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Shattered Talus Report / Analysis
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By Brice Harris
Sep 28, 2011
I shattered my talus about a month and a half ago. I was 18ft up a dihedral that was maybe 22 ft tall, about to make the last real move of a route with relatively good gear, my last piece being maybe 7 feet below me, and I was at the crux and my right foot blew. I immediately lost it and came off. As I fell I saw the rope coiling through the gear, hoping it would hold as the last piece was a small mastercam. It held, but only really caught me about a foot above the ledge/slab that the dihedral started out of.

I crashed my entire weight onto my right foot, and in an effort to crumple as much as possible I slid backwards a ways down the slab. I immediately heard/ felt the explosion in my ankle and began yelling down to my belayer to prepare to lower me. The impact had blown my shoe off my foot, so I gathered myself and hopped over the pillar that the first half of the route had climbed up and lowered with my broken and severely deformed ankle away form the wall.

I got to the ground and crab crawled a ways to some more flat ground while my buddy assessed me. I knew I wasn't hurt anywhere else, surprisingly. I drank water for a little bit while my belayer searched for help to get me out. Fortunately we were only maybe a hundred yards from my truck so I crab crawled back to it while he was gone searching, just to give myself something to do instead of think about the ankle.

After an hour and a half drive to Salida I got into the ER, no wait on a saturday night. They weren't sure if they were going to do surgery immediately or not so they waited to give me pain meds. I was still in shock, so really didn't feel much, just general uncomfort. The doctor was pretty worried about the ankle. He said I would have a long road ahead of me. Also when my bud was trying to console me and telling me that I could have had a broken back, the doc said this injury was on par with that as far as seriousness. So I am freaked.

They took a few xrays and decided to not cut me open immediately, but told me to get it taken care of in a few days. Percocet and a perscription and we were off. Salida was full for some festival so we drove to Canon to get a hotel for the night and get some sleep, it was close to midnight by the time we got to the hotel. Didn't sleep much obviously.

Fast forward many percocets and a few days later I get an appointment with a podiatrist/sports medicine ortho guy. He see's my x-rays and immediately flips shit and very sternly tells me that this should have been taken care of already; that the blood flow to the ankle is probably compromised and I may end up getting a fusion. Shit. I'm going nuts at this point. I broke down on the way back to my house thinking this is going to get serious quick and confused as to why this information wasn't more properly conveyed to me. Fortunately the guy I talked to set me up with a trauma orthopedist that specialized in feet. Wade Smith at Modus which is part of Swedish Med in Denver.

Anyways, I get the surgery set-up for the next day (Wendesday, the accident happened the previous Saturday evening). I go in and before I go under Wade comes in and tells me that the previous doc had not been correct, that some research had come out and shown that regardless of time after accident the likelihood of bone death and fusion were the same, so waiting wasn't as big of an issue. Obviously this was good news, at least it wasn't a definite fusion. I go under and come back up with 9 screws and 8" of scars.

So move forward to now, scars are pretty well healed up, swelling is mostly gone, getting movement back. I also have had time to analyze. I think the accident happened for a few reasons.

1) I had gotten too used to running it out and making it on similar terrain and that lead to me not being as interested in placing gear and thus not climbing fully committed. I've climbed harder routes and significantly more run out routes at the same grade (9) and been ok. I was lazy and paid for it.

2) I lost both visual and audible contact with my belayer during the climb and without that you can't properly belay. My guess is there was more slack in the system because of the wandering nature of the route, but also my belayer knows I hate being short roped. So he couldn't tell and I couldn't tell him I was in a bad place to be given too much slack.

3) I should have downclimbed and re-assessed the moves instead of going through expecting that as usual I would stick when in fact I was on incredibly dense/slick granite. Again I didn't treat it with the respect it deserved and I got spanked.


