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Curry to Undergo Exploratory Ankle Surgery that is Unlikely to Identify True Problem

April 23, 2012

curry ankle surgeryGolden State Warriors guard, Stephen Curry, plans to have an ankle arthroscopy to fix his oft-injured right ankle.

Curry consulted with three doctors who all agreed it was best to perform an arthoscopic surgery in order to explore whether or not additional surgeries would be necessary to fix the ankle.

Curry had ankle ligament repair surgery last summer, but sprained his ankle again this season after only 26 games.

While the three doctors Curry consulted with agree on an exploratory arthroscopy, MN Orthopedic surgeon, Dr. Lance Silverman thinks there are better treatment options.

Dr. Silverman Comments

Something doesn’t fit.

If his doctors don’t know the cause of the pain before the arthroscopy, they will be just as clueless after.

Let’s break this down:

  • Stephen Curry had ankle instability and underwent some tendon surgery. His surgeon, Dr. Robert Anderson (whom I trust), has examined Curry following his recurrent ankle injury and said, “his ankle is stable.”  I don’t doubt that.
  • Curry has ankle pain and feels like it’s going to roll.
  • The MRI is inconclusive.
  • 3 surgeons have evaluated him.

This leads to the logical conclusion that the problem is not coming from the inside of Curry’s ankle—it’s coming from somewhere else.

Curry underwent a ligament repair by Dr. Robert Anderson, one of best orthopedic surgeons I know. And ankle ligament reconstruction is one of the most successful procedures orthopedic surgeons perform. It works almost every time.

So why is Curry in pain? Why does he feel like his ankle is still unstable, and why does something continue to give way? Because there is something else wrong. Something much more difficult to diagnose and treat. The problem could be any number of factors, such as:

  • The joint below his ankle (the subtalar joint). This joint is notoriously difficult to isolate from the ankle on examination.
  • The transverse tarsal joint, meaning he might have an unstable hindfoot— a condition barely acknowledged in American literature.
  • A tendon that is partially torn but doesn’t show up on MRI.
  • A nerve in his leg that isn’t functioning correctly.

A concentrated therapy plan is a smart first choice in many circumstances, but I am concerned that without the right diagnosis that treatment will fail. If Curry was my patient this is what I would do differently to find the problem:

  1. First, I would listen carefully to what he says. 90% of the time the key to diagnosis is in what the patient says—”When all else fails, listen to the patient.”
  2. I would examine him, looking for all the problems described above and more. Chances are he has one of those problems I noted above as they are rare enough to fly under most doctors’ radar.
  3. Then, I would perform an ultrasound examination in my office. This is a test just like the machines used to look inside an expectant mother. It has no radiation exposure, allows me and the patient to see the joints and tendons move, evaluate the ligaments and nerves, and compare one side to the other. In many ways, it is more sensitive than MRI.
  4. After looking at his MRI and ruling out any other obvious issues, I would have a diagnosis.

Instead, the latest media reports that Curry plans to undergo a diagnostic ankle arthroscopy. I don’t agree with this approach. Scar will be removed but nothing else will be gained from this procedure. Diagnostic arthroscopy of the ankle has very limited indications as only a few conditions can be diagnosed and they don’t cause the symptoms that Curry is reporting. If the media reports are accurate, the problem is not coming from the inside of Curry’s ankle, it’s coming from somewhere around the ankle.

Update (4/30):

Curry’s surgery “consisted of cleaning out loose debris and scar tissue,” and found his ankle to be stable. That is all you ever find on an ankle arthroscopy. Curry needs someone to think outside the box.  He may be “spraining his ankle multiple times this season,” but if the ankle is actually stable then the problem isn’t in the ankle.  Curry’s foot and ankle are now swollen and tender from the arthroscopic procedure. He won’t be able to undergo an exam until one month passes. I hope that he realizes that a cleaning under the hood won’t fix a flat.

Related Sources:

USAToday.com

From → Ankle Injury, Surgery

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