Climbing life after damaged subtalar joint
|
Hi there.. I came back from the orthopedic surgeon last week with some quite devastating news: I broke my ankle 4y ago, falling badly from a boulder, and never fully recovered. I was diagnosed with a small fracture on the outer malleolus, but what I wasn't aware of is that the extent of the damage in my ankle was way worse. Last week's CT scan revealed severe bone spurs and damage to the cartilage in the subtalar joint. The orthopedic surgeon straight up recommended subtalar fusion surgery, which would make it impossible for me to run and make me loose all side to side mobility in my ankle. I ain't doing that though... Currently I can still run daily for about half an hour without triggering the pain, I can still go on day-long hikes and make it home (although I pay the price the day after..), and most importantly, I can climb without ever triggering any pain... For now. It is however a degenerative damage, which means it will worsen with time... And I want to know what to expect. Currently for me I am very limited in where I can climb. I used to climb in the Tatras mountains in Slovakia, but the approach has become too harsh on me and I'm now limited to sport climbing crags. I'm hoping injections can help me get back to the mountains... But I'm also scared of making things worse by overdoing it... Anyway, please, did anyone here suffered similar injury, and maybe has few words of wisdom on how to live with this as a climber? |
|
Watching this thread. I took a lead fall and broke my ankle badly about 18 mths ago (June 2022). It was an open fracture dislocation; I looked down and my foot was hanging off the end of my leg with the bone exposed. Miraculously there was not too much bone damage (I learned I have very strong bones) but I lost most of the cartilage in my subtalar joint and my surgeon also recommended fusion, which I rejected. There also seems to be lots of peripheral damage that has not been catalogued and that I am slowly finding out about. I am still improving, anecdotally I'm expecting improvements to continue for up to 3 yrs post accident, and I'm looking for options to repair the cartilage. Mostly focusing on physical therapy, strengthening, and gait training. My foot never feels "normal" but I can walk, hike, climb with some limitations. I can't run or jump. I had a hyaluronic injection about 6 weeks ago and I'm currently feeling improvements. I'm not sure if it's causally related, because I also went on a climbing trip immediately after, but after the trip it felt noticeably better. Could have been the daily hikes though. I heard steroid injections will relieve pain but will actually speed up cartilage degeneration so I've been avoiding those. My cousin who is an orthopedic surgeon told me that pain seems very subjective. He has patients with bone-on-bone arthritis that feel very little pain, and patients with barely any damage that are in a lot of pain. I'm learning more and more about pain and it's anything but straightforward. Starting to think that we can rewire ourselves to not feel the joint pain. On the topic of cartilage regeneration - do you know the extent of your cartilage damage? After a year of pestering my surgeon offered me reconstruction with Chondro-Gide, "no guarantees it will help". I have not taken him up on it yet. I was told the subtalar joint is difficult to access and would probably involve creating soft tissue damage, and I feel like I want to understand the surgery better before making a decision. Multiple orthos have told me that anything I can do to strengthen the surrounding muscles is good, but impact (running and jumping) is bad. So I feel pretty confident about hiking and climbing on it. My plan is to see if theres any reconstructive surgery that could be an option at the 3yr mark. If not, just wait as long as I can to delay fusion. The thing with fusion is that it will remove the pain in the joint, and probably increase function, but it will cause the adjacent joints to move abnormally and eventually lead to problems with the other joints. So that's why I'm planning to delay it as long as I can. |
|
Hey Bruno, I think I'm in a similar situation- I have severe subtalar arthritis due to a climbing accident about 5 years ago. Might not be quite as bad because no surgeons have recommended fusion blatantly at this point in time (though thats also bc I'm 26 and they don't want the other joints to develop arthritis early, like you mentioned). But I'm in a similar place where I can walk mostly fine to a point, but if I push it in walking or even standing for too long my foot gets very painful and my muscles tense up to lock the ankle joint into place. Also I feel like I could usually muscle my way through things, but the evening or day after I would really struggle walking. A year ago I bought an exosym device from the hangar clinic and its been a game changer. Its basically an external prosthetic. I wear it for climbing approaches and most of the time in every day life, and I hardly feel impaired anymore. Would highly recommend looking into it, happy to answer any questions. Also, cortisone shots worked really well for me. But I have heard they are not good for long term joint health. Since getting the exo, I havent had any shots. |
|
I don't have advice about healing the subtalar joint, as I ended up getting fused after a climbing fall in December 2021. If you have questions about subtalar joint fusion, end stage post-traumatic osteoarthritis, recovery, and return to sport, I'm happy to share my experience. I had an excellent outcome, but fusion is a one-way street, so approach it with caution. |
|
Hey Bruno, 9 years ago, In 2015, I had taken a ground fall and completely shattered my left heel. In addition to this calcaneal fracture I also damaged my subtalar joint. I underwent surgery which included a cadaver bone inserted into my foot with a steel plate and screws, which I still have the hardware inside my foot. I joke around that I have to lose a little more weight to compensate for the added hardware :) I'm thankful to climb again, and harder than I've ever climbed before at 38yrs old. Here's an old thread that many people have had dialogue with each other on : mountainproject.com/forum/t… |
|
I think there is joy to be found in all forms of climbing. Sometimes I have injuries that prevent me from doing alpine or crack and I go into a bouldering/gym phase. There is so much 5 star rock out there. |
|
I damaged my big toe joint - there was cartilage damage and bone spurs. I tried cortisol and PRP injections with absolutely no help. I ended up having surgery where they cleaned up the joint and performed micro fracture on the bone to help regenerate the cartilage. I’m 6mo after the surgery and still can’t climb pain free.. running is out forever. I have started shockwave therapy and considering pentosan injections.. if you have bone spurs they need to be cleaned out. I would try another surgeon before committing to fusing it — they may be able to remove the damaged cartilage and attempt micro fractures as well. Also stop running!!!!! I switched to cycling as it it’s a no impact cardio. |
|
Hi Bruno! From one Bruno to another, I understand what you are going through. I'm 51 years old, a lifelong athlete, and I have had many small injuries, and five surgeries on my knees, ankles, and feet over the yeas. The injury most relevant to yours involved several torn ligaments on my lateral ankle, and full thickness cartilage damage to the superior medial surface of my talus, due to a ski accident. I had ankle surgery to repair the ligaments, and the doctor also used a technique called micro-drilling to repair the cartilage. Basically, they drill many small holes into the bone to stimulate blood flow and consequent healing. It's not a perfect fix--the collagen that fills in the lesion is not the same as the original, and there will always be some roughness, but it's much better than having an open lesion, especially if it goes all the way through the cartilage to the underlying bone, as mine did. Five years out from the surgery, my ankle is doing great. It's basicaly normal, and never gives me any problems. I don't know if micro-driling would be an option for you, but you might ask your doctors. I don't know how old you are, but you do have to think long term. Your ankle seems relatively functional now, but how will it be in one year, or five years? The cartilage damage will just get worse, and it might create more problems. If you do have the ankle fusion, you might not be able to run, but could you hike, bike, swim and climb? I guess what I am trying to say is that this sounds like an injury that you will have to address, sooner or later, and that you will likely have to make some compromises and adapt. One of my guiding principles as that as we get older all athletes become adaptive athletes. There is a strength that comes from that. You just have to keep doing what you can with what you have! Good luck, and feel free to keep me posted, or ask more questions. |