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. 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. UCSF charged my insurance over $1000 for the boot. If I’d bought the boot without insurance it might have only been $700. But go look on Amazon, you’ll find the same boot for $65!!! – A damning indictment on the state of over-charging in American healthcare.

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
This modification enabled me to drive with my left foot. I found it fairly easy to learn and get used to. Note that the police, and your insurance company, may not be as impressed by this. You should do your own research, and give consideration to the liability of getting into an accident while left-foot driving.

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 really happy. It took a while to get to 100%, but it was well worth doing!

Good Links

126 Comments

  1. Charli on June 24, 2020 at 5:13 am

    I’m having this surgery performed on my ankle in about 2 weeks. I was a bit nervous until I read your blog. You’ve done a really nice job of describing what we can reasonably expect at certain stages of recovery. Although every person and situation is different, it’s nice to have a general idea of what’s to come. I am also glad you offered advice on crutches. I have the American style under arm crutches, but will look into the forearm version you suggest.

    • PJ on June 25, 2020 at 1:11 pm

      Great blog. Thanks for taking the time to post. It is so helpful for people to describe their experience in plain English. You can read many medical journals online, but that is like reading a foreign language sometimes.

      I had the Brostrum repair 8 months ago. I also had a biocartilage repair of an osteochondral lesion of the talus. My ankle has been messed up for almost 30 years, starting with a football injury that was misdiagnosed. I had microfracture surgery in 2002 which helped, but my ankle has never been “right”since it was injured.

      The biocartilage repair feels great…the ever-present ache that I had there for 30 years is gone. I still have some soreness and swelling over the area where they did the Brostrum repair, but not too bad.

      The biggest problem is that a nerve was damaged by the surgery, and my toes have been numb ever since. At times it feels like it is getting better….at times not. It is frustrating…if not for that I would feel like the surgery was a great success. The doctor said it will be 12-18 months before I’ll know the full extent of the nerve recovery.

      It is hard to be patient…I also love running but hadn’t been able to run in years. Part of the reason I elected to have the surgery was that I hoped to be able to start running again, and get in better shape as I’m about to hit age 50. I’ve tried to run a few times, but it always seems to set me back, especially with the numbness and tingling in my toes.

      One thing I would recommend is that, even after you are set free after rehab, always wear the brace or at least high-top shoes for support when you are outdoors. I was wearing some running shoes while walking in the grass at about 3-4 months after surgery, and stepped into a hole and slightly turned my repaired ankle. That didn’t feel very good and I feared it would set me back, or worse. But my ankle snapped back quickly and I don’t think I hurt the repair. After that, though, I wore high-top hiking shoes every time I went outside, which worked great.

      One additional thing….before the surgery I had a nasty case of plantar fasciitis, which often hurt as bad or worse than the arthritis. I asked the doctor if maybe that was caused by the instability in my ankle and he said quite possibly. The plantar fasciitis is now gone after having it for years, so there definitely seemed to be some correlation.

      If I could just get over the numbness in my toes, I feel like my ankle will be the closest it has been to normal in 30 years. I’ve lived on naproxen and stronger things that whole time, and worry about the long-term effects of that. I’m hoping to be able to leave all that behind and run again, but I think it will depend on the nerves. Hoping more surgery to repair the nerve is not in my future.

      I’ll check back in at 12 months with an update.

  2. Hunter on June 24, 2020 at 8:56 pm

    Two weeks ago I had bostrom repair on my ATFL and CFL ligaments along with tightrope fixation and a clean out of old scar tissue. I was expecting alot of pain also but it never came..

  3. Patti on July 4, 2020 at 12:29 pm

    So, I had my surgery on 5/21 and I’m six weeks post op. They removed my cast yesterday and the doctor told me to start walking with the Cam boot at least 30 mins a day. I tried but the pain was so bad. I barely made 5 mins w/ crutches as support. I have had only mild discomfort since surgery. The pain kind of scared me.
    Today, my foot is very swollen and a blueish purple when it’s not elevated. Is this normal?
    It’s painful if I sit with it down longer than 20 mins or so. The doctor has me worried about a blood clot but I don’t have any stabbing pain in my calf. The muscle just feels sore.
    Has anyone else had this happen?

