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Shattered Talus Report / Analysis

bmdhacks · · Bellingham, WA · Joined Jan 2012 · Points: 1,633
KenSnow wrote:The real shit kicker here is that I broke it two weeks before going to Yosemite for my wedding (my fiance was none too pleased).
Hah, I shattered my talus four days ago. Wedding is in 10 days.
So how'd it go?
KenSnow Snow · · Salt Lake City, UT · Joined Apr 2013 · Points: 15

I am happy to report that the wedding did indeed actually happen, and somehow I managed not to destroy my erector set ankle after all the drinking and crutch hopping/dancing. :)

Mark Maltese · · Flagstaff, AZ · Joined Feb 2013 · Points: 0

Hearing the stories in this thread has helped me deal with my injury, so here my story, in hopes that it might help someone else. This past May (about 3 months ago) I was leading on some rock and took a moderate fall, nothing too large, maybe 12 feet. Two pieces of pro zipped out of the thin crack and the jerks from the gear catching and popping made the fall unclean, causing me to take the brute of the fall on my right foot. I immediately knew something was wrong and couldn’t put any weight on the foot. I was lowered and luckily had some great friends with me, who served as my crutches as I hopped and crawled out of the gorge and back to the car. I was out of my home state and about a 4 hour drive from my primary hospital, so I ordered a few pitchers of beer before enduring the long drive to the ER. We got in really late, around 3 am, and I had an X-ray done. The ER Doc came in and told me the X-ray showed no breaks— I just sprained my foot and it should be better within a couple weeks. She gave me two days worth of hydrocodone and 14 days worth of 600 mg ibuprofen. I was in an ace bandage and unable to really move my foot for the first week, but gradually I started doing range of motion exercises and kept taking the ibuprofen. Looking back, I wish I never took the ibuprofen, as I have now found out NSAIDs can inhibit bone repair. I was on crutches this whole time and never really had too bad of swelling, just a yellowing of the skin around the injury, and was frustrated with my inability to climb, run, or basically do anything besides upper body and walks on my crutches. I scheduled an appointment with a sports medicine doctor 3 weeks post injury, who gave me a “walking boot” and ordered an MRI. I got an MRI one month after the injury and promptly received a call later that night, saying to ignore any previous opinions and to not be bearing any weight, even with the new walking boot. Luckily, during this entire month, I listened to my body and decided I would not attempt to walk on my bad ankle, and remained completely non-weight bearing until I got the MRI results. I went in for an appointment with the doctor the next day and was told I had a comminuted (smashed) talar neck fracture, a rare injury. In fact, he was surprised my calcaneus (heel) wasn’t also smashed to pieces. I was immediately referred to a orthopedic surgeon. After review from the surgeon, I was told that somehow, even after a month of no cast, the comminuted pieces seemed to have not displaced enough for the need of surgery and started to piece themselves back together. I was non-weight bearing for another month and a month ago I switched to partial weight bearing and am now, 3 months later, full weight bearing, without a boot. Granted I was lucky enough to not have major displacements of the talar neck, however the severe comminution makes my break a questionable Hawkins I case. I am still not able to walk 100% and am on the watch for AVN. Furthermore, the bone is stronger, but to my knowledge the fractures are not completely healed. I should find out this week.

Here is what I have been doing to stay active, as I believe as soon as you can move it, use it or you will probably lose it.

4 weeks in I began swimming twice a week, for as long as I comfortably could. I also started taking the following vitamin doses and supplements, after reading up on preventing AVN and promoting bone growth:

Morning: Calcium-900 mg, Vitamin D-1400 IU, Magnesium and zinc (which are covered in most multivitamins), Fish oil, Safflower oil, Astragalus root-1410 mg, and Cordyceps sinensis-1500 mg. The last three supplements were some of the few homeopathic items that I read might prevent AVN. Maybe it is a load of ****, but I am willing to try anything to get my ankle back.

Evening: Calcium- 600 mg, Vitamin D- 200 IU, Astragalus root-1410 mg, and Cordyceps sinensis-1500 mg

Since progressing to partial weight bearing I have also been biking at least twice a week, continuing the swimming twice a week, and have been doing PT twice a week since week 5 of my injury. The PT has helped immensely and each week I notice improvement. One of the huge hurdles is regaining lost leg muscle and movement that results from atrophy during immobilization. Be as active as you can without further injuring yourself! Also, no caffeine, as it is horrible for bone healing. I have been occasionally drinking, and still went out even when I was on crutches. Being injured is hard— being depressed and injured is harder.

