Tom Tumlin with his wife, Judy, outside the Catherine Palace inSt. Petersburg, Russia. Photo courtesy Tom Tumlin
Tom Tumlin is not a man to let a little pain get in the way of having a good time. On a visit to Eastern Europe in 2011, the avid golfer and traveler noticed some ankle soreness and difficulty in getting around, "but I didn't think much about it," he says. "As a youngster, I had a lot of twisted ankles from playing basketball, and I thought it was just that." It wasn't until some months later, when he found himself slowed-down to a painful shuffle while out Christmas shopping, that he realized he needed to do something.
Tumlin, who is 68, was referred to Dr. Mark Jones, an orthopedic surgeon at Johnston-Willis Hospital in Richmond. "He told me I had stage 4 osteoarthritis in my ankles [the most severe grade]. He showed me the X-rays, and in my right ankle I had no cartilage [left] between where the bone hits the foot."
Ankle osteoarthritis — the wear-and-tear form of arthritis — is on the rise, as a more athletically active generation matures, and the results of earlier joint trauma become apparent. But historically, says Jones, treatment has lagged behind that for the more common ailments of knee and hip arthritis. Total ankle replacement surgery, which Jones practices at Johnston-Willis, is a relatively new and little-known procedure, having only become mainstream in the late 1990s. Even now, Jones, who has been doing the surgery for five years, knows only a few other surgeons performing it in the Richmond area. (It is also available at VCU Medical Center.)
The previous treatment for severe ankle arthritis — still widely in practice — was ankle fusion, which involves "welding" the bones of the ankle together to prevent any movement. It often leads to an alteration in gait, and to arthritis developing in other joints. "One of the main advantages of total ankle replacement is to preserve the normal ankle motion," Jones says, "and therefore preserve the adjacent joints in the foot and leg." This is perfect for an active person like Tumlin, who says that when Jones presented the two options of ankle fusion or ankle replacement, it was a no-brainer — as long as he could take a planned trip to China first.
The two- to three-hour operation involves replacing the worn-out surfaces of the ankle joint's two main bones with a metal and plastic device. The patient is in a cast for six weeks, and then must wear a boot for a further six weeks. Tumlin, who had his surgery in June 2012, seems to have found resting up afterward the hardest part of the whole procedure, and was relieved to be able to tentatively start playing golf again around November that year. By July 2013, he felt fit enough to go on another vacation, to Russia this time, which he rates as a success: "It's not like it was before I had any problems, but I got around very, very well."
"Patients tend to gain slightly more mobility than they had prior to surgery," Jones says, "but their primary goal is to eliminate the pain they had." Among his patients, with whom he tends to follow up on a yearly basis, he says there's a high rate of satisfaction, even with those up to five years past the surgery: "About 75 to 80 percent would rate their ankle as ‘normal' or ‘nearly normal.' "
Given its efficacy, why are there so few doctors practicing it? Jones cites the procedure's challenging nature, and thinks that some surgeons are waiting for longer-term data on the replacements' durability. But, he adds, "We do have data that suggests a high percentage of them will last up to 12 years."
Tumlin's latest visit to his surgeon was in July. "He said, ‘You've probably got all the mobility you're going to have, but the pain will continue to get better, gradually' — and it has," the Chesterfield man says. "I'm playing golf two or three times a week now. You get to a point and you look back and realize, ‘I'm doing a lot better.' But it's a slow process." One thing his new ankle hasn't slowed? The wanderlust. "We're thinking about Ireland [next]," he says of his annual adventure with his wife, Judy "Or Greece or Turkey — or a combination, probably.