Anyways, I'm on the way to recovery. I demolished most of the cartilage on the bottom side of my talus, I'm going to have some arthritis. It will be interesting to see how this affects my back country travel. Doc says distance running is a no go, I imagine because of the impact, so hiking will still be feasible, so will cycling. I'm nervous about it all, I don't like the idea of losing mobility (a definite) or having chronic pain, but that's where I am. PT starts in two weeks. Ready to move forward.

If you made it this far, thanks. I needed this catharsis.




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By Marc H
From Lafayette, CO
Sep 28, 2011
The Cathedral Spires in RMNP, left to right: Stile...
Thanks for sharing your story and analysis.

Good luck on your road to recovery!

I've had surgery on my ankle, so I have some idea of what you're going through.

--Marc

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By JWong
From Los Angeles, California
Sep 28, 2011
Good luck with the rest of your recovery. I broke my talus a couple years ago.

Be extra diligent with the PT and stay with it as long as possible (continue to do the exercises even if the insurance runs out for the sessions). I think I could probably have a bit better mobility if I had kept at it longer and my mobility is probably 85%. It seems like once I stopped and just did regular walking around and climbing and stuff, that it sort of settled into a groove.

However, I'm pretty much able to carry on like I used to. Hope your case is similar.

Cheers,
Jason

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By Tzilla Rapdrilla
Sep 28, 2011
Brice,

Sorry to hear about your accident and injury, it does suck, I know from experience. I had a very similar situation in 2008, except it was the calcaneus. The whole crab walking thing you mentioned brought back some fond memories of descending Eldorado Mountain & thru the train tunnel. In my case they wanted me to wait a week before surgery to reduce swelling, so that's consistent with your situation & I now have 18 screws in my heel. I also got the extra bonus of a blood clot and PE (Google the symptoms so you'll know what to look out for), nearly deadly, watch out for that with lower extremeties. The good news is that I was able to run again within a year and am still able to do that, so there is light at the end of the tunnel, hang in there!!!

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By Aram Attarian
Sep 28, 2011
Where were you climbing and what route were you on when you fell?

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By Joseph Stover
From Batesville, AR
Sep 28, 2011
Thanks so much for sharing. I think these kinds of stories help us to be more aware of the risks we take, and to better manage that risk.

...not to keep repeating what you've no doubt heard a thousand times... it could always have been worse!

Best wishes to a speedy recovery, and to regaining your full mobility...

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By Brice Harris
Sep 28, 2011
Not sure of the route name it's on the left side of Pumpstation north of Buena Vista maybe 15 minutes.

Edit: Well shit, downgrade that. MP says 5.9, I think I looked at the variation in the guide book. I fell basically where the red line makes its last jog up and left and landed on the slab just to the right of the xx's for the first pitch. I was going to do it in all one pitch, another mistake apparently.



Thanks for the words of encouragement.

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By JohnnyG
Sep 28, 2011
I broke my talus in 1998 falling off a wet climb. Tough bone to heal...I still feel it. The odd thing is that it is still healing. Still getting better.

For example, after two years, I couldn't really do a 5 mile approach to a climb without really feeling it the next day. I was bummed because one doc told me I would do 90% of my healing in the first year, and then by the end of the second year I wouldn't heal that much more. That sucked because I love alpine climbing.

But now I do long days in the mountains no problem. After a decade, I picked up running again, at first just 10 min, but now I'll go for an hour plus. I just pop a a few ibuprofen (and crackers to buffer my stomach) before I set out. Rock climbing, skiing, biking, swimming all came back much faster.

It's good you got it pinned. There was some new research around that time showing this made a big difference (look up snowboarders fracture) but my original doc didn't know about it. 6 months later I got surgery and the new doc had to get creative reattaching ligaments. That doc was awesome; I owe him my sanity.

