fracture dislocation/microfracture repair of the talus

[rugby13]

Hi,

15 months ago I dislocated my left ankle breaking the fibula in two places (webber c type fracture) and rupturing all but one of the ankle ligaments.After surgery (ORIF) I was put in plaster cast for 6 weeks followed by six weeks in a aircast boot (NWB).Whilst in the aircast boot I was allowed to do ROM exercises eg dorsiflexion/plantarflexion and theraband strenthening exercises.
12 weeks post surgery I had the two screws that was holding the joint in place removed and began gradual weight bearing (in the boot) over the next month before finally weight bearing fully unaided.
During this period I began a progressive rehab programme that involved stretching,ROM exercises,proprioception work,hydrotherapy and bike work.
During the rehab programme I was still experiencing swelling of the joint,stiffness and a continual clicking sensation especially on the medial side.
After regular consultations with my OS he sent me for an MRI which discovered I had a osteochondral lesion of the talus (6x6mm).He said this was due to the dislocation where the talus collided with my tibia and fibula causing the lesion.He prescribed me to have complete rest for around 10 weeks to see if the lesion would heal itself.
After a second MRI it was confirmed that the lesion hadn't decreased in size so he recommended that I have a microfracture repair of the talus to promote the healing process and develop new fibrous cartilage.
I had surgery on 22/9/12, 12 months post the original injury and was put in a aircast boot for 6 weeks non weight bearing where I was allowed to do ROM exercises eg towel stretches.Post 6 weeks operation I was allowed to gradually weight bear until I was fully comfortable walking unaided and started a rehab programme that involved maipulating the joint to help with ROM,rebounder and regular stretching of the calf.
Post 9 weeks operation I started hydrotherapy and bike conditioning where I'm not experiencing any pain.
Post 11 weeks operation (today) I started proprioception work eg balancing on one leg where again I experienced minimal pain.

Problems??
Issues I'm struggling with are stiffness of the joint especially dorsiflexion
I struggle in the mornings after the joint is immobile for a significant period of time, it's painful when I weight bear.After going through my stretches I find it alot easier when walking.

I was wondering how long should this stiffness and lack of ROM with dorsiflex last and is this normal for what I've gone through.I can't find a rehab protocol or information regarding microfracture repair of the talus so was wondering am I on track??

Regards,
Rugby13

[Heidi]

Stiffness is common and a regular problem with ankle surgery. Lots and lots of calf stretching, alongside soft tissue work such as massage and muscle energy techniques should help.
Wearing a splint at night to stretch the calf muscles whilst you rest may also help. See www.return2fitness.co.uk for their night splint.