Ankle surgery here we come - 80 Days to surgery (S-80)


If you've ended up at this blog, then I guess it's because you have some interest in ankle surgery.

My name is David Shaw, and I'm going to have ankle surgery quite soon.

I need my surgery as a result of end-stage osteo-arthritis in my left ankle. My surgical options are essentially either a total ankle replacement (TAR), or an ankle fusion (arthrodesis).

Right at this moment, I don't know which procedure I will have (see below and next blog for explanation).

My journey towards my ankle surgery started some 18 months ago and, along that journey, I've found it quite difficult to find two things in particular :

  • detailed, preferably research-based, data on patient outcomes for ankle surgery in general, and specifically for relative outcomes for the two options
  • patient accounts of their own experiences both in the lead up to, and the aftermath, of the operation itself

So, as I have today just been given a confirmed date for my own surgery - 6 July 2015 - I thought I would start this blog with the aims of :

  • creating my own diary of the experience
  • giving an account, useful to others, of the whole journey up to and past surgery - as well as the obvious...... how was the surgery/how is the pain/when is the cast/boot coming off/when can you start walking again etc. - also an insight into some of the day-to-day practical issues associated with preparing for and managing after ankle surgery
  • creating a forum where interested individuals can ask questions and share their own experiences.

It is my intent to publish regular updates to this blog (aiming for two to three a week), both in the lead-up to my surgery, and for perhaps a year thereafter. I will endeavour to give both a medical and practical account of my experiences and - although I guess I'm a typical "stiff-upper-lip" Englishman - I will try to share with you some of my feelings and emotions on this journey, which I must say, and despite all the information I have acquired, I approach with not a little trepidation.

To round off this very first post, let me tell you a little about myself, and also a brief history of how I've arrived at where I am today, so far as my ankle is concerned.

I am 62 years old, and I have a home both in Norwich in the UK, and on the Costa Blanca in Spain, and we (my wife Barbara and I) divide our time between the two. I retired just under two years ago, having spent almost 40 years in a career in Human Resources, mainly in the Banking industry.

I have enjoyed pretty robust health for most of my life - the only previous surgery I have had was a tonsillectomy in 1975. I have played a lot of sport, and have been an active gym-goer over the last 15 years. Notwithstanding that, I am currently significantly overweight (though see below and next blog in particular).

The months after my retirement were incredibly busy, and quite physically demanding, especially in establishing our second home in Spain, and I spent the whole of the summer and autumn of 2013 on my feet doing DIY or gardening all-day-long.

In late Autumn I noticed that I was getting significant and regular pain on both sides of my left ankle; I put it down to tendonitis (which I'd had before), and went along for some sessions with a physiotherapist. That treatment did provide some symptomatic relief, albeit temporarily, but during the third or fourth session the physio - based for sure on his experience - advised me to get an X-ray of the ankle.

When I showed him the X-ray at our next session, whilst being reluctant (not being a physician) to provide a diagnosis, he nonetheless strongly urged me to consult an orthopaedic specialist. Based on the X-ray and an examination, the specialist made a preliminary diagnosis of osteo-arthritis, which was confirmed by a CT scan.

Faced with that unwelcome news, but armed of course with the internet and Google, I did a great deal of research, mainly into non-surgical management of the condition, and resolved to give myself 12 months to see whether I could manage the condition without resorting to surgery.

This included :

  • weight loss (mostly unsuccessful until recently - see next edition),
  • shoe inserts - fitted by a podiatrist, these initially gave me some cause for hope, but I could only use them in certain footwear, which meant I couldn't/didn't wear them a lot of the time,
  • strapping, with some quite sophisticated ankle braces - I found very little benefit from this at all,
  • cortisone injections directly into the ankle joint - these did provide significant immediate symptomatic relief, including reducing the considerable swelling I was experiencing all around the  ankle; however, that relief (and reduction in swelling) proved transitory (say a couple of weeks), and it is not recommended to have these injections more than quarterly,
  • and, of course, dropping far too many pain killers - both conventional (e.g.paracetamol) and anti-inflammatories (in my case initially diclofenac (Voltaren), though I have subsequently been prescribed etoricoxib (Arcoxia) which I have found to be far more effective),
  • modifying my lifestyle

The last of these proved to be the most effective at managing my condition and the pain associated with it, BUT (and it took a little while for this to dawn on me), I ended up modifying my lifestyle to such an extent that the end result was unacceptable. My great love of golf proved almost impossible to satisfy, certainly not walking the course and, even with the aid of a buggy, I would pay for it afterwards with three or four days of increased discomfort. Working in the garden, which I love, became a painful and uncomfortable chore, especially since I now found walking on any sort of uneven or sloping ground something I approached with great trepidation.

I suppose my "light-bulb moment" was last (2014) summer. My wife and I have been very fortunate to remain close friends with a group who got to know one another at University some 40 years ago, and a dozen of us try to get together at least once a year for a "reunion".

Last summer we rented a most delightful villa in the middle of the Tuscan countryside but, after our first visit to one of the many splendours of that part of the world, I realised that I was proving a drag (almost literally) on the rest of the group when walking around sightseeing. Rather than face that, I spent the rest of the week, albeit agreeably, relaxing around the villa, but feeling guilty both towards my friends but especially towards my wife who had nobly elected to stay with me.

Having resolved that I could/would not tolerate this any longer than necessary, as soon as we arrived home, I started researching surgical treatment for my condition, which is when I first came across mention of the TARVA (Total Ankle Replacement v. Arthrodesis) trial. (If you have come to this blog via the TARVA website, then you probably already know something about TARVA; if not, and rather than repeat their excellent information, can I refer you to their website ( ankle arthritis.co.uk ).

The TARVA trial appeared to offer me the chance to explore options for surgery for my ankle osteo-arthritis and at the same time participate in an important piece of research (which will hopefully fill one of the knowledge gaps I found when first considering surgery).

So, I spoke to my GP in Norwich and arranged to be referred to the Royal National Orthopaedic Hospital (RNOH) in London (my nearest centre in the initial stages of the trial). After a short wait I received a letter from RNOH confirming an appointment in early January 2015 with Mr. Andy Goldberg, a foot and ankle specialist consultant at RNOH who is also the Lead Investigator for the TARVA trial.

So, my ankle surgery journey begins.

In the next blog I will relate my initial interaction with the TARVA trial, starting with my initial  appointment with Mr. Goldberg and bringing you up to the present day. I will also explain in more detail why I don't yet know which operation I will have.

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