Brostrom ligament repair experience and Cast phobia

Regarding a boot for an alternative to a cast for cast phobia

I recently had a brostrom ligament repair on my  left ankle for chronic ankle instability. I have had multiple multiple sprains since age 12. Apparently, one of those, maybe the first one, completely tore a ligament.

I found, while wearing the splint, that I had cast phobia I did what I could to tolerate my splint, even in the midst of the percocet induced panic attack. However, I was positive I was going to have extreme anxiety with a cast. On hindsight I have some claustrophobic symptoms I never really thought of in the context of wearing a cast, namely the idea of being put in handcuffs terrifies me, as well as being held down or having my extremities held onto tightly or even wearing really tight clothes like dive suits or turtle necks or closed shoes on a hot day. I really didn't see them as claustrophobia since they were manageable and in my mind were more about being controlled than being claustrophobic. I had no issues with the MRI for example.  I wish I had thought about possibly having that issue with casts going into the surgery. If I had, I would have mentioned it to the doctor to see about a workaround from the beginning, but it came about while I was wearing the splint.At this point I might mention that I,myself, am a nurse but not an orthopedic nurse. I do have the occasional orthopedic patient as do most nurses. 

So, for my two week visit, I had my research done and ready and I had a whole list of explanations and alternatives prepared for my two week visit to the doctor when I was supposed to go into a hard cast for two weeks followed by a boot for two more weeks. I had researched what few alternatives there were, which is not much. I could do some kind of a bi-valve cast, I could go straight to the boot or I could take anxiety meds. I was afraid to bring up the subject with the doctor but my knowledge that a cast wasn't going to work out weighed my fear of confrontation. I started to rattle off my explanation " I'm sorry I didn't know this before, but I am not going to be able to tolerate a cast and blah blah blah..... I saw some people do this on the internet or this.... what do you suggest?" 

It turned out, per his explanation, A bivalve cast won't work because you cannot walk in it" He never offered anxiety meds and that is fine with me because I tend to be a lightweight with meds (see above).

He said "I'll put you in the boot then." My mouth dropped open. I said "will that be ok? Is it as stable as the cast?" He said Yes. I prefer the cast because it's not removeable. Patients tend to take the boot off too soon and not follow my instructions."  I pointed out that there's no problem there for me, since I've been guarding that ankle my whole life. My problem is going to be taking the boot off and going to rehab where I have to actually use my ankle in ways I haven't, instead of guarding it. LOL, I was even guarding when he examined it. I had to be told to relax. No problem with me holding it at 90 degrees for 5 weeks. 

I asked him when I could start walking, since I'm going to be in a boot instead of the expected cast and he said "today". I again said "and the boot is as good as the cast for that?"  "Sure" he said "Just don't take it off. You can remove it to shower, but treat your ankle like it's still in the cast and keep it at a 90 degree angle." No prob doc, got this covered!

So a staff member put the boot on me and out the door I went.

I have a few words to anyone reading this, if you are going to request a boot for cast phobia. You should know a few important things. 

 Some doctors will not be as accommodating about using this as an alternative. Too much hinges on the patient being willing and knowledgeable enough to follow instructions explicitly. The doctor is trying to get you healed the best way he/she can. Ideally, they want to use the tried and true and slightly safer method of a cast, but severe emotional stress and panic is also not good for healing and hacking up your cast in a panic would be more damaging than just wearing a boot and being extremely careful. Tell them where you are coming from. Remember you chose that doctor for a reason, so trust them to guide you the rest of the way to being healed.

       It is going to be on you to follow instructions perfectly, if the doctor chooses to do it this way.  You can seriously injure yourself further by not following instructions exactly. I cannot stress that enough. You will have to purposely choose to follow instructions and be conscious of your foot when you are washing. Every time you take the boot off your foot is unprotected from any false move, bump, etc. 

      I've already seen a bunch of comments on the internet in forums about people standing up in the shower and not wearing their boot at night like they are told to and taking the front piece off and all kinds of other silliness.

      Don't stand up in the shower people. The doctor said you can take a shower not that you could stand up without your boot. Sit down in a shower chair, already. You shouldn't be standing without the boot unless your doctor specifically said you could and even then, you can slip in the shower!! Your balance is still off, your strength in the affected foot is not at maximum yet. Slipping means hurting that new surgical site. Don't risk it. Don't be an idiot. You could really do some damage to yourself.
     Not wearing the boot in bed as instructed also is a bad idea. It means the foot is not being held in the position the doctor wants it to heal in, 90 degrees. It also is once again, unprotected from a wrong roll over or bump in the night. How do you know you won't wake up groggy and forget about it and step on it. You need to leave the boot on!
     I haven't had much problem with wearing my boot at night as far as comfort. I loosen the velcro slightly and elevate it on some pillows. I also put a smaller pillow between my legs. It's all about the pillow.
     Yes, the nasty dirty boot has been all over, but protecting the foot is more important than how many germs you bring to bed right now. Your options are covering the boot or cleaning the boot. Taking it off is not a good option. Someone suggested putting the boot in a pillowcase. I'd rather just elevate my dirty boot on pillows and wash the pillowcases and sheets later. I like clean sheets same as the next person, but it's temporary. I like a healed ankle even better. Besides, a cast would get just as dirty (and a lot stinkier inside) and you wouldn't be able to take it off for sleep either. 