This past week I was fortunate enough to go to the Tetons. Unfortunately I originally planned the trip with hopes to summit some peaks and climb some ice, but it was looking like I wouldn’t even be able to walk. I surprisingly ended up being able to walk again around week 10, just in time for the trip. I did a couple moderately strenuous 7 mile hikes, which resulted in a sore ankle and some pain, but hope that a broken talus may not permanently eliminate mountaineering from my future. I am still at risk for AVN and have an appointment to check for it this week, but it is important to keep looking forward. A fusion, or even an amputation, doesn’t necessarily mean an end to climbing, but it will sure as hell necessitate a need to dig deep, mentally and physically, in hopes to overcome adversity.

Update: After 4 months of healing and lots of physical therapy, my ankle is about back to where it was (90%). I can do basically anything I used to be able to with it, with minor discomfort, although running long distances does take its toll. On the bright side, face climbing and foot jams are back to where they were! Best of luck everyone, just keep in mind it does get better, and I'm still noticing slight improvement, even 6 months later.

bmdhacks · · Bellingham, WA · Joined Jan 2012 · Points: 1,633

Just an update on my shattered talus. Three months ago I shattered the lateral process of my talus into 10+ pieces. This is sometimes called the snowboarders fracture. However the talar head and body were fine so blood flow wasn't a concern. But because the small lateral process was in so many pieces nothing was big enough to put a screw in.

Three months later all the pieces have fused as if you dumped a broken glass bottle into a box and squirted hot glue in while shaking it up. So I have bone volume, but it's full of sharp edges. The end result is pain when I push down with my calf muscle. I can still climb in a half-assed way on toprope, but I walk with a limp and it's not getting better.

So next week I'm scheduled for surgery where they're going to grind off all the sharp edges. Then another two weeks on crutches again.

There's a lot of hardcore people with unshakable constitutions, but I'll have to be honest this is really hard for me. My fitness level is shit, and I'm just barely keeping depression away with with seated rows and pushups.

I'm writing this down here so that when my update in 6 months comes with me hiking the PCT or something, others can get context that it's temporary.

Caitlin Mac · · Tempe · Joined Oct 2011 · Points: 115
Fractured Talus injury 20 minutes after falling 10-12 feet onto lots of rocks

1 week after the accident

After searching on Google, talus fractures, I came to this thread and realized my injury must be pretty common for climbers.. So here's my story.

Written on DEC 1, 2014

Well, last week, I was in South Africa on a 2 month climbing trip when I fell on the final pitch of a 1000 ft. I was starting off a big ledge, and as the climbing was easy, I had not placed any gear when the big jug I was holding onto broke. Here is what my ankle looked like right after the injury, and 1 week later. Originally they also told me it was just soft tissue and I would be out of a splint in 2 weeks. The second doctor realized there was a fracture and some chipped bones. Now, 9 days later I am finally learning (after flying home and ending my trip over a month early) what happened. I am also just beginning to realize that the talus bones is the worst bone to break.. I have a cat scan tomorrow, and a follow up 4 days later to determine if I need surgery. Any advice on if screws are the way to go or not? My doc was hoping I wouldnt need any surgery, but Ill be able to update tomorrow after the CT..

Any advice that will help me get walking/running/climbing/alpine climbing again ASAP is welcome.

Thanks
Paul Hunnicutt · · Boulder, CO · Joined Sep 2006 · Points: 325

This is the WRONG thread to get psyched on climbing! This thread makes me want to find a new sport altogether...as if I didn't already have enough reasons.

Best of luck healing! Thanks for sharing how even a small fall can dramatically impact your life.

ben smith · · Unknown Hometown · Joined Dec 2010 · Points: 81

Have faith!

It has been just over three years since I broke my talus and lamented my desperate concerns in a post on this thread. While my ankle is not what it used to be, I most likely finished my last pitch of rock climbing for the season today and am looking forward to ice this season.

In fact, I have more FAs and wilder experiences status post my talus fracture. For me, the hardest part was keeping a positive attitude and having faith that everything would be all right. Especially after doing an internet search on talus fractures....that can certainly grim and not helpful for your psyche.

