Ankle fusion and crack climbing

I've had a fused right ankle for about 13 years and am just starting to become curious about crack climbing. Is there anyone with a fused ankle who has had success with crack climbing? Obviously, I am limited in the way my right foot can get into a crack, but I'm just curious/looking for some hope if anyone has found ways to adapt. Thanks!

Interested to see what gets said here. I have a fused left ankle from a motorcycle crash about 13 years ago. My hope is that having to be able to jam both feet won't be a requirement until the higher grades (5.10<). 

Hmmm, this could be a problem. 

Not a PT nor do I have a fused ankle.

But I think it's one of those things you won't know until you go.

First and foremost I'd get someone to teach you technique.

It can be quite painful without a fused ankle as is.  

Update: I climbed at Indian Creek this past weekend and successfully top roped 2 routes! One was a left facing crack, so I mostly used my left foot which was helpful. On the other one, I had to find creative ways like mentioned above to get around jamming my right foot into the crack. I have hope though and will continue to try :)

Page Nelson wrote:

Update: I climbed at Indian Creek this past weekend and successfully top roped 2 routes! One was a left facing crack, so I mostly used my left foot which was helpful. On the other one, I had to find creative ways like mentioned above to get around jamming my right foot into the crack. I have hope though and will continue to try :)

How does smearing feel with that foot? Can you use your toes on the wall? I feel like a lot can be climbed without a foot in the crack, it’s more demanding on the hands but it definitely works. I think I climb a decent amount of right facing corners in that style. Something like Cave Crack at battle is an example.

Hi Page, my right ankle (at the talus-tibia joint) has been fused for almost a decade -- how it affects crack climbing (i.e. ankle inversion, or turning it inward) depends on where you're fused. If it's at the talus-tibia joint, you really should be fine. This is what I had been told by my surgeon and physical therapist, and the anatomy of it makes sense (since talus-tibia is an up & down hinge joint), and that has certainly been my experience in the time since my fusion -- i.e. no issue with crack climbing. Takes a little playing around to get the feel, sure, but it sounds like you had a good trial run the other day to demonstrate. The subtalar joint, on the other hand, is the one responsible for inversion. If that's the site of the fusion, I've heard it's quite a different story and requires lots of changes to crack technique and strategy. But even if so, don't let it stop you! I've known people with that fusion who climb just fine, and I've been amazed at how well my body has naturally learned to adapt to movements that are essentially "blocked" by my fusion. Unfortunately, in other words, I've not been able to use it as a viable excuse for my flailing :). Good luck!

Kelly Cordes wrote:

Hi Page, my right ankle (at the talus-tibia joint) has been fused for almost a decade -- how it affects crack climbing (i.e. ankle inversion, or turning it inward) depends on where you're fused. If it's at the talus-tibia joint, you really should be fine. This is what I had been told by my surgeon and physical therapist, and the anatomy of it makes sense (since talus-tibia is an up & down hinge joint), and that has certainly been my experience in the time since my fusion -- i.e. no issue with crack climbing. Takes a little playing around to get the feel, sure, but it sounds like you had a good trial run the other day to demonstrate. The subtalar joint, on the other hand, is the one responsible for inversion. If that's the site of the fusion, I've heard it's quite a different story and requires lots of changes to crack technique and strategy. But even if so, don't let it stop you! I've known people with that fusion who climb just fine, and I've been amazed at how well my body has naturally learned to adapt to movements that are essentially "blocked" by my fusion. Unfortunately, in other words, I've not been able to use it as a viable excuse for my flailing :). Good luck!

I'm curious what taking lead falls is/was like. I have what's essentially a complete ankle fusion. I have almost no range of motion in any direction. I fear that the limited ROM will result in an injury where a normal ankle would flex/articulate to absorb impact. I have taken plenty of lead falls in the gym, but as everyone is aware, outdoors (especially moderate grade routes) have a lot more texture and crap to hit and thus more dangerous by nature. I'm holding out hope that once I'm strong enough to warm up on 10s and jam on 11s It'll be ok because they will be cleaner falls.

