UKC

Fused Ankles, Anybody?

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 david morse 03 Oct 2007
Anybody ever broken their talus bone, or had a fused ankle? messed mine up pretty badly looks like its gonna be fused. read all about it online, just wondering if anyone has any first hand experience as far as climbing/mountaineering goes?
 Bill Davidson 03 Oct 2007
In reply to david morse:

Not had mine fused but had a plate in the outside & a screw in the inside after I badly broke it in a fall. The plates still there but got the screw taken out & so far its as good as new. Gets a bit stiff first thing but wears of quickly.
Bill
 Jus 03 Oct 2007
In reply to Bill Davidson:

I've got a few screws in mine after breaking my Talus in half and dislocating my ankle. It's been 4 years since the fall.

How did you go about having your screws out/ what was it like etc etc?
iceaxe 03 Oct 2007
In reply to david morse:
My wife broke hers falling of a climbing wall. Like the previous guy, she has a couple of plates in it. I think fusing was only going to be an option if the pain became too great but thankfully it hasn't. She is sometimes stiff on it in the mornings and she can't run but she still climbs and goes into the mountains. Hope yours starts to heal as well as hers.
 Jus 03 Oct 2007
In reply to david morse:

Sorry to hear about your foot!

Have you had second/ third/ fourth opinions about having it fused? I would only have it done if your sure it's the only way.

As for climbing with a fused ankle, I'm sure somethings will be fine (eg. overhanging limestone) and somethings won't (eg. technical smearing).

Good luck with it all.
i.munro 03 Oct 2007
In reply to iceaxe:
> (In reply to david morse)
> My wife broke hers falling of a climbing wall.

I'm curious to know the details of that if she'd be happy to make them public. Did she do it swinging at the end of a fall or catching a big hold with a foot on .the way down?
Llke to know what to watch out for.


Thanks

Ian

 david morse 03 Oct 2007
In reply to Jus:

> I've got a few screws in mine after breaking my Talus in half and dislocating my ankle. It's been 4 years since the fall.

Thats exactly what ive done, dislocated and shattered talus. 2 screws, coming out of cast on tuesday

Ive been given very high chance of "avascular necrosis" which is the bone dying. ive read that if you suffer a dislocation theres usually 100% chance of this happening. is this what happened to yours?

 Jus 03 Oct 2007
In reply to david morse:

I don't remember much apart from them rabitting on about fusing it before the op. The surgeon said that he wouldn't fuse in the end.

As soon as I had the cast off I never went back to hospital and that was that. They had left me with a great big hole in my foot after the op where they forgot to stitch me up so I didn't trust 'em!

 dek 03 Oct 2007
In reply to david morse: I have an interest in this, any chance you can direct me to the online info you mentioned?
 david morse 03 Oct 2007
In reply to Jus:

thats both worrying and good to hear i suppose! looks like youre climbing fine from your profile, hope i make a similar recovery. after 6 weeks on my ass and the prospect of another op im getting a bit fked off. good to know other people have recovered from this, the doctors have been painting a pretty bleak picture so far
 david morse 03 Oct 2007
 dek 03 Oct 2007
In reply to david morse: Wow, many thanks!
 Petzl 03 Oct 2007
In reply to david morse:

Sorry to hear about that.

A friend of mine really stuffed up his talus bone - it never recovered and started to crumble. His main option was to have it fused, but in the end he opted for an artificial foot as that would give him far superior quality of life.

Anyway, hopefully it won't come to that.
 Jus 03 Oct 2007
In reply to david morse:

Doctors like to paint bleak pictures. One of them told me I was lucky to be able to keep my foot, seriously! Climbing again was of course, completely out of the question.

Don't get it fused unless your absolutely sure it's the only way.

I was sport climbing and bouldering (about stacks of pads) about 4 - 6 months after the accident.
 Jus 03 Oct 2007
In reply to david morse:

Well f*ck me that site's all doom and gloom. Maybe I was very very lucky. Maybe my discolation wasn't too bad, but it was pointing at 5 o'clock and needed putting into place by a burly nurse.
 david morse 03 Oct 2007
In reply to Jus:

yeah i had that 5 o clock business, wasnt happy sat at the bottom of mother careys with the tide coming in contemplating climbing out of the water. fking getting dark too, what a balls up. they sedated me to snap it back into place, apparently i was telling the nurses and xray dudes i loved them and it felt like id had 20 pints. no idea what was going on. some good stories anyway i suppose, always a bonus
 Jus 03 Oct 2007
In reply to david morse:

Hmm, the tide comes in quick at Mother Carey's too.

