Climbing/Falling with Ankle Arthritis

I have arthritis in my subtalar (ankle) joint due to a lateral talus fracture a year and a half ago. The fracture was undiagnosed for 7 months, then I had surgery to remove the non-united bone piece. I'm now about 10 months post surgery and have post traumatic arthritis. I just got a steroid injection and right now the pain is not that bad- it is stiff in the morning and after a long day of standing/walking on it. 

I want to get back into climbing and the actual movement of climbing doesnt hurt. But I am terrified to fall on lead right now because I envision the impact on my ankle, even though when I've taken small falls it feels okay. I am having a hard time getting over this fear of falling because I can't tell if its logical or not. 

My doctor says climbing should be fine as long as I don't take any falls but thats not very helpful. Does anyone have experience taking lead falls with ankle arthritis? How does this feel on the joint? Any advice on managing arthritis in general? (Besides chugging Ibuprofen..) 

Switch to easy trad?  Just kidding. 

Bill Lawry wrote:

Switch to easy trad?  Just kidding. 

I think you meant to write wildly overhanging sport routes with zero approach. 

Elise B wrote:

I think you meant to write wildly overhanging sport routes with zero approach. 

I thought so.  You must be another one of those hard-climbing women who can out pace me with one of your legs tied behind your back.  :)

edit for clarity: absolutely no misogyny intended; I climbed with a young women earlier this year with a severe ankle issue who gravitated towards the overhanging routes; I generally could not follow.  

I have early onset arthritis due to a birth defect. I have very little cartilage left in my foot.

Things I do every day: wear hiking boots/high top shoes that provide extra ankle support, stretch parts of my body that are overcompensating due to having a weak ankle (hamstring, glutes, etc.). Any supplement out there that is for cartilage isn't worth it and at least my MDs + PTs said no scientific evidence to warrant them.

For climbing: lead fall practice. Take longer lead falls in a safe environment (e.g. gym or overhanging sport) until you feel comfortable. Bouldering falls are much worse for your ankle. I think, as you mentioned in your post, you are probably way better off to take lead falls then you think. 

Everyone's foot is different but hopefully that helps. It took me a long time to recover from my surgery, so you may have to adjust your outlook a bit. It took me about a year and a half to crack climb pain free. 

Bill Lawry wrote:

I thought so.  You must be another one of those hard-climbing women who can out pace me with one of your legs tied behind your back.  :)

I can vouch for this as her climbing partner.  After I just barely onsighted an overhanging 5.11d (owens RG 'chocolate to morphine'), she proceeded to crutch her way to the base of the climb, tie in, and tr onsight it with a climbing shoe on one foot and a sock on the other.  Much like her foot, my ego has yet to recover   

I have traumatic arthritis from shattering my ankle decades ago. Don't worry about it. However, as others have noted air falls and practice falling are great ideas. Its not that you have arthritis, a hard fall on your feet is bad news no matter what.

Elise B wrote:

I have arthritis in my subtalar (ankle) joint due to a lateral talus fracture a year and a half ago. The fracture was undiagnosed for 7 months, then I had surgery to remove the non-united bone piece. I'm now about 10 months post surgery and have post traumatic arthritis. I just got a steroid injection and right now the pain is not that bad- it is stiff in the morning and after a long day of standing/walking on it. 

I want to get back into climbing and the actual movement of climbing doesnt hurt. But I am terrified to fall on lead right now because I envision the impact on my ankle, even though when I've taken small falls it feels okay. I am having a hard time getting over this fear of falling because I can't tell if its logical or not. 

My doctor says climbing should be fine as long as I don't take any falls but thats not very helpful. Does anyone have experience taking lead falls with ankle arthritis? How does this feel on the joint? Any advice on managing arthritis in general? (Besides chugging Ibuprofen..) 

Hey! Based on your profile looks like you got back to leading over the last three years. Would love to hear more about your progress and how you manage the post traumatic arthritis day to day. I tried to explain lead climbing to my doctor but it felt like a waste of time so i stopped. He did say impact activities like running and hiking were only going to make it worse, but that climbing was fine. 