    • Holly on July 10, 2020 at 11:21 am

      I’m so grateful to read your comment! My surgery was 5/7 and I’ve been out of my cast for about 10 days. My foot swells up and turns purplish unless it is elevated. It’s so uncomfortable, and I also have a “pins and needles” feeling. Both my doctor and physical therapist have assured me that this is normal and that the “edema” has to be managed. Some suggestions were icing after therapy and doing exercises or practicing the weight bearing, elevating, and a compression stocking. Also, today my PT said I was ok to (carefully) try walking and standing in a pool, although I am still very nervous about standing. I didn’t expect the swelling and how uncomfortable that would be. Apparently it can be an issue for many months post surgery

      My first steps were painful. I started with 25% of my weight with crutches and I’m up more now, but still have pain, even during my physical therapy appointments. That’s how I found this blog tonight… looking to see if anyone else has had these difficulties after surgery. .

      Wishing you a good recovery. Glad to know I’m not the only one with a purple foot!

    • Kim on July 10, 2020 at 10:08 pm

      So glad I came across this! I have been googling Bronstrom recovery time..fractured my ankle and tore 3 ligaments last July. Tried everything possible to heal it, nothing worked, dr decided surgery was needed, then covid came. Finally on June 8th I was able to have the surgery. I had debridement of the ankle, a bone chunk removed from the fracture that was causing problems, and 2 ligaments reconstructed. I am in a hard cast with 32 days down, 10 days to go, it is no fun at all being on one leg. I found a sitting knee scooter and it’s been a lifesaver, but still have to use the crutches sometimes, just not fun, especially navigating stairs! Next Monday the 20th I will HOPEFULLY move into a CAM boot and compression sock, and then I suppose the next round of fun begins. I am getting a better idea of what to expect from reading these posts. Thank you all. I understand a full recovery can take up to a year, but how soon is it realistic to go back to work? I have already missed an entire year! I am a teacher and on my feet all day, in a building of 900 students and 3 stories. I know September is not an option, but I can’t afford to miss another year!
      James, I wish I had one of those contraptions for driving, as not being able to drive is the worst!

      • Izzy on July 27, 2020 at 8:50 am

        I had a Brostrom ankle reconstruction and tarsal coalition excision removal on May 11th and July 18th respectively. I completed my fourth week of physical therapy and can now walk without an assist. My follow up appointment is next week (12 week). I now have to see if I need orthotics and to enter the next phase of therapy.

        Hang in there and do everything the physical therapist recommends. The first few moments you start putting weight on your foot sharp and stinging pain will spike but as you go along with therapy you slowly begin to awake the biomechanical process of the foot and ankle. Total time in therapy has been 4 weeks and started in on July 1st.

        My ankle feels very stable at this point and different parts of my foot are now working properly. I predicted that i would be walking by the end of July but I don’t see myself running until the 6 month period.



      • Dotty on August 16, 2020 at 11:38 am

        Hi Kim, I am also a teacher and currently trying to determine the best time to schedule my surgery. How many weeks until you’ll be cleared to go back to work (stairs, lots of walking, standing all day)?



      • Kate on September 12, 2020 at 2:26 pm

        Hi, fellow teachers! I had my surgery on 1/20/20 and returned to school (with a knee scooter and walking boot) on 2/18/20. I’m an elementary school teacher and my surgeon told me to be at home completely non-weight bearing for 4 weeks. He explained that if I was a high school or middle school teacher, I could’ve safely gone back after 2 weeks if I was comfortable with teaching while sitting down. Mine was my left ankle so driving wasn’t an issue luckily!

        Once I was back to work, I taught for 2 weeks mostly on my knee scooter/crutches. before I was able to use the walking boot without the scooter. At the start it was just too painful (I didn’t use the prescribed pain medicine since I react badly to it, just ibuprofen) and my other muscles were so weak. After 8-10 weeks, my surgeon usually has patients alternate between the walking boot and regular supportive shoes, an hour on and an hour off throughout the day. However, he said I would have to do my “out of the boot” walking time at home instead of alternating throughout the day because he wanted me to wear the boot at school to protect me from the 8 year olds’ erratic movements (lol). This probably extended my physical therapy time a bit.