Yeah man I too was high as a kite. Which route were you on?
 SuperTed 03 Oct 2007
In reply to david morse:

Terry Taylor (you was a mountain guide) has at least one fused ankle (I think). Never seemed to hold him back! Super handy at ice climbing and guided on it for decades. Come to think of it, i should think ice climbing might be easier with a fused ankle!
 AlisonC 03 Oct 2007
In reply to david morse: I had my right ankle fused in 1997, two years after shattering my ankle in a climbing accident. The bones healed OK, but I was left with very bad arthritis (bad enough that a climbing weekend would leave me on high doses of NSAIDs and crutches for the rest of the week). In the end I opted for the fusion and I have never regretted it.

The fusion was done privately (due to 2-3 yr NHS waiting lists in those days) by a very skilled orthopaedic surgeon who managed to fuse only one of the three ankle joints (not easy by all accounts), leaving me with an ankle joint that is not totally fixed - I have good lateral movement.

I can walk normally, although I have trouble going up and (particularly) down very steep, rough slopes as the foot is in a fixed position. I can run, but awkwardly and not long distances. I can't jump from the leg with the fused ankle, or land on it. However, rock climbing poses no problem whatsoever - in fact I lost quite a lot of leg muscle mass over the course of 3 major operations (original surgery, bone graft, then fusion) and ended up climbing harder than I had done pre-accident!

I have since had very few problems with the ankle, although I had some ankle pain about 4 years ago - I saw an orthopaedic surgeon in France who said that (as expected) the other joints in the foot and ankle are suffering from over-use and on their way to becoming arthritic. He recommended sticking with rock climbing and mountain biking but avoiding doing too much mountaineering/ walking.

You can e-mail me if you want any more info.
 AlisonC 03 Oct 2007
In reply to AlisonC: Incidentally, doctors tend to paint a bleak picture of life post fusion. In fact, the prognosis for a young person with a fused ankle is pretty good (there are lots of climbers out there with one, and in some cases, two, fused ankles). You have to remember that orthopaedic surgeons spent their lives operating on elderly people, not young fit ones. I was told I would never walk with a normal gait again, yet 6 months after my operation, the surgeon in question was using me as a "here's one I did earlier" story with a happy ending to impress his students.
 ScraggyGoat 03 Oct 2007
In reply to david morse:
Suffered a broken talus 18 months ago and possibly also the adjacent navicular, fortunately wasn't as bad as yours sounds, as mine lacked any displacement and consequently went unidentified for c. 8 weeks. No screws, plates, wires or pining. With any displacement they have to surgically intervene, otherwise necrosis is almost certain.

Still slowly recovering having lost alot of lateral movement in the ankle. But in order of increasing difficulty I can cycle, rock climb, walk and mountaineer. Nowhere near the end of an active life.

Discuss with your doctors and physio's, they are after all the professionals, but I'd wait to see if the bone knits, and only go for fusing if necrosis sets in, or pain/dysfunction is too great.

I'm still hobbling, but confident of substantial improvement to come. Thinking of you, and hoping for your speedy recovery.
 CurlyStevo 04 Oct 2007
In reply to david morse:
I broke mine as a kid falling from a tree. The doctors missed it first time at the hospital and called me back a few days later. The fracture was unmoved and very hard to identify but none the less had gone right through.

I also had no metal work just plaster for quite a long time.

I was monitored for a period of time after and various tests done on me (including a radiation injection marker test), and the doctors said I had mended well and it was infact very hard to detect it had ever been broken.

Suffered no real side affects the ankle I broke can have the tendency to crack a bit more and isn't quite as smooth. But other than that it is still good to go

I have however twisted both ankles badly over the years, probably partly due to the broken ankle ligaments being stretched. Now I have the tendancy to turn my ankle when I start getting tired.

Stevo
 JamesA 04 Oct 2007
In reply to david morse:
Like some other people have said, its worth getting a second opinion. I broke my talus about 2 years ago, but luckily didn't displace it. The hospital I went to had 2 consultants for ankle and foot injuries -according to the nurses in the plaster room, one fused ankles almost automatically, while the the was much better & up to date. I saw the one they recommended, & he thought (correctly) that it would probably mend without operating.
The same with physio - the first told me I would always have restricted movement, the second gave me back full movment in a couple of sessions. Listen to what they say, but remember it still just an opinion at the end of the day.
 potted shrimp 04 Oct 2007
In reply to david morse: I've read this thread and feel much, much better after merely upending and spraining the thing the other day. The conditions you all describe are much worse.
iceaxe 04 Oct 2007
In reply to i.munro:
she was on a bouldering wall that didn't have the appropriate mats placed flush with the wall. Subsequently, she slipped off and her foot went down the gap between the mat and the wall breaking her talus bone.
i.munro 04 Oct 2007
In reply to iceaxe:

Ah that one! Thanks that was helpful.
 john35 04 Oct 2007
In reply to david morse:

The risk of avascualar necrosis largely depends on whether it's a Type II or Type III dislocation.