Good luck with your recovery. I really wish you the best.
-John

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By ben smith
Oct 8, 2011
Bruce,

I too fractured my talus on 9/3/11 after running it out 7' and falling 18' on a ledge rock climbing. Initially, I was not going to seek medical attention, but reluctantly went to ER. I was about to be discharged w/ a sprained ankle, but radiologist informed ER physician that I had a fractured malleolus. After multiple attempts of weight-bearing w/ and w/out boot as instructed, I saw the orthopedic specialist who ordered more xrays and informed me of my fractured talus 3 wks after injury. A wk later I had a CT scan that revealed that my talus was fractured vertically at the body and displaced by 3-4mm at the bottom. Moreover, there was a bone chip in the displacement. After consulting specialist, the surgeon thought it was best to let it heal on its own due to the invasive risk of breaking/cutting bone to remove a chip and using screws to union the fractured talus. This appeared to be a gamble as the surgeon had not seen a fracture like mine and was more familiar w/ repairing talus' that were shattered and or immediately after the injury, not after a month. So, it will be interesting to see how it turns out. Not worried about AVN, but we'll see how the arthritis turns out

At this point I am in a removable cast (great for showering!) and will not bear weight for next three months and am refraining from coffee as it impedes vascularity as I am told. I am trying to exercise the rest of my body in that it promotes healthy blood flow and healing.

I am going stir crazy not climbing now, but am looking forward to sending soon. Keep us updated on your recovery.

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By The Hippy
From Boulder, Co
Oct 8, 2011
Brice & Ben,

I just passed the one year anaversary of surgery to repair my talus bone that I broke in an accident at work. I'm a contractor and fell off the roof of a house I was building - went 2 stories into a firewood pile.

At this point, my anke is definatly not 100%, but it no longer bothers me to the point that it keeps me from doing most things. I can climb as well as I did before the accident. I can't wear really tight shoes, but my TC pro's do pretty well. I've even been bouldering again, but a bit more cautiously. I get sore after long days at work or after big days climbing, but the pain isn't all that bad. The one notable exception is running. I don't think I'll ever be a regular runner again, but running kind of sucks anyway.

For me the worst part of recovery was not being able to do any of the things I loved to do. It made me realise how big a part of my life climbing is. It's the reason I know most of my friends and my fiancee, it gives me something to look forward to every day and It's what makes me feel better when things are shitty. To have that taken away was pretty hard to deal with. Plus, my doctor said I really shouldn't drink (bad for bone growth) and I can't stand pain pills. About the only thing that kept me sane was trying to exercise as much as I could. I met with a trainer and designed a weight lifting program I could do while sitting down and as soon as I was able to put partial weight on my foot I started riding an exercise bike with low resistance. I also did a lot of one footed toproping at the gym.

I remember while I was hurt that it seemed like it was never going to be over. I am not good at sitting around and the days semed to drag on forever. But, looking back it is amazing how quickly I was able to get back to doing things. They had me completly of of it for three months and then only partial weight bearing for six weeks after that. But, once they let me start walking again I was back on ski's two weeks later - skiing actually felt easier than walking for a month or so. Be carefull and you can start doing stuff again pretty quickly, you just might have to do it at half speed for a bit.

The PT exercises seemed to be really helpfull in getting range of motion and balance back. I would definatly recomend sticking with the program they prescribe you as closley as possible.

Hang in there.

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By Brice Harris
Oct 10, 2011
I realized that my coping mechanisms are basically some form of outdoor beat downs. I like horrible approaches and long days in the mountains, it was my release. I've never been a real drinker/ smoker though I do enjoy beer, just not as a way to cope with life's woes. It's made me realize more about myself. Nothing like a major injury to make you incredibly introspective.

Start rehab tomorrow. This is going to be fun (but probably hurt). As far as I'm concerned I'll just keep plugging along and work around the limitations. When the doc told me I couldn't run marathons I told him that was about as much of a loss as telling me I couldn't take up jousting.

Good luck to everyone who's in the talus boat. I'm ready to ride a bike again.