Also curious about lead falls and ankle fusion ^^ Recently found out that i already have arthritis in my ankle after pilon fracture 8 months ago. Doctor suggested i live with the pain and manage the symptoms as long as I can before considering ankle fusion. Being only 24 he suggested trying to put off any surgical treatments as long as possible. But just for future reference, I am curious how ankle fusion has impacted your climbing in all ways -- leading, crack climbing, approaches, multi pitch, etc. and how its impacted general mobility. Thank you all who've already shared!

Forgot to say that if i needed the fusion it would be tibia-talus. So far my inversion/eversion has recovered more and quicker than dorsi/plantarflexion. 

I've only been climbing for a year, and I figure starting at 40 will be a bigger limitation as to what I'll be able to do than my lack of ROM in my foot. With that said, I’m leading 10b sport outdoors and almost 11a indoors and I’m nowhere near limited by the foot yet. No crack experience yet tho. However, as for fusion and mobility in general I have had my ankle "fused" for about 12 years. The last 10 years I've been riding/racing/training endurance mountain bikes (50+ mile events), even winning and placing on podiums in CO in pro fields. I have done numerous hard 20+ mile multi day hikes with a 70lb pack in the back country here in CO and some 14ers. Running is absolutely out of the question, but I don't run so that's not a loss to me.  My footing isn't great and I have to put  more thought into my steps than most people. My friends are constantly amazed that I don't hurt myself because I stumble a lot and look like a total shit show most of he time, but I have no trouble keeping up with them  I trip over dumb shit on that foot because I can't flex it up and you'd be surprised what a couple degrees of flexion will keep you from kicking lol. Good footwear is also important. 

I say "fused" because it isn't surgically fused. I severed my foot in a motorcycle crash. Broke my fibula just above the ankle joint, and separated the tibia/talus. The whole thing got infected and to fight that, all of the hardware they initially installed was removed. Infection persisted so the fracture in my fibula wouldn't heal and they cut about a 2" chuck of it out to mitigate pain (I spent about 2 months with a broken leg before they did that). The plan was to go back in and bone graft my fibula back together and surgically fuse the joint. However, because it took so much to kill the infection (I was on my 10th and last debridement surgery before amputation) they did not want to open me back up and risk reinfection. I was diagnosed with end stage arthritis in my ankle, and doc said see what you can do with it as is and if surgical fusion is necessary then we can revisit that. That was in early spring of that year. I spent that spring/summer stubbornly riding my mountain bike every day. I could only ride for an hour and afterwards was in excruciating pain. I iced it every single day and after every ride. By the end of that summer I was in significantly less pain and did my first century ride post injury. I had my last appointment with the ankle doc that fall and he was shocked that I could even walk on it based on the xray. His best guess, which would have required a CT scan to confirm, is that between the initial trauma to the joint and the infection, the cartliage was sufficiently removed and then the mountain bike rides perforated the bones which are 2 of the things they do when they fuse a joint. That allowed the joint to autofuse. His take, no pain=no problem,  come back if there's a problem. It took a further 2 years before I was pretty much pain free. But there is almost zero ROM in all, whatever, directions of the joint. There's almost always a solution to the limitation if you're determined enough to find it. I doubt I'll ever be sending 5.13 but there's a good chance that wasn't going to happen anyway. 

TLDR: If you're tough/stubborn/stupid/desperate, you'll figure something out.

Martha Helsley wrote:

Recently found out that i already have arthritis in my ankle after pilon fracture 8 months ago. Doctor suggested i live with the pain and manage the symptoms as long as I can before considering ankle fusion. 

