I was in a head-on auto collision on June 30th that resulted in a broken Talus (hanging together by a sliver I was told) and displacement of the ankle. I had very bad nerve pain prior to the emergency surgery. I was later told that the displaced bone was pressing on the nerve near the heel of the foot. The nerve was compressed but intact, so I was told.

The surgery successfully repositioned my ankle. I have 5 screws holding it all together (there were 2 additional smaller fractures). After surgery, I had no feeling on the bottom of the foot for about a month or more. Now, 16 weeks later, the Talus is fully healed and healthy. But, I can't move my 3 smaller toes sideways, although I can curl them. Some sensation has returned to most of the sole, but it feels very spongey and I get lots of tingling, pins & needles, sometimes a burning sensation, and sometimes some numbness. I can't walk much because of this, although I am allowed to put full weight on the leg; (actually, I still use the boot cast when outdoors but expect to be out of that next week). In the house I use crutches but no cast on the leg, and do put full weight on it; I also walk without the crutches for short stretches. I've been going for acupuncture to help the nerve along, and am seeing some seperation between my 4th & 5th toe now, but very little.

I'm wondering if these symptoms are a good sign that the nerves are coming back, or indicative of a problem? I'm not sure if I should walk on the foot when I feel numbness or rest it? Any information is greatly appreciated, as is an indication for recovery(?) and the amount of time it can take. Thanks!!

Hi Ann and welcome.

You're a very lucky lady. Sounds like that was one heck of an injury.

What you're experiencing is a form of tarsal tunnel syndrome. We don't typically think of tarsal tunnel syndrome in such an acute sense, but I think he above link will help you with the anatomy and problems associated with an entrapment of the posterior tibial nerve.

Jeff

Hi Dr. Oster,
Thanks so much for your reply; the link you gave was quite informative. Yes, I know I am very lucky! And I had a wonderful surgeon! My Honda Civic was hit head-on by a Ford Bronco when the driver lost control and came on my side of the road. We were both going about 40 mph. The ankle was the only significant injury I sustained. Says alot for the safety features in a Civic!! The surgeon told me the type of injury I sustained is called Aviator's Astragulus. Unfortunately, the accident happened in Vermont and I live in NY, so when I returned home (after 10 weeks) I had to start with a new Orthopedist and he is not communicative and always rushing, so spends very little time with me.

Now about Tarsal Tunnel Syndrome, which from the photos and description in the link looks like it is the affected nerve - the bone (guess it was the talus) that pressed on the nerve prior to surgery was moved back into place. I was told by the surgeon that the nerve would recover completely. So my question to you - do think the sensations I'm feeling are the nerve recovering from the trauma it sustained, or do you think something else, scar tissue, adhesions, etc might be the cause of the problem now? Also, what would you recommend at this point?

I just want to get past this and get my life back!

I really appreciate how quickly you've responded and the good evaluation of my situation!

Ann,

Bear in mind that trauma to a nerve can take 12-18 months to heal. It's indeed a long road.

So at this stage of the game, I really don't think you need to change your game plan. As long as you have partial feeling now, there's no reason why it should not come back to full feeling in the future.

Jeff

Thanks, Jeff, for the encouraging words!!

Hi Dr. Oster,
Well, I went for my latest visit to the Orthopedist recently. I was told there is an area of the Talus (on the xray it looks like it's the upper part, just below the leg bones) without blood supply. I was quite shocked, as previously was told that what could be seen of the MRI (there were black splotches on it from the screws which interfered with the reading) was healthy bone. Now, 3 weeks later, an xray is showing a problem. I was told to stay in the boot cast or a custom brace for 2 more months, maybe longer, in the hope that the blood supply will reestablish itself.

I assume this is AVN, although the term wasn't used. On the xray, it looks white, like a stripe across the top of the Talus. It seems to cover about 15% of the area of that bone, almost looking like a straight painted white line.

My questions to you - what are the chances that the blood supply can regenerate and how long until we know if it will or won't? Also, could the trauma to the nerve that I had affect the bones' ability to reestablish a blood supply? And last, do you think driving a car locally (it's my right foot) would be detrimental? The fracture is completely healed now.

This is really a distressing turn of events; needless to say, I'm very upset! Thanks so much for your time and advice.

Ann,

Yes, indeed it does sound like AVN. Take a peek at the following image and I think this will help you to understand the fragility of the vascular supply to the talus...



You can see how the dome of the talus is very fragile.

In cases of AVN, the return of blood flow does occur, but the majority of cases are going to have some degree of collapse of the dome. Again, the outcome is very variable and depends upon the specific injury. How long does it take? That'll vary too. But you can pretty much be assured that what you have at 24 months post injury is as good as it's going to get.

No, I don't think the nerve injury would have had anything to do with it. I think you just had a loss of blood flow immediately following the injury.

I'm going to pass on whether or not to drive. What's your doctor saying about that?

Jeff

Thanks for the information Dr. Oster, much as I wish it were better. I'd asked about driving; the Dr responded that the concern is should it be necessary to slam on the brake it could be problemmatic. Then he recommended calling Motor Vehicles to get certified for driving with the left foot. Doesn't seems to be any such certification, so I was left puzzled and assume he means I should brake with the left foot. He's not very receptive to answering questions; just rushes on to the next patient, which leaves me bewildered and making assumptions; ergo the question to you.

Ann, I had a similar injury 14 weeks ago. About the driving situation, I think physicians are reluctant to recommend driving at least in part due to liability issues. I found a small, but sturdy ankle support that I wear while driving which I have been doing for about 2 weeks. I'm extremely careful and I brake with my left foot to be on the safe side. In fact, I instinctively use my left foot now and I'm surprised at how quickly I adapted to that manner of braking. Before i get out of the car I put on my "moon boot" and I still use crutches. I, too, am walking short distances in the house with the boot and my orthopedist said he may begin to wean me off crutches in another few weeks. Best of luck to you. --John

I went to get a 2nd opinion today on the diagnosis of AVN. Saw an ankle specialist at Hospital for Special Surgery in Manhattan, a prestigious institution.

The diagnosis was confirmed. I was told that the bone marrow on the MRI looked healthy, so there is a good chance that the blood supply will regenerate, but...

While it is regenerating (if it does) the bone is soft and can easily collapse. Therefore it's especially important at this time to keep weight off it and use a brace that'll transfer the weight to the calf & knee. I've already been fitted for such a contraption and looking forward to getting it as it'll fit into a shoe - easier to walk (I hope!) and easier on my back than the boot cast I now use. However, it'll probably be necessary to stay in this brace until a year has passed since the surgery, maybe longer.

This doctor said, as Dr. Oster posted in this thread, that most cases go on to have some degree of bone collapse and then require ankle fusion.
Almost seems like a waste of time to spend so many months incapacitated in a brace if the end result winds up being more surgery, recuperation, and then not being able to walk well at the end!

Thanks for your time and professional opinion Dr Oster. I do hope your son is on the mend!!