Real Story: Complex Foot Surgery
Recently we treated a complex case at Corona Foot & Ankle in which past injuries combined with current factors for a situation that required persistence and a graduated approach to treatment to fully resolve.
Our patient is a 27-year-old woman who first presented to us with pain and limping. The issue started in early December 2020, after she had been doing backward lunges during a workout. She felt a painful “pop” in her ankle during the activity but didn’t think anything was wrong. However, after about three weeks of persistent limping and increasing pain, it was clear there was a problem that wouldn’t resolve on its own.
This latest injury was in addition to earlier traumas our patient had suffered. She had been a gymnast for 8 years when younger, and had broken the growth plate in her right ankle in the 6th grade. At that time she was on crutches and in physical therapy for a year before she could walk pain-free without a CAM (controlled ankle motion) walker. About a year and a half after her ankle injury, she had surgery to remove a large ganglioneuroma (a benign tumor of the sympathetic nervous system) from her sacrum. That procedure severely damaged her sciatic nerve, which still causes her pain and some weakness in her right leg. While she is capable of regular activities, the leg weakness does inhibit her ability to take on physical workloads.
Dr. Amin immediately started our patient in a lace-up boot to stabilize the ankle, which produced some improvement in the pain. When her limping returned, we put her in a CAM walker to immobilize her foot and ordered an MRI. Even without the results of that test, it was clear she was suffering from tendonitis and needed support to reduce her pain and prevent further injury. The scan revealed that she had a tear in her peroneal longus tendon, one of the two tendons that connect the muscles on the outside of the leg to the bones of the foot. We recommended a PRP injection (an injection of platelet-rich plasma from the patient’s own blood) to accelerate the healing of the tear.
After the injection had been given time to work, the patient noticed that the nature of her pain had changed; now when she walked, she felt a kind of clicking every time she took a step. The patient also had an enlarged peroneal tubercle, and the combination of that and the type of pain she was experiencing led us to think that she might ultimately require surgical intervention. A follow-up MRI showed that while her tear had healed, she had masses on either her fibula or on the ligament of her tibia and fibula.
The patient requested that Dr. Amin and Dr. Lee, both board-certified surgeons, perform the procedure to remove the masses. The surgery went smoothly, and the doctors were able to inspect the previously torn tendon to confirm that it had fully healed. We monitored our patient closely during her post-op appointments, adjusting her splint as needed to alleviate her discomfort.
Our patient experienced one minor setback during healing. She had quit a long-time vaping habit shortly before surgery, knowing that the use of nicotine can interfere with wound healing. Unfortunately, a one-day lapse from her resolve during her convalescence resulted in her wound reopening slightly. We gave her some Juven, a nutrition powder to enhance healing, and applied an Oasis graft to the site to help it heal completely. After two weeks of this treatment, the wound was 95% healed.
As someone who enjoys the interaction of her normal office work, our patient has been eager to return to her regular routine after working from home as she recovers. With adherence to a regimen of physical therapy and care in not increasing her activity level too abruptly, we anticipate that she will be able to resume her previous routines without pain.
At Corona Foot & Ankle, we’re dedicated to helping all our patients solve their foot and ankle problems, whether they’re simple or complex. If you’re experiencing foot or ankle pain, don’t wait—find out more about our services or schedule an appointment by contacting us here.