Ankle Update 20240531

A lot has happened since the last update ten days ago. I hinted at stuff in some more recent posts, but I will summarize here after speaking to both orthopedic surgeons.

• Due to my diabetes, peripheral neuropathy, and even the kidney transplant, my bones are likely weaker than normal. One surgeon said rolling my ankle should not have resulted in bone fracture.
• I was healing fine from the initial surgery. The CT scan from March 20th showed everything was normal and healing.
• From the May 28th CT scan, one of the two bone fusion sites did not heal properly. Some bone filler from the ankle has been reabsorbed.
• Additionally, my heel bone has fractured along (near?) one of the screws holding the metal rod. The surgeon said this was likely due to my weakened bones. There is some bone loss here too.
• Unless the heel bone heals itself, the ankle will continue to deteriorate if I keep walking on it. If it heals, and the ankle is not bothering me, then we will leave everything as is.
• There are two surgical options, but both are risky. The first involves going back into the joint and adding more bone filler and hoping it sets. The other is to rearrange all the bones again and use a ring external fixator with wires to hold everything together. This looks scary and will take many months. Search “Charcot external fixation device.”
• The final option is to amputate below the knee and get a prosthetic lower leg and foot.

For now, we are casting the leg and hope my heel bone will heal on its own. That is the usual treatment for a heel bone fracture. We are also hoping that by not putting weight on the ankle, the ankle joint will regrow some bone. The surgeon ordered a blood test to see if my blood chemistry is conducive to bone growth, and they started the process of getting an EM bone stim machine. A representative from that provider has already called me for insurance approval. I am really hoping this will help and is not a scam.

Obviously, I do not want to lose my leg. I would have the lamest reason for injuring my ankle and amputation. I still have a ton of questions. I did try to ask as many as possible, and I may call or text both surgeons some more for clarity.

• Were my bones strong enough for the initial surgery? Or was that the only option so we had to take the risk?
• The physical therapy order said 50% weight with boot. However, the therapist had me out of the boot by day three and putting full weight on my ankle. Was that the reason for or contributed to the current issue? I just followed instructions from the physical therapist, and there were several x-rays done after starting physical therapy without showing any apparent issues.
• What are the chances of the heel bone healing by itself? I know we have to see if it happens, but I will need to live with a cast and not walk for several more months. I am also suffering from anxiety and panic attacks from the cast and the current situation. The physical symptoms are is making me feel worse.
• Are my current surgeons okay with me getting a second/third opinion? I believe that is a pretty standard process before making a major medical decision or getting surgery. Someone from my parents’ church already gave them the name of a foot/ankle orthopedic surgeon from UCI Medical Center.

So, now I need to wait and pray. I waited three months after the first surgery, and I wonder if I somehow pushed the surgeon to get out of the cast early. This time, I need to be more patient, even if the panic attacks are more frequent and intense.

Another decision I need to make is where should I stay? I am currently still at home and living on both floors. That means several trips up and down the staircase. Going down is easy but climbing up on my knees is tiring. It also discourages me from going to the kitchen and getting food. I have lost seven to eight pounds since getting a cast again. Prepping food is also much harder with crutches or a knee scooter. Other options are putting up a bed in my mostly empty living room and staying downstairs or moving back to my sister’s house. At least there is food available at my sister’s house.

Since I am officially retired, I am just sitting around all day regretting past decisions and asking God, “Why?” I know this is bad for me but like the panic attacks, I seem to have zero control. I was on dialysis for three and a half years and this feels way worse.