     Also, a word about the boot. It's heavier than a cast, hotter than a cast and awkward to walk and drive in because of it's larger size than a cast. The only real thing it has over the cast is that ability to be removed. If you can tolerate the cast at all, it's better to go with the doctor's preference. If for no other reason than, the doctor has the most experience with the method he prefers. This means that any complication that may arise he's likely to know how to deal with it better and is most comfortable doing it the way he's been doing it. His goal is a healed patient, same thing you want. 

I say all this because I am afraid that posting my experience will encourage people to demand a boot instead of a brace and then not follow instructions and damage themselves further. I imagine it's why there is not a lot posted on the internet regarding cast phobia. I don't want to be responsible for people getting hurt. 

Regarding my experience of having the actual Brostrom Procedure:

I have had a great recovery so far accept for a bad reaction to Percocet. Apparently it makes me have panic attacks. No biggie, I didn't end up needing anything but Tylenol. I only took the Percocet because I was afraid that, when the block wore off, I'd be in pain. It was ordered for me, but I really should have only taken 1/2 tab despite having an order for a lot more. I know how narcotic naive I am.

Other than the above and the cast phobia that is the subject of the blog, I have had no clinical problems with my recovery. I have no swelling, I do have bruising along the bottom outer ridge of my foot and at the top base of my toes. The incision looks clean. The stitches are out and the steri strips are in place until they fall off in a few days. What is the most amazing is I have absolutely no pain! 

Surgical day went as follows. I went to a surgical center so I arrived, was prepped and had the procedure in just a couple hours and was home that day. I had a splint which was essentially a plaster cast that didn't come all the way around my leg that was padded on the inside and outside. Before my stitches came out and after the block wore off, they would occasionally catch a little on the dressing and I'd be aware that they were there, but it didn't really hurt,just gave me a tiny little prick feeling. I had the popliteal block during surgery and it lasted about 30 hours. I was told 12-24 hours is the usual, but everyone is different. I never needed the Percocet (despite taking it) since I've had no pain so I would definitely recommend it. Not being able to feel your foot is unnerving to some but hey, you can't beat no pain.
 I used a knee scooter to get around for 2 weeks. Since I lived on the third floor I had to crab scoot up and down my steps to get out of my house. That's a lot of work on your abs, thighs and arms but I managed.
   Now I can walk but my stamina is down. My foot gets a little achy if I stay up too long and the boot isn't that comfortable when used along with the scooter because it pushes on your shin and pulls the bend part of the boot even tighter across your incision. I tend to just walk everywhere.  I rest a lot and have to elevate my foot frequently but walking is probably best anyway. I get little pin pricks on occasion and I will get a little ache if I have been up too long, especially now that I am weight bearing, but nothing unbearable. I consider it a warning to just sit down for a while and it goes away. I wouldn't be able to tolerate work right now.
 I'd recommend asking several friends to come by and visit and maybe get you out of the house. I only planned on my son helping me and he got tired of playing nurse. Some people just aren't caregivers.  I had to ask friends to come help me get out. Get your friends lined up ahead of time. Make a nice nest by your recliner and by your bed, because you will spend most of your time in those two places. 

    The boot does want to sit right on the "top of the foot" part of my incision, but adjusting the strap and the front foot plate a little helps. I do take the front foot plate off to check on my foot once in a while, but I'm completely seated and my foot is properly elevated and I don't leave it off for very long since it serves a purpose. I'm just grateful that, since I have the boot, I have the option to carefully do that. 

I'm very excited for my progress!

Amazingly, before fitting my boot, the doctor was checking my stability and turned my foot in the way I am terrified of turning my foot (inverting it) and it held I felt the strength and tightness. I was getting ready to yell stop and I just kind of looked at him and smiled and said YES! in amazement. It's going to be a long time before I get over being practically PTSD over my ankles and I still cannot stand to hear about people breaking or spraining their ankles but that was a milestone for me to not have my ankle pop out of place a little just by inverting it slightly. I'm not quite ready to let my guard down yet when it comes to protecting my ankle but it's nice to know that it really is more stable.
    It's my left ankle so I can drive but I have to be very careful with this huge boot because it sits really close to the brake due to the fact that I'm also short and tend to pull the seat very far forward. I don't want to accidently hit the brake, so I keep my knee bent as far as possible. This means I don't go too far from home because I can't really stay in that position for long trips or the occasional traffic jam. I think rounding up one of my shoes that has a really thick sole for my right foot might be enough to be able to pull the seat back farther and give me more room for driving. I haven't tried it yet though.

     All in all the panic was the very worst part of the experience with having my foot hot and confined and knowing it'll be that way for a while being second. The best is getting to be off from work for 6 weeks and second is that "aha" moment when my foot didn't give during examination.