Do you still get steroid shots? My Dr did not recommend them for me at my age. Do you do anything else to mitigate the symptoms? 

This is crazy. I thought I was the only one. I have 100% fusion on left ankle from motorcycle accident many years ago. I just started leading and was also wondering about lead falls. 

Hey! Sorry to hear about your ankle, I know how much post traumatic arthritis can suck. I had a pilon fracture of my tibia six years ago and just destroyed the cartilage there. I had about 8 surgeries to fix the bones and get a somewhat usable joint, but won't ever have full mobility back in it. For about three years, the arthritis was so severe that if I walked more than a mile in a day it was so painful and stiff the next day that I had a hard time getting out of bed. I tried plenty of surgeries to remove scar tissue and steroids and other injections and we were discussing ankle fusion before I finally found the combo that basically completely resolved it three years:

1. Annual hyaluronic acid/Durolane (brand name) injections. It's non-steroidal and not bad for you to have repeatedly; my doctor said that if anything it 'fills in the frayed edges' of my cartilage and that my joint actually looks better on imaging that it did three years ago. Once I started taking getting them, I was basically immediately able to return to a normal life and even moderate impact activities, only the longest alpine approaches bothered it.
2. Ibuprofen BEFORE activity. Taking it at least 20 min before you start moving on it prevents the inflammation from ever really setting it. And I'm not talking like crazy high doses, like just 200-400mg every 4-6 hours even on like 16 mile 6k ft of gain days on rough talus has made it pretty much fine.

As for your specific question about falling - it's never bothered my ankle, even when I hadn't figured out those two items, so I don't have any specific advice. I'm primarily a boulderer and have taken plenty of dumb, hard falls on it and have never noticed that causing any more inflammation. Perhaps I've gotten better at rolling in falls since I'm not as good at squatting when landing anymore with my limited ankle mobility.

Martha Helsley wrote:

Hey! Based on your profile looks like you got back to leading over the last three years. Would love to hear more about your progress and how you manage the post traumatic arthritis day to day. I tried to explain lead climbing to my doctor but it felt like a waste of time so i stopped. He did say impact activities like running and hiking were only going to make it worse, but that climbing was fine. 

Do you still get steroid shots? My Dr did not recommend them for me at my age. Do you do anything else to mitigate the symptoms? 

Hey! What was your injury and how did you end up post traumatic arthritis?

I struggle-bussed along for about 3 years post injury with various degrees of limitation. I was still climbing outside and on lead, but with a lot of issues. Hiking was always the worst for me, although low-angle terrain also bothered me a lot. I would usually be able to get through the activity with quite a bit of pain and then in the evening or next day I would have major issues walking. I also found that the main issue was not exactly pain but that my ankle would lock into a flexed and internally pointed position (I've been told this was peroneal spasm), and moving my foot out of this position was painful. Also, the idea of taking a fall on my foot while its like that just sounded horrible. I got cortisone injections every year to 6 months and responded really well to them. The doctors were pretty happy to prescribe them, though I was cautioned they would make it worse in the long run. I was 22 when I started taking them, and definitely concerned about doing long term damage. Sometimes after a shot I would feel basically normal. They would eventually wear off though, and it was getting to the point where 6 months after every injection I would have problems just walking after a day of work. 

I eventually bought an exosym ( hangerclinic.com/blog/featu…) this february and it has changed my life. Unless its something crazy, like long scrambling approaches up uneven terrain, I don't need to consider whether I can get somewhere or not or how its going to affect me later. I can run for short distances without pain, which was out of the question before, and I generally function like a normal person. I don't wear the brace when climbing. 

I've also found that falling on the ankle doesnt really aggravate the joint. I've taken quite a few falls (bouldering and sport climbing) onto the ankle, and honestly it doesnt bother me that much. I do try to avoid hard catches and falling from heights, but I've never had a fall affect me like hiking or slab climbing does. That being said I've never taken a hard fall onto the joint when its "locked up" or spasming, so I'm not sure how that would feel. 

