Full Metal Ankle

Specialized surgery—a first at Mary Greeley—rejuvenates a Story City man’s active lifestyle.

By Stephanie Marsau

Michael Deacon loves to ride his Harley, work outdoors, and dance with his wife.

Here’s the thing, though. You need two good, strong ankles to do those activities safely and gracefully. Deacon only had one. At least he did until the bad ankle was replaced. You read that right. Replaced.

Deacon was the first patient at Mary Greeley Medical Center to receive a complete ankle replacement. The complex operation has him back on the bike, the ladder, and the dance floor.

Fall

Deacon worked in the printing industry before recently retiring, and he now helps out at the Salvation Army. His proudest accomplishment is being elected as the National Commander of the Sons of the American Legion in 2004–2005. The son of an Army commander, he’s been involved in helping veterans for more than half his life through the American Legion. He currently serves as the chaplain for The American Legion Riders, Chapter #37, in Ames.

A tough, engaging, and generous man, Deacon’s life took a turn when in 2009 he fell from a tree at his Ames home. He was trimming back dead limbs when he fell about 10 feet and suffered a significant tibial fracture that required surgery.

“As a consequence of Michael’s injury, he developed severe post-traumatic osteoarthritis,” recalls Dr. David Cain, a McFarland Clinic podiatrist who specializes in foot and ankle surgery. “This was severely limiting the range of motion in his ankle, and it was also causing stiffness and significant pain.”

What is post-traumatic osteoarthritis?

Post-traumatic osteoarthritis is exactly what it sounds like. It is arthritis that occurs after an injury has impacted the joint, which in Michael Deacon’s case meant that his ankle was affected.

A severe injury to a joint can cause a couple different things.

1. It can damage the cartilage surrounding the joint, causing it to thin and erode, which eventually results in bone rubbing on bone. This is the same with regular osteoarthritis, but post-traumatic osteoarthritis happens over a much shorter period of time.

2. It may cause the joint to stop making some of the substances that are needed to maintain the joint. Simultaneously, the bone may become stiffer, thicker, and heavier, which reduces its shock-absorbing capability.

Suffering from post-traumatic osteoarthritis doesn’t always equate into surgery. Symptoms can sometimes be alleviated by rest, ice, orthotics, physical therapy, or cortisone injections.

Deacon had been seeing Dr. Charles Gilarski, also a McFarland Clinic podiatrist, for cortisone injections. “Those helped a little, but they weren’t a permanent fix,” said Deacon.

Gilarski recommended that Deacon meet with Cain, who was doing training on ankle replacement surgery and on the lookout for a candidate who would benefit from it.

No stranger to joint replacements, Deacon had already had both of his knees done. When he first met with Cain in October 2020, he quickly realized an ankle replacement would be a different kind of joint surgery.

“Both of my knee replacements had gone really well,” said Deacon. “With those, they want you up and walking around right away. Dr. Cain explained that the ankle is a bit different though—and that I would be nonweight bearing for eight weeks.”

Deacon was given other options. He could continue the cortisone injections, which were moderately helpful. He could undergo ankle fusion, but that likely wouldn’t help much with his range of motion.

“I really appreciated that Dr. Cain gave me all of the options,” Michael said. “He’s such a caring person and he really wants you to decide what you think is best. He doesn’t want to make you get something done that you don’t want done.”

Deacon learned that if the surgery did not go well, there would be little else they could do. An unsuccessful knee or hip replacement can be done again. Not so with ankle surgery. Because of the invasiveness of the procedure, there would be no option to correct it.

Deacon, that toughness shining through, was undeterred. He opted to move forward with the surgery.

“I told Michael that I would need to go in and remove the plates and screws that he had in currently,” said Cain. “I also let him know that I would likely have to do a little bit of extra drill work to get everything realigned and that after it was all said and done the surgery would likely take four to five hours.”

“I told him that was fine by me,” said Deacon with a laugh. “Anything worth waiting for has to be a good thing.”

Mechanically Engineered

Deacon shared his news with several people, thinking some may realize it was an option for them.

“I would tell them I was having my ankle replaced and they were just shocked,” said Deacon. “They would say, ‘What!? Do they cut your foot off for that?’”

No, foot amputation is not involved, though a fairly significant incision is. A cut is made at the front of the ankle so that the ankle joint can be exposed. From there, damaged cartilage, along with damaged bone from both the shin (tibia) and the top of the ankle bone (talus) that the leg bones rest on, are removed.

The replacement ankle joint consists of two metal parts. One is attached to the tibia and the other to the talus. A piece of plastic is then inserted in between the two parts to act as cartilage. That all sounds simple. It isn’t.

