Mention the name “Jane Forman” to anyone in Miami who plays tennis and chances are they’ll know right away who you’re talking about. That’s because Jane Forman, 63, is a legend in the sport – and not just among locals. The former top 50 world-ranked tennis professional has competed at the highest levels and has coached thousands of players of all ages, many of whom fly in from across the U.S. for an opportunity to participate in her Team Forman Experience training.

But when a decades-long problem with her right ankle suddenly became much worse in 2023, Ms. Forman was told by two different orthopedic specialists that she would need an ankle replacement. This would enable her to stand upright, she says, but it would have effectively ended her lifelong passion for playing and coaching tennis.

Ms. Forman was determined to find a better solution, and she found it in Thomas San Giovanni, M.D., an orthopedic surgeon with Baptist Health Orthopedic Care who specializes in foot and ankle injuries.

(Watch now: Jane Forman, former top 50 world-ranked tennis pro, thought her playing and coaching days were over after suffering a severe ankle injury in 2023. But thanks to Thomas San Giovanni, M.D., at Baptist Health Orthopedic Care, she’s back on the court pursuing her passion. Video by Alex Calienes, Gort Productions.)

Breaking Records in High School and College

Ms. Forman says she started playing tennis at age six or seven and never stopped. “I always knew I wanted to be a professional tennis player,” says the petite, energetic and outgoing instructor. “I started playing professional tournaments around the age of 17 or 18 when I was a senior in high school. I played all through college as an amateur and then turned pro after college.”

In a profile of Ms. Forman as part of last year’s Women’s History Month, the United States Tennis Association (USTA) Florida Chapter highlighted her remarkable achievements on the court:

“Jane played four years of high school tennis, never dropping a match or even a single set during that span. She earned a scholarship to play tennis at Clemson University and was an All-American all four years. Jane broke many records in her playing career, and they still stand today. At Clemson she won the most singles matches ever in a season (44) and set a career record (137). Jane became a professional tennis player on the Women’s Tennis Association (WTA) Tour and in 1983, she competed in her first Grand Slam tennis main draw match at the US Open. In 1986, she reached the second round of Wimbledon, where she fell to the eventual champion, and 18-time Grand Slam winner, Martina Navratilova. She was inducted into the Clemson University Athletic Hall of Fame in 2003 and named a top athlete of the century from Rhode Island.”

 

Jane Forman congratulating Martina Navratilova after their second-round match at Wimbledon, 1986

Ms. Forman says that playing in the game’s most storied venue – Wimbledon – against Ms. Navratilova, one of the greatest players ever, was one of the highlights of her career. It was also her first-ever televised match and she admits to feeling the pressure before walking out on court with her opponent.

“It was a surreal moment and I was pretty much of a nervous wreck getting ready to play her. I didn’t want to make a fool of myself in front of a huge audience,” Ms. Forman recalls. “But once I got into the match and got used to playing with such a large crowd around me, I just kind of fell into it and had the best time in my life.”

A Lifelong Ankle Problem Gets Much Worse

Ms. Forman says she always felt a weakness in her right ankle, even as a child. “I tore my tendons when I was a teenager. It healed and I played pretty much injury-free all through my career,” she recalls. “After playing professionally, I stayed very active and it was my mission to stay in good physical condition and physical health.”

To improve her fitness and stamina, Ms. Forman was diligent about working out with trainers and even started running half marathons. But she continued to feel like something was going on with her right ankle.

“Tennis is a pretty rigorous sport and a lot of people don’t realize the amount of work you have to put in off the court to be in shape to play,” Ms. Forman says. “It’s an anaerobic sport with lots of quick stops and starts – a lot like the footwork of a basketball player.” Add in training for and running half marathons and “you’re putting a tremendous amount of stress on your body and your ankles.”

In 2023, Ms. Forman’s right ankle had had enough and her tendons ruptured. She knew it was serious but after having two specialists tell her she needed an ankle replacement, she decided to do some more research.

“Everybody I talked to said, ‘You have to see Dr. San Giovanni – he’s the best at intricate operations and even teaches other doctors how to do them,” recalls Ms. Forman. “After reading a little bit about him and talking to people who he had operated on, I knew I had to get in to see him.”

Ankle Instability Leads to Repeated Sprains, Which Can Lead to Cartilage Loss

Besides his local reputation, Dr. San Giovanni is world renowned for his longstanding expertise in total ankle joint replacement surgery. He serves on many international symposiums and is one of the nation’s leading experts in this form of complex ankle reconstruction. He was the first to perform many of these replacements with modern era-designed implants and was the first ever to be filmed performing a total ankle joint replacement, live and unedited on the internet, at Baptist Health Doctors Hospital. Although successful for many that need it, Dr. San Giovanni cautions that this does not mean it is the best solution for all patients.

This type of injury is most often treated non-operatively, according to Dr. San Giovanni. But in some cases, as with Ms. Forman, the ligaments to the ankle can rupture. “They will continue to have instability and the result of cumulative damage from re-injury to the joint is that the cartilage deteriorates and that was what was happening with Ms. Forman,” he notes. “She had a bad injury that just didn’t get better because the cartilage of that joint had really worn out. It was basically bone on bone.”

Although Ms. Forman’s arthritis was a problem, she says Dr. San Giovanni felt confident that the predominant source of her pain and discomfort were not coming from the ankle itself, but from a more upstream problem; namely the significant deformity of her tibia bone concentrating the stress directly to the area of her ankle that had the cartilage damage.

