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Calcaneum fracture

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 dr evil 14 Nov 2020

I’m 8 weeks after fracturing my calcaneum during a ground fall. It was broken into at least 3 pieces and the fracture involves the subtalar joint but no surgery was required. I can’t weight bear on it yet and a knee scooter is my saviour right now. Every day I try and put some weight on it but can’t yet. A friend of mine was on crutches for a year after the same injury. I’ve researched rehab but not found much useful to my particular situation. I’m 53 but very active in climbing and surfing and would like to keep on going at those sports. Any tips from someone who has been through this would be very welcome 😀

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 FreeloaderJoe 14 Nov 2020
In reply to dr evil:

No advice specific to calcaneum fractures. I'm about 11 weeks post-op from a big ankle fracture sustained after taking a fall in August, and feel your pain! This really has been an eye opener for me, and It only struck me once i had injured my ankle , how many others climbing friends and acquaintances that i know who have fractured their ankles (...often in life changing ways) whilst climbing and falling in very normal circumstances. Certainly has provided food for thought on life - I've also been a knee scooter man.

Good luck with the recovery.

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 Rob Parsons 14 Nov 2020
In reply to dr evil:

Sorry to hear that. Your injury sounds much worse than mine was, though sustained in exactly the same way. For me, after about four months I was able to get on (very carefully!) with things.

I was never offered any specific rehabilitation, and it's hard to think of anything which would help (other than generally keeping as active as the thing allows.)

Good luck, and be patient: the body is remarkable, and you'll get back to normal soon enough.

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 John2 14 Nov 2020
In reply to dr evil:

I was able to cycle pretty much as soon as I was discharged from hospital. I found the exercise very good for maintaining mobility and reducing swelling.

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 ASharpe 14 Nov 2020
In reply to dr evil:

I busted mine at Bowden when I was a student twenty odd years ago. It got fixed as it was not totally in bits but was quite impacted. I was on crutches for about 12 weeks and gradually got back to things over a year or so. Doesn’t bother me much these days. Hope you make a good recovery. 
As I was a student my rehab seemed to be mostly getting wasted. Ah youth. 

Post edited at 23:18
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 Big Bruva 15 Nov 2020
In reply to dr evil:

I smashed my calcaneum into multiple pieces 10 years ago. I was in plaster for 3 months, 6 weeks of which were non-load bearing. It all felt very slow at the start but after 5 months I was back doing long alpine ridges. I wouldn't be getting too anxious after just 8 weeks.

Surgeon said I would have to get my ankle blocked one day but it's still going strong although sometimes I get a dull ache when I'm walking on it.

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 wilkesley 15 Nov 2020
In reply to dr evil:

In the 1980's I smashed mine, but luckily didn't displace any of the fragments and there was only one crack leading into the joint. I could sort of weight bear after three weeks with the aid of crutches. I lost a small amount of side to side mobility. It was several months before I could weight bear fully without the crutches and about one year for a full recovery. I did manage to do some easy routes wearing Koflachs (Outside Edge) with a crutch to ease the walk-ins.

Elevating the limb and 20 minutes of bag of frozen peas around your ankle helps reduce inflammation and pain.

Post edited at 13:38
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 Dr Toph 15 Nov 2020
In reply to dr evil:

Not quite the same but I smashed my sub-tibia talus into multiple shards missing my mat a few years back. The bone heals up relatively quickly (liberal application of comfrey poultice + tincture speeds bone knitting) but what cannot be determined before that is the damage to soft tissues. Ankle function/movement/stability will be all out of kilter from ligaments changing length during the recovery, so make sure to get good physio / osteo treatment for that once the bone is sufficiently healed or it can become a nagging issue for years. Good luck!

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 John2 15 Nov 2020
In reply to Dr Toph:

That's true about the ligaments changing length. My heel bone was compressed, so the ligaments were too long and the ankle was unstable when suddenly standing up. There was an infamous occasion when after drinking 8 pints of beer in a pub garden I stood up to go to the loo. My ankle collapsed and I fell into a flower bed. Everyone thought it was because I was drunk, but it was because of the instability caused by the ligaments (honest).

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In reply to dr evil:

Don’t push things too quickly. Most climbers are really keen to get back to fitness after injury but there is always a risk of being over enthusiastic. Despite what the voice in your head says you won’t forget how to climb and your strength will return. The talus and calcaneum can be slow to heal, also soft tissue damage in the ankle can take months.If you don’t think you are making any progress then get a proper medical re assessment.