Post-op & Almost Pain-Free

Deacon had the surgery in February. It went well, but took a few more hours than anticipated.

“Once I got in there, I realized that one of the screws from his previous hardware had been stripped when it was put in,” said Cain. “That made the hardware more difficult to remove. We used about every option we had available in the OR to get that plate and screw out and eventually got it. After that, the implant part was smooth sailing.”

Every option included using an esmark bandage (think a giant rubber band) placed on top of the stripped screw to help the screwdriver gain traction. When that didn’t work, a small threaded nail called a trephine that cuts into the screw itself was used…until the trephine snapped. Finally, a diamond-tip burr did the trick, allowing Cain to cut through the metal plate and top of the stripped screw.

Deacon couldn’t help but laugh when he learned the reason for the lengthier-than-planned surgery. “It just made me chuckle a bit that it took longer to get the old stuff out than it did to get the new stuff put in.”

Deacon was nonweight bearing for nearly the next eight weeks. Remarkably, he had minimal pain throughout his recovery.

“I really only ever took Tylenol for the pain,” he said.

Cain credits some of that to the nerve block given to Deacon just prior to surgery.

“I try to have my patients get a good block prior to surgery because it really seems to help afterwards. Michael was still numb the next day from his block, which served him well,” said Cain. “That being said, I am a bit surprised that with all of the extra work we had to do to remove the old hardware he had so little pain. Everyone handles pain differently though.”

Land and Water Rehab

On April 12, 2021, roughly six weeks after his surgery, Deacon had his first physical therapy appointment at Mary Greeley Rehab & Wellness. Still not able to put pressure on his foot, he had his first aquatic therapy appointment just a few days later on April 15.

“Aquatic therapy allows patients to become weight bearing sooner because the water reduces the amount of weight on the leg,” said Cain. “The water pressure can also help with swelling in the lower leg, which also helps with pain.”

“They are so great down in Rehab & Wellness,” said Deacon. “I saw them, Brent [Baerenwald] specifically, for both my knee replacements and they’re fantastic about pushing you just far enough—but not so far that it’s painful, but not so little that you won’t see results. On top of that, they’re genuinely nice people.”

Knowing Deacon from his knee replacements, Baerenwald knew that he had a good work ethic. There was a biological component to it, though, as well.

“When a patient undergoes a surgery like Michael did, they clean everything out,” Baerenwald said. “For him, the pain was being caused by the arthritis, and by removing the joint, they removed the arthritis. Any pain he had after the surgery was caused by the surgery—and that pain is much easier to control than the pain caused by something like post-traumatic osteoarthritis.”

Total Joint Rehabilitation at Mary Greeley

The Mary Greeley Outpatient Rehab & Wellness department is housed in the lower level of the Medical Arts building and offers a variety of programs to help total joint replacement patients, regardless of the joint replaced.

The Total Joint Replacement Program at Mary Greeley encourages patients to start physical therapy PRIOR to surgery. This can help with strengthening, balance, and range of motion prior to surgery, as well as pain and mobility after the surgery. Typically, the better shape a patient is in before surgery, the better the outcome for the patient.

The program takes the patient through the recovery journey alongside trained therapists. A patient may find themselves in the pool in the same way Deacon was or doing various physical therapy exercises on land. A therapist will sit down with the patient and create an individualized care plan that both parties are comfortable with.

Questions regarding the Total Joint Replacement Program at Mary Greeley? Call Outpatient Rehab & Wellness at 515–239–6770.

Back in Step

Deacon now has a virtually pain-free ankle joint, for which he credits both Gilarski and Cain.

“If Dr. Gilarski hadn’t recommended I talk to Dr. Cain, I may never have known that a total ankle replacement was even an option and I’d still be suffering with almost constant pain,” he said. “The surgery Dr. Cain performed has made all the difference. So much so, that I’ve told him if he has any other candidates considering this kind of surgery, I would be more than happy to share my experience with them. That’s how much it has improved my quality of life.”

Nine months after his surgery Deacon had finally gotten back to doing the things he loves. Recently, he got the Harley out for a Ride for Sleeping Angels, which is a support group for families who’ve lost children. It was 230 miles of open road, with stops along the way at Painted Freedom Rocks. He also got to do something else he’d been missing.

“My ankle is feeling so much better and I can walk and stand for much longer periods of time,” says Michael. “I have even been able to go dancing with my wife, Sandy, and a year ago that wouldn’t have been possible without a great deal of pain and discomfort.”