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I learned a lot today... R is the recently sprained but healing well; L is 30-yr old "repaired" subtalor compound dislocation.
Starting with steroid shots to provide relief, but moreover to determine if discomfort source is the ankle joint (where leg bone meets foot, flexion, extention movement) or subtalor joint (black arrows drawn, sideways roll movement). Once we know we can move ahead to... Addition shots up to 3x/year; clean up joint contact arthroscopically; clean up plus subtalor fusion with two screws (my L subtalor presently has almost no motion, so it's virtually fused already); ankle joint replacement surgery (which doesn't address subtalor).
Steroid shot in ankle joint did provide relief but I'm putting my money on subtalor joint as the problem. He said it could be some bone-on-bone there, believable considering the cartilage cups were pretty much exploded according to the repair surgeon. I can see it going to subtalor fusion after more diagnostics. Ankle fusion is a big deal – don't need it. Subtalor movement I've lived without. There is arthritis in both joints and some spurs and calcification noted from previous injuries.
The ortho I hooked up with is the right guy. Doesn't believe avoiding the activities is a viable path forward. He'd rather see my joints flame out and at least try to make them wortk for two more decades than me get unhealthy physically and mentally not doing stuff. I'm pretty psyched to be doing something with this after all this time. It's been more problematic lately, which seems like will lead to major improvement vs just dealing with discomfort and laying low on certain activities I still love.
PS: Left leg was dominant before dislocation. Look at that skinny peg now.