Ankle Deformation After TBI

achilles tendon surgury surgury
After a traumatic brain injury, you’re left trying to cope with various issues you never thought you would have to deal with. There are headaches, paralysis, seizures, irritability, and many other health issues that vary depending on the circumstances.  One of these possible health issues that may arise is ankle deformation, ankle contractures, and they are yet another struggle to add to the list.   In particular, it can affect any one’s ability to walk properly.  However, there are solutions to this, as well as all of the other symptoms that you should learn and understand to be aware of your options.


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How Do Foot Contractures Occur?

My foot contractures after TBI

When regarding a traumatic brain injury, ankle deformation can occur through contractures and/or spasticity.   For any bone disorder, it’s typically the result of bone, muscle, or soft tissue damage.  However, in the case where someone has had a traumatic brain injury, spasticity occurs when there is damage to a portion of the brain or spinal cord, and it affects the corresponding area. It can also occur from a stroke, birth defects, genetics, or even from diabetes.  The ankle might curve inwards, be oddly positioned, or, in my case, appear as though I’m standing on my toes when I’m not trying to.  As  a matter of fact, I had to learn how to both stand and walk again after TBI and I could not move forward with my therapy plan until I had a tendon lengthening surgery because my heels  could not touch the floor due to my foot contracrures.  This is a serious health condition that can significantly hinder anyone’s ability to walk properly. Furthermore, other symptoms can follow, such as pain, involuntary movements, and aching. You might also experience poor posture, a lot of discomfort, and an abnormal toe positioning.

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What Are The Treatments for Foot Contracture

serial casting for foot contractures
Serial casting  is a minimally invasive attempt to correct foot deformation which requires many rounds of casting, in my case with Botox, to avoid having surgery.

To correct ankle deformation, there are several possible solutions to try, and you should consider your options carefully.  Soft leg braces and stretches were the starting point for correcting my foot deformity.  Then, I proceeded onto a  treatment of serial casting  and muscle relaxers.  Muscle relaxers were implemented to release muscle spasticity, so when there was stretching or weight-bearing, the Achilles tendon would stretch for a more pliable advantage.  Ultimately, I couldn’t receive the neutral foot correction that I wanted.  Botox injections and serial casting was the next method before I had to go to the extreme last resort – tendon lengthening surgery. You can read this article, which goes more in-depth on using Botox to treat spasticity.  The Botox wore off, and my feet reverted to a negative 19-degrees.   I was back to square one and left taking a lot of muscle relaxers.  These results were clearly dissatisfying for me. While this was a method that didn’t work for me, Botox is a treatment that can certainly work for some.

Tendon Lengthening After TBI

tendon lenthening after tbi for foot and ankle deformityFinally, the most extreme and inevitable procedure, Achilles Tendon Lengthening Surgery, was next. Surgeons are guaranteed to fix me feet in this procedure.
The operation for Achilles Tendon Lengthening Surgery is approximately five hours long with the aim of stretching the Achilles tendon. This allows you to walk flat-footed without a forced bend in the knee. Furthermore, the surgery also provides significant relief to chronic foot pain associated with spasticity and allows you to wear shoes more comfortably once again.  The technique used during tendon lengthening surgery depends on your muscle anatomy and the degree of correction required. The primary goal, however, is to release spasticity.

How Does Tendon Lengthening Work?

To elongate a contracted Achilles tendon, the surgeons make small cuts on the back of the ankle where the tendon is located, and as the wounds heal over time, the tendons elongate.  Following the surgery, extra care should be taken during the healing process.  You will be put in a walking cast for about six weeks, during which there should be no intense physical movement to allow proper healing.


Tendon Lengthening Surgery Recovery

tendon lenteneninf after TBIMy experience with tendon lengthening surgery was very positive. Before the operation, I was extremely nervous and anxious, but every measure was taken to ensure my total comfort. I felt no pain throughout the entire process.  Immediately after the operation, I noticed the corrected results. Before, my feet were crooked, sideways, and disfigured. When I awoke with the cast on my legs, they were in perfect 90-degree angles at the neutral position.  After the tendon surgery, I had to wear Ankle Foot Orthotics (AFO’s).  These braces strap to your legs and feet, and it can be quite difficult to wear shoes with them on. I had to get shoes half a size bigger with a wide width for me to wear my favorite shoes and feel cool.

After Tendon Lengthening for TBI Foot Contractures

tendon lenthening surgury for foot contractureThere was no pain when I woke up – however, I asked for a nerve blocker just as a precaution. For two days, I couldn’t feel my legs, which was extremely beneficial.
Afterward, I was instructed by my physical therapist that I was not allowed to put weight-bearing pressure on my feet while I recovered, although I could quite capably do so without issue.  As a matter of fact, I got out of surgery and went straight to my yoga class after I left the hospital, the entire procedure lasted a couple of hours.  With that said, I can now stretch my legs with better flexibility and reduced spasticity. My toes also wiggle, and my plantar flexion goes up and down without any struggle.



To Sum it Up

Overall, Achilles Tendon Lengthening Surgery was a success for me, which was an overly joyful feeling after trying many different treatment methods.  If you’re considering tendon lengthening surgery for your feet deformities or pain, consult with your doctor and physical therapist first.  If you are feeling anxious, this is completely normal, but I hope my experience has helped ease your worries about pain, benefits, and results you feel afterward.  Before you try this surgery, though, be sure to follow other treatment solutions first, such as Botox, and use the surgery as a last resort. Surgery always carries other risks that should also be considered carefully before you decide it’s right for you.
My foot inversion and foot contracture before tendon lengthening surgery




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