When I was 55 I smashed my ankle and foot badly to the point where there was talk of amputation, took best part of a year to walk. Once I started climbing again my meagre strength returned and I’m back to where I was pre accident. 
 

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 rachelpearce01 15 Nov 2020
In reply to dr evil:

Hi Dr Evil (I hope youre not too evil!).

I broke my heel and ankle falling straight onto it from about 10 foot down into a basements trying to climb into my friends house through a window. Luckily I was rather intoxicated at the time so must have fallen very gracefully and only hurt the one ankle. But I was told my heel bone had shattered like an egg into loads of pieces. I also broke the subtalar joint and my tibia. They said that these sorts of injuries are common with criminals running away from the police ! With my heel they basically encased it in metal, and they plated my ankle. They said at the time that they were unsure what my prognosis would be for how much range of movement I would get back, and I was a keen runner at the time, they didn't want to say whether I would be able to run or not. All in all they painted a bleak picture, but in actual fact its near enough as good as my other ankle now.

Things that I think aided my recovery:

Because I had it plated it wasn't in a cast and I could essentially start moving it myself as soon as I was out of hospital, I would routinely manoeuvre my ankle around turning it and stretching as much as I could.

I also got a sports masseuse to massage it, but he also manually manoeuvred it around too. I had this once a week as soon as I was out of hospital for at least 6 weeks. This I think promoted blood flow to the area and ensured it didn't seize up.

I had physio from the NHS fortnightly, you should definitely be getting this. If not get private ??

I started weight baring and walking without crutches as soon as I could, basically I listened to what my body said and if it didn't hurt I took that as a good sign. I got rid of the crutches sooner than advised. 

Once off the crutches I bought some swanky black diamond carbon poles, and used those to walk around with to take a bit of the strain off. 

4 months after the accident I left to do a month of skiing! My mum wasn't too happy, but I feel like getting back to normal and doing as much stuff with my ankle to strengthen it again and get it moving was good. I also work in a river, and walking around on uneven surfaces, always walking on slippy rocks and my ankle is subjected to loads of different movements and strains. I think this has in the long term made it much stronger, and when I went for follow up appointments with my surgeon he was amazed at much movement and range I got back in my ankle considering he saw it when it first happened. 

So basically my advice is start moving it as soon as you can and do as much stuff as possible to strengthen all your muscles in those areas. maybe for the first year or so after my accident my ankle would ache after doing big walks, and it would also be stiff in the mornings until I got going, or if I woke up in the middle of the night. but most of the time I forget that there's even a problem. 

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 wilkesley 15 Nov 2020
In reply to rachelpearce01:

I remember my physio suggested putting a square of wood on top of a football and then rotating your foot to help get back flexibility.

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 Mr Lopez 15 Nov 2020
In reply to dr evil:

> I can’t weight bear on it yet (...) Every day I try and put some weight on it but can’t yet.

Confused... You can't weight bear because the docs told you so? Or you can;t weight bear because it hurts?

If the later, and assuming you have been cleared to put weight through it, then i'm afraid there's no shortcut to avoid the pain.You gpt to pull through it.

If you are cleared to swim that's a good exercise, plus that also means you are cleared to go bodyboarding (minus the fin) which will help you get surf fit.

Once you can surf again you can stack up chunks of tail pads to make a sort of orthotic traction pad to suit, putting softer padding at the heel and harder at the forefoot to relieve the pressure for example. For me with a terminally arthritic ankle a 10mm arch traction pad and an extra 10mm at the heel makes wonders

As for climbing, just stop heel hooking. Heel hooking makes you weak anyway ;-)

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In reply to dr evil:

Hi, I fractured my calcaneus on 24th August bouldering at stanedge. It required surgery and I was operated on the next day, with 4 screws now in place. 12 weeks on and I've been weight bearing for a couple of weeks, in fact on Friday I managed the walk in to Burbage valley south to watch my boys bouldering. I think I've healed quite fast compared to what I've seen about this injury, but then again everyone is different and heals at their own pace. I've tried to keep the mobility going as soon as I was able, really once the cast came off. I was doing exercises with a theraband to build up the flexibility initially and this has been the biggest challenge, and still is. My dorsiflexion is not fully there yet, and having a full range of motion is something I'm working on. The physio at hospital should give you some exercises to do once you're able to, and these might help at first. They only gave me about 4 exercises to do so if you want better advice id go private and see a good physio who specialises in this kind of thing.