        Being back at school for the last 3 weeks, without any brace or boot, has been painful. Whenever I can find a few minutes to sit down for lunch, I‘ve been icing my ankle and it helps a lot. I also need to ice when I get home.

        My case could be different from yours because I have a connective tissue disorder that causes extremely loose joints and led to me breaking my ankle and completely tearing the three ligaments. I also had an Arthrex internal brace in addition to the regular Brostrom procedure and an ankle debridement. I‘m fortunate to teach on the first floor. My principal lets me wear sneakers to work now which makes me feel much safer!

        I hope this helps with planning your timeline a little bit. Wishing everyone luck on your recovery and with this crazy school year!



    • Mr Robert G Ayley on August 31, 2020 at 9:50 am

      Hi Patti
      I’ve just had 1 ligament repaired and Kevlar replacements in my right ankle 5 August. I’ve been mostly in bed for 3 1/2 weeks to control the swelling although the cast was removed 10 days ago. It’s been very painful – especially the first 2 weeks. But getting up and about now with crutches and partial weight bearing and it’s OK.
      As for as for DVT take no chances!
      My ankle was broken and in a cast 12 months ago and I had DVT. The hospital wouldn’t listen but having read a piece on the internet by a nurse who had just ONE symptom I just knew it. I had a calf pain like a dull constant cramp. In the end they took the cast if and did an ultrasound – low and behold I had a clot that could have lead to thrombosis and death. I has stomach injections for two days and three months on Apixaban to dissolve the clot. This time after surgery I have to inject my tummy daily with Fragmin to ensure I have no repeat. Take no chances and good luck.

  4. Sarah on July 8, 2020 at 10:49 pm

    I’m 10 days post op and I’ve been fitted into a moonboot straight away with full weight bearing. I’ve found it interesting reading about your recovery. I’m hoping because I’ve been full weight bearing from the moment I woke up that I may avoid some of the difficulties you’ve all had afterwards. I agree that pain has been tolerable so far.

    • James Dilworth on July 9, 2020 at 1:03 pm

      Fascinating! I’ve heard of people being partial weight bearing in the weeks after the surgery. I wonder what accounts for the different recommendations? Possibly different variations of the procedure, age, etc? It did feel like a lot of my recovery was simply recovering from all the time on crutches. But safest bet is to follow whatever your surgeon recommends.

      • Mr Robert G Ayley on August 31, 2020 at 9:53 am

        Agreed – I’m 57 and an accident caused my injury. This procedure is often for sports people quite a lot younger.
        It’s important to do what YOUR surgeon says. That’s what I’m doing to the letter!



  5. Leon on July 19, 2020 at 9:25 am

    I’ve known several people who have had the Brostrom surgery and all have said that it worked well for them. I’m next on the list. I’ve had a number of sprains to my left ankle, and torn lower leg and metatarsal ligaments over the years. I fractured my right ankle (and sprained it) a couple years ago and that was fixed, but the pain kept coming back. So I went to a very good orthopedic doc who gave me cortisone. It helped. But my left ankle has always been problematic, and after my last sprain, which also involved two toes (super painful), I visited him again. He noticed that my left ankle was now quite weak and making some clicking/grinding noises and said “You need your ligaments tightened” and mentioned this procedure. I was looking online to see what factors indicate the need for the Brostrom procedure and I’m glad I found your article because there is not a whole lot of dialogue like yours about it. I don’t know when the surgery will be, as Covid-19 has stopped a lot of non-urgent procedures such as this, especially in Covid epicenters like Los Angeles, where I live. I can’t say that my left ankle has slowed me down a lot – I’ve pushed through swelling and pain and stuff for years but I think now is the time to fix it once and for all. Otherwise I think I’m in for more sprains and eventually my ankle will be like Jell-O. Thanks again for this, it is much appreciated.