So....have faith that it will be okay and keep your self busy!

Ben

Stuart Teague · · Unknown Hometown · Joined Apr 2009 · Points: 15

Caitlin:

I had 6 screws placed in my right talus 3 years ago. They seem to be working. The surgeon recommended against taking them out. He said the removal surgery is just as invasive as the original work. He told me that the bone is fine with them there as long as they do not work out.

I can't say that I'm back to normal, but I climb and run on my ankle regularly. Some days it hurts so bad I wish they'd cut my foot off. But, some days I barely feel it. I have run as far a half marathon since the surgery though so I can't complain too much. The good news as far as I am concerned is that it turns out ankles aren't that important to actually climbing. You just need them for the approach! good luck!

Lzpup Brewster · · North Bend, Wa · Joined Nov 2011 · Points: 40

I have bad arthritis from my accident and I find that Glucosimine helps. I also find that icing my ankle after a big approach or hike helps a lot. I only wear really stiff boots with tons of support. I have a good ankle brace which I wear alot. I make sure to use treking poles on approach. Trad shoes are nice on the ankle. I Mountain Bike like crazy, seems to be much less of an impact.

bmdhacks · · Bellingham, WA · Joined Jan 2012 · Points: 1,633

I'm coming up on 6 months post-fall and 2 months post-surgery for my shattered lateral process. The debridement surgery was super helpful, but I'm still a bit limpy. I'm climbing as hard as I have before, but only on toprope. A lead or a boulder fall on pads would be devastatingly painful. Approach hikes are brutal, but I'm still seeing improvement.

bmdhacks · · Bellingham, WA · Joined Jan 2012 · Points: 1,633

7 months. I went jogging for the first time this week, one mile uphill with a goofy galloping lope, but still pretty stoked. I top-roped a longtime project that I'd never got cleanly before, so it's safe to say I'm climbing better than I ever have before. I'm still battling down the added weight that I gained whilst being sedentary.

There's still a sizable strength and balance difference between my two feet, so I do a lot of one-legged sled squats, calf raises, and balancing exercises to equalize them. I'm probably capable of barbell squats and deadlifts, but I'm waiting for a bit more parity before beginning the strong lifts.

My footwear has changed drastically. Converse lowtops and light approach shoes have been replaced with spongy-soled running shoes and heavy hiking boots for approaches. I still feel my ankle with every footfall, but in the right shoes I'm pretty solid.

The next step is to start taking some controlled falls on the pads at the bouldering gym. I'm probably a few months out from taking a comfortable lead fall. Other things to experiment with: burpees, box jumps, jumping jacks.

Jon Powell · · LAWRENCEVILLE GEORGIA · Joined Jan 2012 · Points: 110

Stretch stretch and stretch that foot as much as you can. 11 months since I broke my talus and calcaneus in a lead fall and if I do not stretch before I get on my feet in the morning I am stiff and sore all day. Descending long approaches still take it's toll on me but I am back 90%. Took me a while to get rid of the weight I gained but it will come off. Congratulations of the come back. The mental part was and still is the hardest for me to overcome.

bmdhacks · · Bellingham, WA · Joined Jan 2012 · Points: 1,633

8.5 months, first lead sport climb. I was terrified, and honestly a lead fall on my ankle would at the very least be extremely painful. Didn't fall though. 1-2 mile approach hikes, while noticeable that evening, are not painful enough to care. I almost missed the bus the other day and sprinted to it. Only when I got on did I remember my injury.

Next milestones: bouldering gym falls, lead falls, backpacking trips

bmdhacks · · Bellingham, WA · Joined Jan 2012 · Points: 1,633

9 months: did a 5 pitch trad climb that included a 2 hour approach both ways. I wore big hiking boots for the approach, then lighter approach shoes for the descent. I certainly wasn't fast on the trail, but it got done, and the pain was manageable for multiple days of climbing.

So at this point I can pretty much do everything I could do before. My hiking is a bit slower and I'm not gonna go bouldering or project a sport climb, but that's totally fine. I still would like to get to a point where I could do a multi-day backpacking trip ala PCT/AT but I think that's a possibility in another few months.

In the meantime though, life is good!