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By JSH
Administrator
Oct 10, 2011
JSH @ home  photo courtesy of Gabe Ostriker
Brice, I shattered my calcaneous in May. The surgeons opted to do a clean-out the night of the injury then installed hardware and reduced the fracture two days later.

I just had the plate and 5 of 7 screws removed 4 days ago. I had been walking but with a lot of pain and still a heavy limp due to dysfunction in my big toe. My PT thought that a screw tip was possibly irritating the medial tibial nerve. However the surgeon reported that my posterior peroneal tendon was pinched down by a screw head. At any rate I can now wiggle and bend the toes normally (leg still in post-op cast). Anyway, don't rule out getting that hardware out at a later date

I hear you on missing climbing. I feel like my whole life is on pause, which is ok for now while I need to heal, but ...

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By Robbovius
Oct 17, 2011
Hi Brice.

in august of 2009 I took a short ground fall at the beginning of a lead, that caused me to suffer a Hawkins III Talar Neck Fracture of my left ankle. My Talus frx was not so bad as yours (you have 3 times as many screws in there as I do), though I did fracture the bottom corner of the tibia and dislocate the talar dome out to the inside of the ankle.

my prognosis was similar to yours - AVN, bone death, multiple surgeries, etc. I even had one Dr tell me that "..this injury has the piossibility of being limb-threatening..."

I'm sure I'd heve been very upset if I wasn't so highly sedated.

long story short, I wore an exfix for 7.5 weeks, and was climbing - in the gym, on 5.5s - again in 12 weeks (wearing a hacksaw-modifed aircast boot)

the good: two years down the road now, I still have the 2 cannulated screws in teh ankle (though I don't need them anymore, just don't want to be cut again), and I climb and hike and cycle and kayak, and pretty much do anything I used to do before. My surgeon was pleased enough with my recovery - which he credited partially to my agressive early usage - that he told me I was the kind of patient that made him look good.

the BAD: my foot hurts to some degree ALL THE TIME. the nerve damage I suffered from teh dislocation has caused the paralysis of the pinkie toe and 3 middle toes in my foot, as well as partial paralysis of the big toe. the sole is pretty much numb. the ankle joint pops and cracks and makes all kinds of disturbing noise.

Be encouraged, and good luck, the talar frx is a bad injusry, but the ultimate result depends mostly on what your body does with it, and how you accomodate the "new Normal" as I call it.

again, good luck.

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By shawn bradley
Oct 17, 2011
Brice and everyone else with injuries,
I suffered a severe sprain in a lead fall a few years ago, I realize it's not the same as what you are going through, but after your physical therapy, look up a Feldencrais practitioner. I couldn't get through a full day without pain for quite some time after PT. After one Feldencrais session it was as if I never had the injury. Can't say you'll get the same results, but it's worth a try. Best of luck and be safe.
Shawn

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By Mike G
Oct 17, 2011
Sorry about your ankle Brice. I broke my tibia and dislocated my rt ankle some years ago playing football. The best advice i can give you is to be positive!, You will heal fully!

At the ER the doc/surgeon made an brief comment about my break being a non weight bearing bone so I decided that i would heal with no problem. When the last screw was removed i started walk/running, 50 paces of each. Ive never been a runner, but two months later, my last Dr. visit he had me move the foot and asked if it hurt I said no, he said "thats amazing, i have patients with the same injury who are still limping 6 months later", i told him, what i heard him say in the er and that I had been running on it already, he was amazed.