  6. Brianna on July 21, 2020 at 8:05 am

    Hello! Thank you for posting this, I had surgery on 6/12 to take out a bone chip, tighten the ligaments on the outer side and inner side of my ankle as well as repairing a tear in my peritoneal tendon. I was surprised by how you said that you had the boot weeks after surgery! I was in a soft cast for 2 weeks til the stitches were taken out and have had a cast for 4 weeks which I will get off Thursday. After that I am supposed to be in a walking boot for 6 weeks with physical therapy twice a week. I am not sure what the next step is that, I have seen people that get the stirrup thing afterwards? I am a bit nervous when I will be able to get back to standing for hours at work or even walking without pain or how much longer my recovery and symptoms will be since it seems my journey has been different that what you explained. But your post was super informative and I am so scared about when I will be able to run again or get back to even walking without assistance but although it is different for everyone I am hoping in a year I can as well.

    • Mr Robert G Ayley on August 31, 2020 at 10:01 am

      Your timeline and treatment plan is the same as mine.
      Don’t rush it.
      I had terribly post operative pain from the time the block wore off for about 2 weeks (needed Oromorph at times).
      I kept my ankle above my heart for 3 weeks (in bed) with a quick none weight bearing crutch assisted visit to the loo just to keep some movement going.
      I’m glad I did that because it controlled the selling well and now at 3 1/2 weeks I’m up for about 6 hours a day and mostly pain free partial weight bearing with crutches.
      My surgeon reckons I will be good as new by Christmas. That’s good enough for me.
      Good luck.

  7. Joey311 on July 21, 2020 at 10:59 am

    Hello James. Thanks much for sharing your experience. My backstory is extremely similar to yours. I’ve seen 2 orthopedics and unfortunately have gotten some conflicting opinions about this surgery being a good option for me. I have a couple of questions, if you don’t mind.
    How old are you?
    Did you have any significant arthritis of the talofibular joint? I have moderate arthritis of this joint, and because of this one ortho isn’t very keen on a lateral ankle reconstruction for me.

    Thanks.

    • James Dilworth on July 22, 2020 at 1:02 am

      I’m mid 40’s, and yes on some arthritis at the edges of the joint. No-one had any doubt about surgery for me…. my PT, two other surgeons, and the one I went with. The arthritis was seen as a good reason to do the surgery as another 10 years of spraining my ankle would only make it worse. While they were in there, they made some microfractures to the joint which supposedly enables stem cells to seep out and kind-of-repair some of the cartilage damage.

      • Joey311 on July 22, 2020 at 3:13 am

        Very helpful. Thanks.
        BTW I’m 53. So not too far off.



      • Sian Lewis on August 9, 2020 at 5:56 pm

        Hello James. I have followed your journey exactly, having had ATFL repair with Brostrum technique on 19/7/19. I have recovered extremely well and although I don’t run as a hobby I can enjoy a good CV session and a swim in my gym. I wanted to ask if anyone has ever twist their ankle again after repair? As I type this message, I am in bed having rolled over on it last night in the garden, while stepping down off a patio onto uneven grass. I was looking in a different direction, rather than monitoring where I place my foot, which we can all relate to with our unstable ankles dilemma. I have used ice and elevation and can walk to the bathroom and back, but not sure if I have undone any of the surgical work inside. It’s a wating game for me and a call to speak with my surgeon. The bruises are coming out already but I can say that the ankle joint still feels much tighter than it did before surgery and the swelling is minimal due to RICE.



      • James Dilworth on August 11, 2020 at 1:10 am

        I too rolled my ankle a couple months ago when one of my flip-flops broke while I was carrying a kayak. I was also worried for a while that I had undone the work, but the ankle still felt tight, if sore. I went easy on it for a couple months, and all seems to be back to normal now. I didn’t go see the doctor, but I’d be interested to hear what yours says.



  8. Helen on July 21, 2020 at 3:13 pm

    Hi from the UK and someone now self isolating in preparation for Bostrum on August 3rd. I have found these patient comments really helpful and so much more informative with the personal experiences. It is easy to feel too isolated and slightly worried without having other personal accounts to reassure you in advance of the procedure and follow on.