I'm pretty confident I'll be walking normally again by January, by that I mean at a good pace and with very little restrictions to my foot motion. I hope to go climbing again perhaps in January, indoors on top rope to start though! 

I'd say don't rush to put weight on if you can't yet, but rather focus on flexibility as this will help once you're able to weight bear again. 

It's a long process and I've found it hard to be patient as I was very active before doing this. I've found swimming a great help, although getting into the pool can be tricky before you're weight bearing yet.

All the best mate, let me know if you want to chat over the phone or something...

Phil 

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 Andy Farnell 15 Nov 2020
In reply to dr evil:

I fractured mine in 1997 at Crookrise. It took at least 12 weeks before I could bear any weight on it (but I was climbing indoors after 8 weeks...). It took a year before it was pain free, but several years before it was fully right. I've lost about 10% mobility, but it hasn't slowed my climbing. Admittedly I was a lot younger than you are, but if you're careful you should hopefully heal well.

Andy F

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 martynlj 16 Nov 2020

Hi dr evil:

Hi, I fractured my calcaneum (3or 4 pieces, involving subtalar joint but not displaced) aged 53. Moonboot for 6 weeks and then physio. Main issue, as others have stated is soft tissue damage. Physio to decrease shortening of T. achilles  and also restore ankle stability and muscle tone. Wobble boards good/ standing on one leg (eyes open then once safe with eyes closed). walking, cycling etc. Took about 18 months to restore almost full function but then able to get up Mt Aspiring.

Just keep at it and others have said a bit of pain is OK. Can't say what effect it has had on my climbing as I'm rubbish anyway!

Good luck.

dr martyn

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 dr evil 16 Nov 2020
In reply to dr evil:

Hi everybody thanks for all your replies that has really helped to give me perspective. I have full range of motion but can’t weight bear on it yet. Looking at the replies I think I’m being impatient at 8 weeks to expect to be able to do so. So I will take it easy and be a good patient. Thanks again, Grant

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 IceBun 16 Nov 2020
In reply to dr evil:yeah, good advice above Grant. Own experience of a calcaneum break was not too bad as no displacement but I was still over 8 weeks to weight bearing. Don’t rush it and go steady at it when allowed to weight it. Good diet seems to help recovery. I found a turbo trainer let me build the leg and not stress it too much. When able i used a wobble cushion to work muscles and flexibility. When I had mastered it I moved to a wobble board and a balance beam can be good. I tended to do more than double the work the nhs physio set until she realised I was used to training then she upped the pace considerably and I progressed very quickly. A similar approach worked with a more catastrophic pillon fracture of the tibia. My osteopath did amazing work on flexibility too. Top tip is work your arches to avoid later issues like plantar fasciitis, use  a physio ball or tennis ball. Good luck. Neil

Post edited at 22:38
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 Gary Gibson 12:38 Fri
In reply to dr evil:

From my professional point of view as a retired podiatrist it is a complicated issue and the involvement of damage to the sub-Talor joint is the most complicated issue if the damage involves that joint of the calcaneum joint isn’t pinnedas pinning is complicated anyway as it involves three joints, the navicular, talus and calcaneum. Rest is paramount along with the standard RICe anachronism, Rest, ice,not toon much compression and nsaids, no  steroidal antiinflammatories. During rehab it is helpful to reduce movement of the subtalar joint, as pronation and supination are instigated by this joint. A slight heel raise, no more than around max 4mm, will reduce this motion.you can do that with some flat pieces of cardboard in each should be ensure you do it in each shoe.

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In reply to dr evil:

I smashed mine age 37 falling off the top of Back Bowden. Plate put in, 6 weeks in a cast, 13 weeks before I could put a climbing shoe on. After 4 months I was bouldering outside at a decent level.

Not surfing, but I've been skateboarding on it and fell running. The issue for me is not the joint as such (though it is stiff after a 2hr+ run), but the extent to which the stablising ligaments are knackered (I can't really stand on one leg). I wish I'd worked harder on dorsiflexion early on.

Good luck!

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