Talar Neck Fracture and Subtalar Joint Inury

Hi everyone, Writing in hopes of getting some guidance / insight from others that have experienced similar injuries.

In June of last year, I was racing my dirt bike and unfortunately made a mistake on a jump and cased it, my ankles taking most of the impact. Thankfully, I didn’t break both ankles. I ended up with a Talar neck fracture, partially displaced, shattered the bottom piece of my fibula, and completely crushed my subtalar joint (which they did not know until they opened my ankle up for surgery). I got surgery, they cleaned everything up, and put in 6 screws and a plate in/on my talus. I had two incisions in each side of my ankle.

After surgery, the surgeon said that I was going to need another surgery at some point to fuse the bones together with a bone graft.

I was very diligent with my recovery immediately following surgery. Followed all the “rules” and took good care of myself. I got the surgery June 13th and was able to weight bare again at the beginning of September (3ish months later). I wore my boot for about another 2-3 weeks and then moved into regular footwear again. Had to use a cane for a few weeks but I can now walk without any additional support, which is great.

However, the pain has been pretty gnarly and has not gotten any better. I’ve slowly been able to do things like yoga and go to the gym to do light exercise, however, even that causes significant pain.

My surgeon referred me to get a cortisone injection with some other stuff in it (forget the medical term) and that helped IMMENSELY with pain, although this is more of a Bandaid and not something to do back to back. He suggested it would work for 3-6 months. It was a night and day difference pain wise, so much so that I was even able to ski again (nothing crazy but was able to do green and blue runs without much trouble other than significant muscle mass differences between sides of the body but at least the pain was fine). However, it’s been about a month and a half since the injection and I’m back to regular pain again pre-injection.

When I’m not doing anything, it’s like a lingering 2-3/10. But it’s swollen and hot. As soon as I get up to walk or do anything, I’m limping again and pain starts to increase, sometimes up to a 7 or 8/10.

I’ve been trying to do everything I can to stay on top of physio and do my best to avoid a second surgery. But I’m just really not sure what to do next. My physio is of the opinion that I can avoid surgery if I continue to work at it while my surgeon is saying that it’s inevitable and basically just up to me now to see how long I can manage the pain.

Idk if maybe there is something else I could be doing or trying? Has anyone had their talus / subtalar joint fused with bone graft? Have you experienced significant decreases in pain? Or was it worse? Have you tried something that has helped?

Just trying to figure out what the best next steps are and lean on some others for support.

Thanks in advance! 

How has it affected your climbing?

I have a subtalar joint fusion. I had an initial surgery to put my talus (comminuted talar body fracture) and calcaneus back together. Then the subtalar fusion 9 months later. They would not have gotten a good fusion right out of the gate because everything was so shattered. Similar to you, after my first surgery, I was great for a bit but then the post-traumatic osteoarthritis in my subtalar joint came in hot! I had about 200 steps available to me each day and it was getting worse. I got 5 opinions from orthopedics and a pediatrist before committing to the fusion. The imaging was clear and everyone said the same thing. I had no motion and a lot of pain, and with the fusion, I still wouldn't have the motion but the pain would be gone. It was still a difficult decision.  

My fusion surgery was much easier than my post-accident surgery. I didn't need to take any pain meds. It was another 3 months non weight bearing but the improvement was much more linear. I'm focused on skiing and hiking now and I don't have any pain. I was able to completely clear my limp. 

Fusion is a one-way street, but for me it was definitely the right one. I'd suggest you get some images CT and MRI and take them for several opinions. 

Happy to answer any other questions. I'm about a year and half post-fusion surgery.