  9. Noah on July 23, 2020 at 10:13 am

    Has anyone done this surgery on an isolated ATFL tear to prevent the development of chronic ankle instability? Tell me I’m crazy.

    I never knew that ankle sprains could be so serious. I recently found out from an MRI and hi-res ultrasound that I tore my ATFL about a year ago. Upon receiving my MRI I was told that I needed to a Bostrom with tight rope, but I’ve seen 4 subsequent orthopedic surgeons and they all agree that my ankle is stable and the first doc got it wrong. However, one said that if I wanted to take 3 months I could fix it. Anterior drawer is positive, but talar tilt is negative.

    I mis-stepped a couple of times right after my injury, but caught that something was wrong in time to prevent damages to my CFL or joint (but not soon enough to save my ATFL). At the time my main qualm was slight pain while cycling long distances. Now I’m constantly worried that I’m going to hurt my ankle by doing anything (walking, hiking, running, cycling). Basically, I’m afraid to leave my house because I don’t want to hurt my ankle.

    My ligament is clearly visible in both the MRI and ultrasound and part of me just wants to fix this. Has anyone repaired an isolated ATFL tear on a stable ankle? Does this surgery have the same risks/recovery? Am I just crazy?

    • jeff on October 14, 2020 at 2:52 am

      I’m in a somewhat similar situation. Do you have any ankle pain?

      My MRI also shows ATFL tear only. +ant drawer, -talar tilt.

      For the past 2 years my ankle has felt subtly “unstable” although I don’t roll it at all. It just feels like things are not aligned properly. Orthos that I’ve talked to are divided on whether to call it “microinstability” or not. And also divided between no surg, scope only, and brostrom.

      If I run or bike or do stairs, it gets very sore for about a week. Wearing a lace up splint helps a lot.

      I think in your case, it really comes down to symptoms. If I had NO subtle feeling of instability and NO pain, and only the MRI finding and ant drawer test, I would definitely NOT get surgery. I would have no problem living life as usual!

      There have been studies that looked at incidental ant drawers and ATFL tear and it is quite common. The studies seem to be inconclusive on whether brostrom will avert arthritis.

  10. Elizabeth Nichole on July 31, 2020 at 6:54 am

    I had this surgery done on 12/2017 and unlike theses wonderful posts I’m seeing of total success; I was not to fortunate. I still have very bad ankle instability, pain like it was before the surgery. Needless to say, it didn’t help. Well, not me at least.

  11. Lisa on August 1, 2020 at 1:43 pm

    This was extemely informative and appreciated! I had the surgery recently myself but the doctor hasnt given me too much info on what to expect for recovery so I’m glad you wrote this

  12. Kellie on August 2, 2020 at 4:16 am

    This was a great article to read and awesome suggestions post surgery. I had the Brostrum procedure done about in 2017 about 1.5 years after the initial injury when the pain just wasn’t bearable daily any longer. While I’ve had relief and it’s better than the start I am pretty frustrated with the overall result now. I had the procedure done 3 years ago at this point and experience inflammation daily that makes exercise painful for days after. I had reached out to my surgeon and done additional MRIs and I’m told it all looks good..but it doesn’t feel that way. If anybody has had similar results and has found solutions please let me know. I’ve done a ton of post therapy and even tried FSM which is a micro current therapy to see if that helped. Best of luck to all with ankle problems.

    • jeff on October 14, 2020 at 2:57 am

      I’m debating about getting this done (2 years debating).

      Can I ask if you also had instability before the surgery? It seems this is often (not always) fixed but that pain can be quite a bit more complicated.

  13. James (Jim) Stillson on August 2, 2020 at 10:15 am

    I had Brostrom Procedure done on both ligaments on July 23, 2020. Used Tylenol and Ibuprofen to stay ahead of pain. Pain never came. Keep my leg elevated with ice bag under knee cap 10 hours a day. Went off pain pills yesterday 7/31/20. I use a knee scooter to get around. Saw surgeon after 5 days. He was very happy. Said swelling was almost gone. Will see him again next week. That will be 12 days and maybe, hopefully I will get a walking boot. Had this surgery to restart my running after being down for 30+ years. My ultimate goal is to run half marathon In under two hours. Would be a dream but who knows. My best half marathon time was 1:35 in 1978. Will turn 77 next week and have allocated three years to achieve my goal. Without this surgery this goal would not be possible. Thank you and your other commenters for their experience and insights.