Been there, done that. Had a pilon fracture from a climbing fall and was approaching end-stage arthritis 1.5 years later. My foot and ankle/trauma surgeon had the exact same approach that your doctor suggests. I didn't like that option, so I pivoted to the Hospital for Special Surgery in New York city and had an ankle distraction arthroplasty. Several folks here on MP have been treated by Drs. Rozbruch and Fragomen with good success - the procedure has approximately an 85% success rate and works better in younger patients. I've lost some ankle dorsiflexion range of motion, but have very few limitations with climbing and hiking. Ankle fusion is not the only option.

Had some Talus ‘thing’ for 30 years which was kept unfused. Climbed many, many cracks with it. Finally in ‘16 i did a STAR total replacement which has been liberating. Falls could be catastrophic but I really work to protect it. No appreciable wear since surgery. I will need a washout and new plastic in 5 years or less.

cieneguita wrote:

Had some Talus ‘thing’ for 30 years which was kept unfused. Climbed many, many cracks with it. Finally in ‘16 i did a STAR total replacement which has been liberating. Falls could be catastrophic but I really work to protect it. No appreciable wear since surgery. I will need a washout and new plastic in 5 years or less.

While I’m not there yet, I plan on having the STAR total replacement done in coming years. I’m currently 48 years and have severe degenerative arthritis my right ankle (talus/tibia) with limited ROM and almost no dorsal flexion.  

I appreciate hearing others experience who have had a fusion or a total replacement. Materials and tech is always changing and evolving so I’m trying to put off ankle replacement as long as possible. I’ve already had chronic pain in my bad ankle for decades. 

Thanks to everyone for sharing their experience as we navigate changes to our body  

Robert Gregory wrote:

Been there, done that. Had a pilon fracture from a climbing fall and was approaching end-stage arthritis 1.5 years later. My foot and ankle/trauma surgeon had the exact same approach that your doctor suggests. I didn't like that option, so I pivoted to the Hospital for Special Surgery in New York city and had an ankle distraction arthroplasty. Several folks here on MP have been treated by Drs. Rozbruch and Fragomen with good success - the procedure has approximately an 85% success rate and works better in younger patients. I've lost some ankle dorsiflexion range of motion, but have very few limitations with climbing and hiking. Ankle fusion is not the only option.

As a counter point to this post, I also had an ankle distraction from Rozbruch / HSS, and the only thing it brought me was a $15,000 bill (he doesn't take insurance) and a bad case of elbow tendonitis from the year of hangboarding during "recovery".  The distraction is a controversial procedure - as one doctor (John Kennedy - top NYC surgeon who works in the same circles as Rozbruch) put it to me, Rozbruch is a good surgeon, but a world class statistician.  My observation from my own experience:

1. The recovery from the procedure is epic - you are looking at 3 months in an external fixator, and then at least 12 months of rehab after - better budget a 1.5 years of "off time". 

2. The outcome varies wildly.  It seems like some people (like Robert) have a remarkable outcome.  Personally though, my outcome (1 year into the rehab process) has not nearly been this positive.  Its a modest improvement, but not a groundbreaking one - in general, the things that I couldn't do before the distraction (hiking trips, big wall climbing routes, long days walking around the city), still feel impossible.  However, I am certainly a bit more comfortable in the limited activities I can do.  Having spent some time in the ADA facebook group (which is great btw), it seems like my outcome is a bit more representative than the 5 star recovery like Robert.  

I would consider a distraction a "hail mary" procedure - if you have the mentality that you would try anything to keep your ankle flexibility, then its a good option as it doesn't close any doors.   The fusion, on the other hand, is a time tested procedure with loads of evidence of positive outcomes.  In fact, It would be interesting to see where Dr Rozbruch is getting this "85% distraction success" rate - I suspect its only possible through his creative interpretation of the word "success".  For example, I suspect he has me sitting in that ADA "success" bucket, and I'm barely tolerating a half day of sport climbing and a walk through the grocery store.   

In the meanwhile, personally, Ill be getting a fusion - just gotta squeeze one more climbing season out - and if only I could get this damn elbow tendonitis to go away!