine it was part of daily life for over 21 years. As avid runners, we tend to take our bodies for granted especially our lower extremities. We deal with the pain and aches, and often dismiss them as minor. Suck it up buttercup, eventually leads to life altering injuries. Reading your post really encouraged me to stick to the recovery plan. I know it will be slow, but I am in no hurry to pound the pavement, maybe cycling is in my future.

  14. John on August 22, 2019 at 9:17 am

    This was a great read, I had a very severe sprain in Feb 2019 that gave me complete tears of the ATFL, CFL and spring ligament of the deltoid complex. Also have grade 2 tears of the of several other ligaments within the ankle and to top it off 2 confirmed avulsion fractures and a possible third fracture. This was the first injury I had ever sustained to this ankle despite all the years of playing sports and it has lead to me having to watch every single step I take regardless of the type of surface I’m walking on as the ankle has the tendency to just give way. I’ve been doing PT twice weekly since about week 4 (was in a moon boot the day after for about 8 weeks) but doesn’t seem to be improving. Surgeon completed Anterior Draw and Talar Tilt tests and both were excessive. I see him again in about 5 weeks and I think it will be a case of surgical repair will be required. I think i have read every single bit of literature and watched every single video there is on Lateral Ankle stabilization and I’ll be bombarding the surgeon with questions.

  15. The shadow on September 6, 2019 at 5:25 pm

    You are doing a good job for sharing this, I’m also part of it, both my ankle had surgery, right ankle 2015 & left ankle 31 dec 2019, back then i’m the first case in the hospital, this sharing make me feel i’m not alone…

  16. Edna on September 10, 2019 at 8:17 am

    Thanks for posting this. I just had my surgery 6 weeks ago and I’m now in a boot for out and about and just regular shoes at home Still a little painful but I started walking unaided today.

    • Rebecca Rivoire on October 30, 2019 at 10:02 pm

      Be careful walking too soon out of the boot. I think that’s why my ankles are the war they are now! (See my comment below)

    • Sierra on November 1, 2019 at 9:41 pm

      I had my surgery on 9/11 and am now just over 7 weeks out. I just received clearance to be partial weight bearing just after the 6 week mark. I was having minimal/no pain by that time, but now all these weird sensations and a deep pain in the front of my ankle- not at the incision but internally near where the ligament was repaired. I’m so glad so see the experiences of others are similar. Could you share with me Edna where you are now- at 12 weeks out? You’re about 6/7 weeks ahead of me.

      • James Dilworth on November 5, 2019 at 9:28 am

        I too had a similar mysterious pain in the front of my ankle for quite some time as I transitioned back to walking. It did eventually resolve naturally, but definitely had me worried for quite some time.



  17. Laura Palmer on September 19, 2019 at 8:34 am

    I am 10 wks post repair too and was encouraged by your posts. I was surprised by the level of pain and tightness but I have been weight bearing for 3 weeks already.

  18. Angie Berzina on October 3, 2019 at 10:49 am

    I’m glad to come across this. Ive been dealing with repeated ankle sprains & one that caused a broken foot since feb of this year. Finally decided i couldn’t take another roll/break. I just had my ligament reconstruction 2 days ago. The nerve blocks are still working so not much pain yet. I was really wondering what to expect in the coming weeks & months. This will be a good guide to follow. Thx!

  19. Heather on October 22, 2019 at 6:20 am

    Hi, I had my surgery 3 months ago, I was non-weight bearing for 6 weeks then started PT. With 6 weeks of PT I have seen little improvement. I am just starting to walk without crutches but am still having a lot of pain. I also have a very limited range of motion by which I mean close to none. My surgeon says that its never a problem to point my foot down or plantar flexion which worries me why its happening to me. I know things take time but my PT thinks its not normal. I am nowhere near driving and I have to use a wheelchair in big stores because of pain in the front of my ankle. I also can not feel my big toe since the surgery.

  20. Amanda Maxwell on October 25, 2019 at 9:46 am

    I had ATFL reconstruction on my right ankle 3 weeks ago. The soft cast was removed on Monday and a hard cast applied. I am non weight bearing for 6 weeks, and can not drive as irs my right foot. I am signed off work for 12-16 weeks and thankful I have a knee scooter to get around. My husband thinks I’m an absolute klutz on crutches, so I use them at a minimal. I enjoyed the post and was actually searching the internet re: increased pain in hard cast. I too could not believe it seemed like a doddle after surgery….no pain, no meds I was in heaven. But now I feel the swelling in the hard cast and sometimes feel a pinch in the ligament. I know the fun will start when physio starts. My pain before surgery was everyday and I walked with a limp. The surgeon said the muscle, bones and ligaments were all remarked except the ATFL. He described it as a “mess”, “frayed” and in “shambles”. I am hoping that my ankle, one day will feel normal.