I had a talus fracture (split in two and stitched back together with two stainless steel screws whcih I will have for life but which haven't casued me any problems) and type II dislocation: with these the sub-talar joint (talus/calcaneous (heal bone)) is dislocated (in my case by about 2cm) but the ankle joint (i.e. the joint betwwen the talus and the fibula & tibia) was intact. With this type of dislocation, the risk of AVN is 30%-50%.

With a type III fracture, the ankle joint is also dislocated and, in these cases, the risk of AVN is, I think, over 90%

The x-ray they do on Tuesday should give an indication of whether or not AVN has occurred as 6-8 weeks post-accident is considered the crucial tim ein assessing the risk (immediately after the accident is too soon to tell)

If the x-ray looks OK, you should still expect to be called back every 3-6 months for another x-ray as there is still a risk of it developing at a later stage. I had my accident in May 2006 and was finally discharged by my Orthopaedic Consultant in August 2007: it took him 15 months to be happy that teh risk of AVN was now negligable...so I'm one of the lucky 50%-70% (depending on which study your surgeon has read: it's a poorly understoond condition) of Type II talus dilslocators who hasn't developed AVN.

Even if the x-ray indicates bad news, it doesn't necessarily mean fusing the ankle..the Consultant in my local hospital (I had the operation to set the bone in a different hospital closer to the mountains) said there were various other means of dealing with it as AVN isn't always total: but he did say it was a serious condition, messy to treat and possibly requiring multiple operations

I hope you can take comfort from the fact that I too was given a very bleak and depressing prognosis on the day of the accident (you'll never climb a mountain again: count yourself lucky if you can walk to a bus stop was the gist of it!) but am now getting back to normal..my ability to negotiate unstable ground still isn't what it was (the ligaments around the sub-talar joint, which, in my case, are now composed of scar tissue, are crucial for this) so I have to be careful on scree for example. I can't run like I used to either (but can run short distances e.g to catch a bus without too much problem). I've started climbing indoors again (I have my reasons for waiting a little longer before heading outdoors again..but I reckon most moves other than foot jamming will be OK..although I should point out that I only climb easy stuff!) and regularly hill-walk (although my ankle is still sometimes stiff after a long walk with a heavy rucksack)

How soon you can get back to climbing really depends on how much ligament damage you've done (unfortuantely, you'll have done some ligament damage if you dislocated the bone)

To get back in action ASAP, assuming the bone is OK, you need to start physio as soon as you can..with a fracture this serious, the physio should triage you as an acute case so you should be seen very soon: hopefully your Orthopod will refer you on Tuesday: once my form made it through my local hospital's internal mail, I managed a next day appointment with the NHS Physio and have absolutely no complaints about them (I found them refreshingly positive after the bleak picture painted by the Orthopaedics!) although others on here have had different experiences. I bought a wobble board and cushion so I could do the exercises at home every day (ask the Physio first though as every injury is different)

There seem to be a few of us talus breakers on UKC: there was another thread a while back

http://www.ukclimbing.com/forums/t.php?t=246934&v=1#3637404

I also added this link in that thread

http://www.wheelessonline.com/ortho/hawkins_type_ii_talar_frx

Good luck and feel free to mail me if you wnat more info!
 Carless 04 Oct 2007
In reply to david morse:

Kenton Cool fractured both ankles badly on (or rather, off) slate about 12+ years ago.

I can't remember what the actual damage was but it involved him having to crawl about for a long time (still remember him crawling all the way down and back up at Freyr - fine effort).

It doesn't seem to have slowed him down too much these days.

Good luck
 John2 04 Oct 2007
In reply to Carless: I think Kenton fractured his heels rather than his ankles.
 Carless 04 Oct 2007
In reply to John2:

Hmmm - yeah, you could be right
janeth 09 Oct 2007
In reply to david morse:

Hi

I broke both bones in my lower leg (1 across the joint) about 20 years ago and as a consequence my ankle has fused iself so that I get lateral movment but no pronation. The docs were very pesermistic but I seem to do many of the things on the impossible list.

I find mountaineering in the UK OK but 3day+ trips are just too sore (tried going to the alps but ended up practically crawling down a glacier) and use ski poles on rough ground. I tend to pick big walks where I can use my bike on the approach.

Rock climbing has not been affected much at all although I get horrendous scabs on my ankle as there are numb patches so I don't realise that i've whacked it and dropping your heel to smear is pretty tricky.

After the injury I did tonnes of physio to relearn how to balance on that foot and also to strengthen all the ligaments ect that had been damaged - the physio's were really good and so positive it made a huge difference.

In terms of longer term effects I keep an eye on my back and hips as my lack of ankle flection puts extra pressure on them - I try and do back exercises to "unkink" it - but that could be just general old age and decrepitude.

I think I was (overall) pretty lucky with my ankle as it didn't get infected so it all healed up quite quickly and the screws were taken out years ago.

The main thing is to focus on what you can do.

janet

PS

although I do get annoyed by lazy bastards who have a fine set of joints but won't use them

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