  14. SK on August 12, 2020 at 6:13 am

    Just saw my doc today and the surgery maybe in my future. Not happy about the recovery time required. Being 66, there just isn’t that much more time available anymore. I’m a hardcore hiker and 18 months without it is hard to swallow. That plus the complete loss of hard-won conditioning.

    Kind of stunned about the doc’s casual attitude about the whole thing. I think he was underestimating, no I know he was underestimating the difficulty of this procedure for the patient. I think I’m going to stay with the brace for as long as possible and get one or two other opinions.

    Very helpful post, thank you!

  15. Sharon on August 23, 2020 at 12:54 pm

    I read all of this and I do have to say each person is different when it comes to this surgery I had it done 4 years ago many of nice I’d scream in pain pain meds didn’t seem to work a lot I was on a knee scooter for I’d say 3 months and as time went by it seemed to feel better when they told me it was time for physical therapy it didn’t go so great it felt really strange like stepping on needles with electricity running through it I ended up having nerve damage in my foot I had spent almost two months in a hospital fighting for my life I had a pulmonary embolism and blood clots that formed till this day I have no feeling in my right foot it hurts so bad I can’t run more than 200 feet and I’m still fighting with blood clots and pulmonary embolism which now I’m on warfrin for life it sucks the day before that surgery happened was the last good day I had I regret ever having it if you can find a better method I say avoid this procedure it’s not as fun as it may sound good luck everyone

  16. Angela on August 25, 2020 at 6:58 am

    Just want to say thank you for this whole post. I had my ankle ligament repair surgery 8 weeks ago for chronic instability following a bad sprain last fall. I’ve come back to this page over & over again during recovery. It has been so helpful in understanding the recovery timeframe! We have plans to visit Yosemite next summer and I’ll think of you as we hike the trails. 🙂

  17. Ally on September 7, 2020 at 6:32 am

    Thank you for sharing! I am a nurse so I had a little information/experience but what had me confused was how long my nerve block lasted… 3 days of no ankle pain! I had taken oxy to stay on top and finally was in need on day/night 3 with pretty severe burning pain. I had scar tissue removal, scope of entire ankle, Atfl repair and internal bracing and ganglion cyst removed. I had 2 nerve blocks.

    If I don’t stay on top of my pain, it’s significant but not the worst I’ve ever had.

    I think the nerve blocks work differently for everyone. I sure did not expect to feel that good for that many days post op.

    • Dannielle on September 29, 2020 at 11:51 am

      Had surgery on a Friday and my nerve block lasted till Monday. I thought it was pretty strange that it lasted so long as well. Not complaining though because I got full sensation back.

  18. Stephenie Pippin on September 7, 2020 at 3:31 pm

    I am almost 6 weeks post op. I have to agree that it hasn’t been too bad at all. I’m just now starting to weight bear And I’m nervous but so far, not much pain. My concern or question now is the how long does it take for the range of motion to return. My ankle is so tight and I’ve been doing therapy since week 2. I expect for it to get better quickly after I come out of my boot or at least I hope so.

  19. Deb on September 10, 2020 at 10:00 pm

    James- Thank you SO much for creating this post, it has been most informative to read it, as well as all the comments. I just saw the doc yesterday and am having the surgery 9/24. I will be buying the products you suggested, so right there you’ve already helped me begin healing! I’ll post more afterward.

    • Bethan on September 26, 2020 at 7:48 pm

      Thank you very much for the post!