20 plus years later still no arthritis that he claimed would occur too, so stay positive you will heal

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By Robbovius
Oct 18, 2011
Mike G wrote:
Sorry about your ankle Brice. I broke my tibia and dislocated my rt ankle some years ago playing football. The best advice i can give you is to be positive!, You will heal fully! At the ER the doc/surgeon made an brief comment about my break being a non weight bearing bone so I decided that i would heal with no problem. When the last screw was removed i started walk/running, 50 paces of each. Ive never been a runner, but two months later, my last Dr. visit he had me move the foot and asked if it hurt I said no, he said "thats amazing, i have patients with the same injury who are still limping 6 months later", i told him, what i heard him say in the er and that I had been running on it already, he was amazed. 20 plus years later still no arthritis that he claimed would occur too, so stay positive you will heal


Mike, A frx of the Talus is a very different animal. the Talus bone is THE bone in the foot, the one that connects the foot to the leg. it has cartilage all over it because so many bones pivot on it: both the Tibia and fibula on top (fore-aft motion of the foot happens in the "ankle mortise" which is formed by the talar dome, and the bottoms othe Tibia and Fiblua) the Calcaneal - heel - bone (this joint provides side to side motion) and the cuboid bones out front which connect the toes thru the metatarsals

the talus bone is very poorly vascularized because of its covering in cartilage, and blood is only supplied theu the head (out front by the cuboid bones, and on the inside thru small vesels in the deltoid ligament (which connects from the bottome corner of the tibia).

as soon as you break the talar head away from the talar dome, the dome becomes avascular, and the bone can die. the early goal is to try to get the fracture to heal fully, and then see where the vascularity winds up. its really a crapshoot, and the odds aren't in the patients favor. go to the Wheeless textbook of orthopedics, online and look up talar fractures adn AVN. you'll see what I mean.

breaking your tibia is cake by comparison. personally, I would rather have broken my tib/fib than my talus bone.


linkage:

Wheeles textbook of orthopedics, talar frx with AVN

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By Brice Harris
Oct 18, 2011
Doc said he see's "Hawkins Sign" which is a sign that re-vascularization is happening. So that's good. I'm hobbling around now with no crutches, getting back on my feet is amazing. Driving again finally. Doc also said the cartilage wasn't as bad as he expected, though there is definitely still damage. Basically there is a big divot in the talar dome where my tibia impacted the cartilage. Overall a good report from the doc. He did say that he felt the best rehab was generally riding a bike. So I'm on an exercise bike for a month then checking on it and looking at the possibility of rehab after that. He said two months till full on green light. Ski season is saved.

I'm going to be king meadow skipper this year, and I can't wait.

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By Robbovius
Oct 19, 2011
Brice Harris wrote:
Doc said he see's "Hawkins Sign" which is a sign that re-vascularization is happening. So that's good. I'm hobbling around now with no crutches, getting back on my feet is amazing. Driving again finally. Doc also said the cartilage wasn't as bad as he expected, though there is definitely still damage. Basically there is a big divot in the talar dome where my tibia impacted the cartilage. Overall a good report from the doc. He did say that he felt the best rehab was generally riding a bike. So I'm on an exercise bike for a month then checking on it and looking at the possibility of rehab after that. He said two months till full on green light. Ski season is saved. I'm going to be king meadow skipper this year, and I can't wait.



Brice that's awesome! When my surgeon gave me the go ahead for weight bearing and PT (12 weeks after te injury), he asked if I wanted to go to a therapist, or do it on my own - he already knew the answer. that night, I went to Central Rock Gym, and groaned my way up a 5.5 jug haul - wearing the aircast. I also began riding my MTB on the paved bike trail near my apt. basically, my PT was using the foot, like it was a foot. I even got in most of the local ice climbing season, though the hikes in and out killed.

one of the most encouraging things that got me thru the tough moments, was rerading the wheeless textbook of orthopedics, and finding the entry about how it took "...36 months for creeping substitution of the body..." which means that it takes your body about 3 years to reconstitute as much of the avascular talar bone as its going to. I'm 2 years down that road, so far, so good.

here's a few pics for reference.

xray just after the frx...



literally 2 minutes after falling. see that bump on my ankle? that's my dislocated talar dome.


my hardware. I still have all that stuff at home, I asked my surgeon if I could keep it and he accomodated me. I'm a gearhead.



approx 14 weeks later...


hacksaw mods to my aircast, to facilitate climbing.