  21. Rebecca Rivoire on October 30, 2019 at 9:59 pm

    I had both feet done. In Sept of 2017 I had a modified brostrom of the right ankle and after recovery, on July 9, 2018, I had the left ankle done. To this day, I am having problems flexing my foot. My ankles still hurt, but I do feel more stability in them which is good. Actually they are tooooo stable! My ankles are so stiff when flexing the foot up with toes up. I’m not sure what went wrong but it’s been a year since the second surgery and my ankle is still so stiff and painful! What went wrong! I told my surgeon, he did an MRI and said everything looks good. But he doesn’t have to live like this. Has anyone else had this issue after a brostrom?

  22. Angie Willmes Berzina on November 5, 2019 at 11:48 pm

    I am now 5 weeks out from Brostrum Gould surgery. I feel like the recovery process for me has been much faster vs what a lot of you have had. I was out of 2 diff cast by 2 1/2 weeks and have been weight bearing in a boot for 2 1/2 weeks. My dr told me to start PT this week (week 5) as well as transition out of the boot. My ankle is def stiff & my calf is sore otherwise it feels good to start walking in a shoe. The one thing that is bugging me is the top of my foot & toes are sooo sore. Like they’ve all been broken. Anyone else feel like this? And my big toe & second toe are still numb but that’s from the nerve block. Hope it resolves soon.

  23. AB on November 9, 2019 at 2:12 pm

    Hi. I am 17 and debating Brostrom reconstruction for my right ankle. I come looking for encouraging, words and positive outcomes . Ah I am scared my ankle will be worse than before. I am wondering if anyone here is around my age with a similar experience and what they chose to do. Also if PT would work? Ah idk. And I am almost completely torn. I have naturally flexible ligaments prone to rolling but I am just worried that I will lose my flexible, become stuff. I am also pretty hypersensitive about my body and though my ankle sometimes pangs me now. And I have stopped running. (I rosparained and rllled multiple times in XC and SOCCER). Also I have tendinitis and plantar fasciitis. Did anyone else experience these conditions, foot pain, cramps, or hip pain before surgery? Or after surgery. Is surgery worth it. What will happen to me long term if I do not get surgery. And what is the chance of PT working. And what is the chance a new technology or invention will come out other than BROSTRom surgery? Hahaha let me know if anyone can answer any of these. It would be super super super appreciated. Thanks. Hope everyone’s recovery goes well!

    • Stefanie on November 12, 2019 at 9:42 am

      Ask about the Arthrex Internal brace. They can preform the Brostrom and augment with the internal brace. Recovery is only 8-10 weeks to return to sports. Most importantly you can walk after only 7 days. My daughter plans to have the surgery in December, so no personal experience.

  24. Stefanie on November 12, 2019 at 9:40 am

    My 14 year old daughter injured her left ankle 4 years ago but we just found the extent of the damage. She completely tore her atfl and cfl ligament and partially tore another ligament. She currently plays club soccer and high school soccer although her foot pain is pretty severe. She is debating when to have surgery. Her doctor told her it will take her off the field for 3 months but after reading this it doesn’t seem likely. Did anyone have the Brostrom augmented with the internal brace? Her doctor is planning to use the internal brace on only the atfl. If used on both atfl and cfl she would be weight bearing by 7 days post op. Looking for personal experiences.

  25. Paula on November 19, 2019 at 9:44 pm

    Thank you so much for your post! I had my surgery 9/24 – so 6 weeks out. My main issue after the surgery has been intense nerve pain. The surgeon told me this happens unfortunately from the nerve block given for surgery. I’ve begun basic exercises at home, mainly drawing the alphabet and stretching and am disheartened because holy cannoli the pain is back now! The nerve pain is lessening every day but it’s still there, plus the pain from doing the PT and the swelling make me feel like my ankle will never be back to normal. Reading about everyone’s experience here has helped tremendously! I am not alone! Whoo hoo!

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