      Hi Deb, I hope surgery went well for you and that you’re settling into immobility. I got my left ankle done September 25th 2020 and I’m in a cast with room for swelling currently and will be switched to a fibreglass cast October 13th with a reposition outwards and up of my foot. Stay on top of the pain, my cast feels like it’s pressing directly on the staples causing pretty severe pain and it may have to be removed and replaced to relieve the pressure. The pain feels external not internal on the ligaments and crutches are an absolute pain but looking forward to be weight bearing by Christmas and start therapy. Great suggestion about the forearm crutches I will be looking into them for sure. Surgeon is aiming to have me in a fibreglass cast from Oct. 13th for 4-6 weeks and then into an air cast. Happy recovery to all you wobbly ankle people and thanks for making me feel less alone in this process 🙂

    • Deb on October 22, 2020 at 12:57 am

      OK, I’m back. I had my surgery at Ortho Michigan (Flint) and they do the more aggressive procedure of inserting an “internal brace” which shortens the down time. So, like Sarah above, I was in the aircast after only 2 weeks before full weight bearing again. Thank God, because using the knee scooter sucked and was hell on my knee! I also bought an iWalk because my office is in the basement and that had it’s own set of problems. All I can say is read the negative reviews on Amazon and good luck if you buy one- I ended up returning it. I didn’t have a lot of help and fell multiple times using the scooter and the iWalk, so was worried that I had damaged the ankle, but it turned out OK. I did “stay ahead of the pain” like James suggested (had Norco and 800 mg Ibuprofen), so it was never more than a 3. Had my 2 week f/u today since being put in the boot and they said take it off and start PT. I have to say, this amount of down time is not bad, less than a month (in terms of not walking or driving). I am sure there will be pain for some time similar to what James experienced and that full recovery will be well into 2021. However, I am going to talk to the surgeon when I go back and see if I can get the other ankle done, which has been broken and sprained multiple times- apparently I have had loose ankles all my life, who knew? I also made sure I used a compression sock all day and I think that really helped the healing. The post-op order said drink lots of water and do a high protein diet, so I drank protein shakes in order to get at least 100 g a day. The arm crutches were too much for me to learn and I never used the traditional crutches I bought as well. The waterproof leg cover worked really well, even in the bathtub. I must have spent over $200 on stuff, but returned a lot that didn’t work for me- thankfully I got it all on Amazon. Good luck everyone and shop around for a surgeon that uses the internal brace- I believe it’s made by Arthrex- there is lots of info online.

  20. Nicole on September 11, 2020 at 11:13 pm

    Thank you so much for the post. I will be having this surgery on 10/16, as I have completely torn my Brevis Tendon, broke off a small piece of the ankle bone and they will be seeing if I tore the little ligaments that were not clearly seen on MRI that run across the ankle bone. I am still very nervous about the drilling…but your article has definitely given me some solid advice, reassured some of my anxiety about recovery and timing will look like. I have printed this article for motivation along the way. Thank you again for the detailed post and for sharing your journey.

  21. Kirsti on September 25, 2020 at 10:04 pm

    I am having this surgery on the 5th october – I am so happy to have found you and Your wonderful diary/blogg!!!

    The surgery itself isn’t worrying me, it’s the waking up, coming home and mangaing the pain :O I live in a partment on the 3rd floor With no lift – 45 steps to accomplish! If anyone has any tips would be great!!

    Good Luck to all of those waiting for surgery and get well soon, speedy but safe recovery to those who have had the surgery!

    • Dannielle on September 29, 2020 at 11:47 am

      With steps, the best way is actually to just crawl up them or scoot down. I could not find a better, quicker way to do them at first.

      The pain isn’t too crazy, It is less than if you sprained it and the nerve block takes care of the initial pain for a while. Ice to the back of the knee is a big help. In a neutral position, the pain didn’t bother me. It became an issue if I had to use the foot or move the foot. Even then it just felt really bruised and throbby.

      Best of luck! Hope you find what works best for you with the stairs.
      Dannielle

  22. Dannielle on September 29, 2020 at 11:41 am

    Hi! I had my ATFL and CFL ligaments replaced a little over 3 weeks ago using a modified Brostrom surgery. They utilized arthrex internal braces. I read a bunch before hand and like you, my foot was starting to feel better before the surgery and started to reconsider before being reminded that I am a high sprain risk and it can only get worse.