2 years in, the ankle is not even close to the limiting factor my climbing.

Brice, good luck, man, keep a positive outlook, try not to be discouraged.

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By JWong
From Los Angeles, California
Oct 19, 2011
Hey Brice,

Congrats on the recovery and getting back on your feet.

If you do a lot of cycling for rehab, don't forget to work out all of the other different ranges of motion. If you aren't seeing a PT, I'd recommend at least one visit to get exercises for all the different motions.

Also consider finding one of those giant half rubber exercise balls to balance on. It really helped rebuild the fine balance that is critical for your ankle.


Cheers,
Jason


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By Ted Eliason
From Westminster, CO
Oct 26, 2011
First lap on Mixed Emotions
Lowered out of a 5.7 chimney when a tricam in a gr...
Lowered out of a 5.7 chimney when a tricam in a gritty crack blew above me. Read the entire Accidents in North American Mountaineering 2010 cover to cover and learned you can fracture the talus on as little as a 10 foot fall onto an 8 inch ledge. The thought of Bouldering scares me. Ledges scare me. Making the second clip scares me.
And not climbing, running, summiting, skiing, cycling or anything else for the past 10 weeks has made me wonder how far you can push combinations of percocet and alcohol.

But I'm going to ignore the doctor if he also tells me distance running is a no go. That is not an option.

I'm going to bookmark this link because it sounds like you are a few months ahead of me in the process and I want to see what to look forward to.

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By Brice Harris
Nov 2, 2011
It's been 3 days since I used my crutches. Hell yeah!

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By Stuart Teague
Nov 15, 2011
Brice,

I broke my talus -- never even knew I had one. I suffered a Hawkins II talar neck fracture. The talus broke in two, and two pieces split off the top. The surgeon put 6 screws in the next day, and I've been idle since. Its been a little over 2 weeks.

I fell and hit the ground before I could get in my first piece. I've done the climb at least half a dozen times, but I guess I was due to hit the ground. The irony of it all is that the better you feel you are climbing, the further you run it out. But gravity doesn't care when your foot pops off.

It will be interesting to see if the bone will heal enough to take it, or whether Avascular Necrosis will set in and lead to multiple surgeries. Regardless, it sounds like you and these guys will all recover. These posts give me optimism. Keep at it.

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By ben smith
Dec 6, 2011
Status update:

After breaking talus on 9/3/11, I have been weight-bearing the past two weeks. I was told by the MD that once I was able to walk w/ a normal gait, I could discontinue using boot. Well, of course I made sure I was walking. I even went out dancing and the next day road a bike. Although it was extremely stiff all this time, I was in some serious pain and swelling 48 hours later. I am still perplexed by the amount and of pain and swelling caused by "over doing it", but I have never had an injury like this before. I officially start PT tomorrow and I am back were I started.....but without crutches!

It has been encouraging hearing all these other recovery stories~

At this pace, I will be climbing before the new year!

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By Mike Watson
Dec 31, 2011
Took a lead fall in JT coming up on two yrs ago. Dislocated my calc and broke my talus in a 20 footer. The first surgery put five screws in the talus and I was on the "scooter" for over four months. Finally to a walking boot for several months and PT. Had to have surgery again 9 months later to remove a bunch of bone that decided to grow where it shouldn't. AVN is some scary s%*t!


ankle after falling 20'
ankle after falling 20'


Climbed Dark Star this last August car to car. Hang in there!!!

Also, hiking in gravel and on talus is still difficult and don't expect your range of motion (inversion/eversion) to be much. Like others have said, PT, PT, PT. When you think you've done enough, do more.

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By Mike Watson
Dec 31, 2011
Hope this isn't too graphic... ;-)


broken talus
broken talus

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By ben smith
Apr 4, 2012
Just got back from a climbing trip in red rocks and the ankle is climbing fine. Stiff in the mornings upon waking, but no big issues. Hope others have had same success that I have experienced.

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