Caitlin Mac · · Tempe · Joined Oct 2011 · Points: 115

So Im almost 5 months into the accident, and I can still just barely walk. If I walk too much, my foot gets really sore. Sometimes when I walk I have shooting pain in the heel/talus area, and I think it could be a bone chip that was missed. I know I have multiple bone chips in my foot, but I never received surgery because my foot was manually set (without pain killers!) a few hours after the fall in a South African hospital.

Im wondering who received the debridement surgery, how fast you healed from the surgery and how beneficial it was. Im desperate to start working, walking normal, and climbing again. Any advice is wonderful.

JohnnyG · · Unknown Hometown · Joined Nov 2009 · Points: 10
Caitlin Mac wrote:So Im almost 5 months into the accident, and I can still just barely walk. If I walk too much, my foot gets really sore. Sometimes when I walk I have shooting pain in the heel/talus area, and I think it could be a bone chip that was missed. I know I have multiple bone chips in my foot, but I never received surgery because my foot was manually set (without pain killers!) a few hours after the fall in a South African hospital. Im wondering who received the debridement surgery, how fast you healed from the surgery and how beneficial it was. Im desperate to start working, walking normal, and climbing again. Any advice is wonderful.
Sounds similar to what I had. Painful to walk even several months after the break. Definitely go see a good doc right away.

I had surgery about 6 months after breaking my talus to get rid of some chips that didn't heal. It took a while to heal (months...although I still feel the injury a decade later....that said, I hike, climb, ski, and occasionally run)
bmdhacks · · Bellingham, WA · Joined Jan 2012 · Points: 1,633
Caitlin Mac wrote:Im wondering who received the debridement surgery, how fast you healed from the surgery and how beneficial it was.
I had the debridement surgery 5 months after the break, and 5 months ago. I was unweighted in a cast for two weeks after the surgery, but when I got the cast off I walked out of the doctor's office and never used crutches again. Honestly it was better than ever after two weeks, but improvement has been slow and steady since then.

The additional benefit from the surgery is your doctor can scope out if there's any cartilage damage. Broken bones heal and small fragments get reabsorbed over time, but cartilage is the only thing that doesn't heal. All long-term issues arise from damaged cartilage causing bone-on-bone friction (and consequent swelling/arthritis). It doesn't really x-ray though, so going in with a scope is the best way to see what's there.

After my surgery, my doc said my cartilage was slightly damaged, but on the boundary of whether it will be limiting to what activities I can do. Well, maybe no trail marathons or any long distance running.

Hope that info helps.
bmdhacks · · Bellingham, WA · Joined Jan 2012 · Points: 1,633

One more thing about the debriedment sugery: it definitely replaced the sharp pains with a more dull achy pain. The after-surgery pain was much easier to avoid than the surprise stabs of a wrong step pre-surgery. This made it easier to exercise and do the PT stuff, and the exercises felt more... correct. Pre-surgery I was always thinking, "Um... this doesn't feel like it's beneficial," as the bone confetti ground around in my ankle.

Caitlin Mac · · Tempe · Joined Oct 2011 · Points: 115
bmdhacks wrote:One more thing about the debriedment sugery: it definitely replaced the sharp pains with a more dull achy pain. The after-surgery pain was much easier to avoid than the surprise stabs of a wrong step pre-surgery. This made it easier to exercise and do the PT stuff, and the exercises felt more... correct. Pre-surgery I was always thinking, "Um... this doesn't feel like it's beneficial," as the bone confetti ground around in my ankle.
^^This is exactly how I feel. I just keep telling the PT and docs that it wasn't right. Well turns out it wasnt... My subtalar joint has changed form or healed incorrectly (they dont know) but now my calcaneus sits at an angle so every time I take a step my whole foot colapses to the outside.. They think I need to get a calcaneal osteotomy surgery now, as well as talus debridement surgery.. Huge bummer, but im hopeful that maybe after I can walk without grinding pain..

Where did you get surgery? Do you recommend them? Im looking for the best Ankle/foot surgeon I can find..
Caitlin Mac · · Tempe · Joined Oct 2011 · Points: 115

ALSO, this is for everyone on this thread, who did your surgery, and do you recommend them? Especially the more complex or delayed surgery... Im looking to travel for surgery as my town isn't that well known for ankle specialist.

Guideline #1: Don't be a jerk.

Injuries and Accidents
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