    Anyways, my surgeon told me it would only be a 2 week recovery before I could be fully weight bearing using this arthrex procedure. It essentially is a strong filament that is drilled into your bones and completely replaces those tendons or can just go in addition to them. They did the nerve block during anesthesia so I was happy about that. It did not wear off for 3 days which worried me, but I was thankful. I was sent home in a walking CAM boot. Crutches did not work for me. I was so unbalanced that I threw them and fell several times. I rented a knee scooter and it was the best.

    For the first week, it was a lot of laying around, elevating my leg, icing behind the knee and scooting to the loo. At my 1 week post op, we tested my strength and reflexes. The pain was very real at certain extensions but completely normal. The doc said she wanted me to start doing exercises out of the boot on the couch for range of movement and to get used to standing and walking unassisted in the boot. I was like… she’s crazy.

    So I did all those things, the pain got less and less each time. For week 2 follow up, I walked into my appointment in a walking boot. I got an A+ for my strength tests. She had me walk around barefooted in her office and I was surprised that it wasn’t painful. There was an awkward “boot foot” as she called the limp but it wasn’t bad. She took the stitches out and I walked out of there with just a lace up ankle support and my own shoes. 2 weeks to fully weight bearing, yes.

    I got a little too happy about my with or without a brace option and when walking without a brace across a parking lot I stumbled through a pot hole and twisted my fresh repair. It HURT bad. I sucked in my breath and just stood there. That type of twist and that type of instant pain reminded me of all the other ankle sprains I’ve had. I freaked and called my surgeon. She said i probably tore an internal stitch and the soft tissue would be irritated but the repair would always be solid. I went home, iced and took some of those narcotics and was feeling better in a couple days though I stayed in a brace.

    Physical therapy starts next week and that freaks me out a little. There is still swelling and I cannot do the full range of motions I could before surgery. The O, Q and G of the alphabet exercises are not going well. So I hope the PT starts me out easy. No tilt boards or standing on one leg and balancing. I still feel like there is a rock in there that I cant bend my foot around.

    Good luck everyone! Mine was a faster recovery. I would ask to see if that athrex internal brace is available to speed up recovery. I also have arthritis but we did not treat it at that time.

    • Melissa on October 7, 2020 at 1:19 am

      I’m so happy that I found your post because I’m having the same procedure o next week and have been told the same thing…that I’ll be back in my feet in a couple of weeks. I am so scared that I’m going to trip right after I come out of my boot, but I’m hopeful that my outcome will be as good as yours seems to be. Praying that you stay upright on your feet going forward! Wish me luck!

  23. Alan J on September 30, 2020 at 8:16 pm

    Hey James, I have been following along as not many detailed threads of this surgery are commonly found. I had the procedure done on my right ankle in January 2019, and a good size bone was removed. All the recommendations and PT was done and it has been a long process. I am a pretty active with fitness and health so it has been difficult. Lately I have been experiencing discomfort, unsure if related to golf motion. Experiencing the same uncomfortable pain commonly in the morning. Curious if anything like this has occurred? I am concerned that another surgery might be required but wishfully thinking other options. X-Rays and MRI since then has shown no damage to the original procedure but the surgeon expressed concern over a part of “missed bone or bone regeneration” that could be causing pain. If you had any thoughts to share that would be very helpful as I have read your entire thread and helped me along my journey.

  24. christy on October 2, 2020 at 8:52 pm

    I had the bostrum with internal brace on 9/24/2019 I never had a cast i came out of surgery with a walking boot and was told i could bare weight as tolerated? Everyone else i have seen on here has had a cast for the first few weeks and no weight for at least 6 weeks so im not sure if this is why i am still having alot of pain and issues a year later

    • Melissa on October 7, 2020 at 1:08 am

      I’m scheduled to have the b Brostrom procedure with internal brace on Monday 10/12/20. I was told that I would not have a car and be back on my feet within a couple of weeks. Maybe I should take it easier than suggested. I certainly don’t want to still be in pain a year from now. I hope you get some relief soon!

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