I guess my TLDR is that the climbing itself wasn't too bad for the joint (unless slab), falling was generally fine, cortisone helped a lot but was not a great long-term solution, and the exosym is amazing and changed my life. Happy to chat more if you like. 

Matthew Mollerus wrote:

1. Annual hyaluronic acid/Durolane (brand name) injections. It's non-steroidal and not bad for you to have repeatedly; my doctor said that if anything it 'fills in the frayed edges' of my cartilage and that my joint actually looks better on imaging that it did three years ago. Once I started taking getting them, I was basically immediately able to return to a normal life and even moderate impact activities, only the longest alpine approaches bothered it.

That's crazy! How bad was your joint when you started taking it? Like did you have any cartilage left? And is your joint still doing fine?

Hey Elise, I had a pilon tib/fib fracture in April 2023. Recovery went super well up until October when I started noticing a lot more pain. Xrays and CT in November showed drastically reduced joint space in the ankle. My doctor basically told me that my body was done healing and whatever pain I was in now is what i needed to get used to. Hard to accept that answer! I've been working easy hiking trips for my job and doing shorter approaches and top roping outside. 

Do you not get the cortisone injections anymore? A second doctor recommended we try an injection at the 1 yr mark to try to get a feel for how much of the pain was from arthritis. 

What is the exosym like? I've seen others online with it but have been curious about its utility with hiking and climbing. It seems kind of bulky? Would love to hear more about that as it soudns like it was the main thing thats helped you.

Every now and then i catch my step wrong on a rock or something and it forces my ankle too far up/down and that hurts, so that makes me worried about leading. Good to hear you havent had issues with it. Slab is rough for me too! But getting better as the muscle builds back.

Elise B wrote:

That's crazy! How bad was your joint when you started taking it? Like did you have any cartilage left? And is your joint still doing fine?

Also would love to hear more about the injections you get, Matthew! Sounds like you went from pretty severe injury to getting back after big days. Thats my dream!!

Martha Helsley wrote:

Hey Elise, I had a pilon tib/fib fracture in April 2023. Recovery went super well up until October when I started noticing a lot more pain. Xrays and CT in November showed drastically reduced joint space in the ankle. My doctor basically told me that my body was done healing and whatever pain I was in now is what i needed to get used to. Hard to accept that answer! I've been working easy hiking trips for my job and doing shorter approaches and top roping outside. 

Do you not get the cortisone injections anymore? A second doctor recommended we try an injection at the 1 yr mark to try to get a feel for how much of the pain was from arthritis. 

What is the exosym like? I've seen others online with it but have been curious about its utility with hiking and climbing. It seems kind of bulky? Would love to hear more about that as it soudns like it was the main thing thats helped you.

Every now and then i catch my step wrong on a rock or something and it forces my ankle too far up/down and that hurts, so that makes me worried about leading. Good to hear you havent had issues with it. Slab is rough for me too! But getting better as the muscle builds back.

Sorry to hear, I've also been told that things are not going to get better. Its super frustrating. Most doctors have told me its only downhill from here and that a fusion is down the line, but I have heard some people say that things do get better over time. How that happens I am still not sure haha. 

I haven't gotten any injections since getting the exosym, but I plan to get at least one more. I think it makes sense to get one at the 1 yr mark. I doubt one cortisone injection is going to do much damage. My first cortisone injection also relieved a ton of the inflammation, and it hasn't been quite as bad since. 

If you're thinking of the exosym as a brace, then its definitely bulky. Its described by the makers as an orthotic-prosthetic, and it looks the part. But considering that, I don't think its bulky at all. Its super light, easy to take on and off, and I actually think it looks pretty cool. Its harder to scramble or boulder hop in it because you lose the ability to rotate your ankle joint, so I'm a slower hiker (not that I was all that fast to begin with). There's also a learning curve to using it, but I think it comes pretty quickly. Its also quite pricey (9k plus traveling 1-2 times to Washington state) and the makers sadly don't take insurance. For me it has been 100% worth it though.