“None of the other doctors ever looked at it that extensively,” says Ms. Forman. “He saw how high functioning I was and even though my ankle was basically deformed at the time, he determined that correcting the deformity could lead to substantial improvement in how my ankle joint would feel and function, even if there were areas on x-rays or scans that showed severe ankle arthritis.” In the end, she adds, it’s how you feel and function. You’re not just an x-ray or an MRI scan. Dr San Giovanni understands that and seeks to truly understand the source; then tries to determine the best solution for that person.”

Searching for a Different Solution

Knowing that tennis was not just Ms. Forman’s passion but also her livelihood, Dr. San Giovanni wasn’t satisfied with just getting her back on her feet. He wanted to help get her back on the court, playing and coaching. Simply replacing the entire ankle wasn’t an option – at least not the best option for her because he knew she wanted to be able to go full force. Restoring Ms. Forman’s ankle function while also alleviating her pain would require a different and far more complex approach, from the standpoint of thought and successful execution.

“If you just looked at her x-rays without looking at her or asking her what she does and what she wants, then your immediate response would be, ‘This is a bad ankle. She will need either an ankle fusion or an ankle joint replacement,’” Dr. San Giovanni says. “The way her bone and joint were angled, it was essentially beating up on one particular area of her ankle while the rest of the joint looked okay.”

Dr. San Giovanni says an ankle fusion locks the ankle so you don’t have movement of the joint. “It’s good for pain but it may not be good for somebody like Ms. Forman who is still extremely active. I had to think of a different solution for her.”

Creating a Controlled Fracture to Save Ankle

That solution turned out to be a supramalleolar osteotomy, which Dr. San Giovanni says involves cutting the tibia and rotating and angling the ankle joint in such a way that the joint surface is realigned.

“We’re essentially creating a controlled fracture to change the joint’s angle or rotation,” he explains. “We make the cut and angle it, fill the gap with bone graft and then use a titanium plate and screws to hold everything firmly in place. This helps load the joint differently in terms of the forces the ankle absorbs and therefore makes it more stable and less prone to injury. We didn’t do anything to the joint itself except for redirect where the force was going through that ankle to a better, more widespread area.”

 

  

X-rays of Jane Forman's ankle before and after reconstruction by Thomas San Giovanni, M.D., with Baptist Health Orthopedic Care

 

Dr. San Giovanni says he has done thousands of different osteotomies but ankle joints are less common because surgeons normally recommend ankle fusion or ankle replacement. However, he and his team understood how important tennis is for Ms. Forman.

Ms. Forman had her surgery at Baptist Health Doctors Hospital on March 12th, 2024. Preserving Ms. Forman’s ankle mobility was their primary goal, Dr. Giovanni says. “One of the advantages of ankle reconstruction over replacement or fusion is that she’s able to keep the mobility of her ankle, and her joint is still her own joint. In addition, it doesn’t preclude her from having either of those two procedures in the future if needed. But she may never need it.”

Quickly Getting Back on the Court After Surgery

Even though Dr. San Giovanni was not actually replacing her ankle, he made it clear to his patient that her recovery was going to be more extensive than if he had replaced it. “The recovery for this, it is almost like a recovery from a fracture,” he says. But the ultra-motivated Ms. Forman wasn’t about to let her ankle reconstruction sideline her for a day longer than necessary.

“The recovery was far better than I anticipated and I returned to the court quickly,” she says with a hint of pride. “I was in the hospital for two days and then rested a full week or so before I was back on the court. I really didn’t slow down.” Physical therapy was “pretty tedious,” she admits, but she says she “hit it as though I was training for a Grand Slam tennis tournament.”

 

Jane Forman coaching students as part of her Team Forman Experience training

 

Ms. Forman says that being able to get back to doing what she loves so quickly was important. She returned to tennis instruction at first by sitting in a chair on the private tennis court behind her southwest Miami home and, with her right leg propped up, feeding tennis balls to her students. After a few weeks, she was able to move around with the help of a scooter. “I wouldn’t say I was playing tennis but at least I was mobile and giving lessons,” she says.

Today, Ms. Forman says she is going “full throttle” and feels like she’s actually doing even more than before. “I don’t know if it was the emotional anguish of not being able to do this for the past year but now I’m hitting it full force and I think I’m actually on the court double the amount of time that I was before my injury.”

Almost Like Solving a Puzzle

Ms. Forman says she was impressed by the amount of time Dr. San Giovanni took figuring out what was actually wrong with her ankle. “It was almost like he was solving a puzzle. He really spent a lot of time figuring out not just how to fix my ankle and get me upright but also how to give me my lifestyle back,” says the tennis pro. “I would have flown anywhere to get this procedure done by him. I was just lucky enough to have him right here in Miami.”

Dr. San Giovanni says he feels very good to have played a role in Ms. Forman’s return to tennis but emphasizes that it was a total team effort. “A lot of the role I played was probably the decision-making and the technical skill but it’s also the schedulers, the scrub techs, the nurses and the anesthesiologist who deserve credit” for Ms. Forman’s successful outcome.

He adds that Ms. Forman’s reconstructed ankle looks great and should hold up for the rest of her career. “Could she need something in the future? We’ll have to see. If she does, it most likely would be a joint replacement years from now.” And, Dr. San Giovanni points out, “the success of that would be much better than it would be if we had done it now, because we’ve already restored the alignment of her ankle.”

Ms. Forman says that in her profession, she’s around injuries all the time and she always recommends Baptist Health Orthopedic Care. “I have numerous students that have things that happen to them, whether it’s their knees, ankles, shoulders, wrists or elbows. But I always recommend they see a specialist at Baptist because I had such a positive experience there.”

For more information about Baptist Health Orthopedic Care, click here.