Dorsiflexion through anterior ankle impingement

I’m back at about 0 degrees of dorsiflexion, and walking is very rough. With the inability to move my foot in this direction my knee takes a lot of the load and I walk with my leg cocked out to help “shorten” it.

It’s been 2.5 months since I was given the green light to ditch the boot and crutches, and I’m doing pt twice a week.

I was able to take a 15 mile mountain bike ride this week with no major side effects. I take this to be a good sign. My overall ankle stability is improving and my calf is much stronger.

8 thoughts on “Dorsiflexion through anterior ankle impingement

  1. Hi there. I found your blog. Thanks for posting this. I also suffered a Pilon fracture on my right ankle mid August.

    I am still NWB and feeling very depressed. I too worry about arthritis and other issues. The hardware for me is very painful. It burns some days on the inside of my leg. I have 2 large plates and I think 9 screws.

    When did you start bearing weight and how log did it take until you could kind of walk? I know you said you are not walking perfectly yet. I would like to be walking at all at this point. It is about to get very cold and snowy where I live (up in Canada) so I need to get a little more mobile hopefully.

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    • Hi Jim
      I am sorry I haven’t replied sooner! Thanks for writing.

      I started bearing weight about 3 months after surgery (I think that was mid-June), I could put 25% weight (in a boot, with crutches) for a week, then put 50% weight, and so on. I was at full weight, with a boot, for much of July. In August I took the boot off. Thats when I realized I had a lot of ankle pain, and very little range of motion. Physical therapy did not help.

      So….I just had my 7 month follow up and they say the cartilage between under tibia and on the talus has degenerated and I have no joint space. That was devastating but I got up-beat again in about a week… I am seeing a specialist this week to see what my options are. My choices seem to be ankle replacement or fusion. That means all the hardware can come out and a little more can go in. If all goes well, I’ll be down for 3 more months. I’m 40 and I have a 2 year old and my own business so 3 month of down time is not ideal…but at 8 months since the injure, its a small thing if the outcome is pain-free living.
      I have a lot of pain at the front of my ankle and can not lift my foot bast 0 degrees of dorsiflexion. They say it is bone-on-bone there.

      Staying happy through all this is so hard but what works a lot is doing things like playing guitar, socializing, and other non-walking things (I can ride a bike ok) Also, I focus on what I do have, and not what I don’t have.

      Jim, do you mind if I ask how did you break your ankle?

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      • Hi Zach

        Sorry to hear about the cartilidge. That is definetly one of my big worries. I am 36 with a 6 year old and a 3 year old. So we are in a similar situation. I am really worried about not being able to play with my kids like I used to.

        I just finally got the go ahead yesterday to start bearing some weight very slowly on my foot. So far it feels very weird and sore. But after almost 4 months of nothing it guess that is normal. Just hoping it starts to get better. Maybe I can walk unassisted by Christmas.

        I broke my ankle in a fall. I fell 6 feet onto cement but landed on top of some stairs. So the impact and angle of my ankle was bad. The front of the tibia got totally smashed. It still has not all healed up but they say it is coming.

        I had horrible fracture blisters as well that led to a bunch of issues with infection. So the recovery has been tough. I still have open wounds they are treating. So I am limited in the things I can do in physio because of the open areas.

        Anyway it is great to hear from you as it is good to hear how things are going with others with this injury.

        Can you walk now but you just have lots of pain? Or have you stopped walking?

        Take care and hope you get some good news from the specialists.
        Jim

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        • Hi Jim

          Thanks for sharing your story We’re on a public forum here and I hope others will chime in with their story too because it sure helps me with we share our experiences.

          Thats a rough situation you’re in! I can imagine your spirits can get pretty low at times. Patience was my greatest new skill that I developed…that and hope (i have this blind faith that this ordeal will eventually end). I know the thing that makes me feel the most “ok” emotionally is when other folks recognize how incredibly sad this situation is. I hate to hear: “people break bones all the time, you’ll be fine!” when I hear that, I take a big breath and decide how sorry for my self I need to get in order to explain to these folks that I may not be “fine” ever agin, at least not in the way that I want to be “fine”. The unknowns are so dang overwhelming that sometimes I can’t see much hope for me.

          Sure, other folks have worse injuries, like spinal injuries or loss of use both legs, but I can’t desire to be “fine” any less just because I know that other people get hurt worse than this. I am living in my condition, not theirs, and this is the worse place that I have ever been. Yes, I am glad to be alive, and to have what I have, but I was very active before this…very very active. Losing that is incredibly hard to accept. So I took up learning to play guitar. No walking needed and lots of distraction.

          When I took my first steps in the boot, my foot felt like it was a foreign object. That lasted for a couple weeks, but now it feels like a normal foot (aside from the lack of range of motion and ankle grinding pain), so have faith that eventually the foot will get accustomed to bearing weight again. I have numbness still in places due to nerve damage, but that is no longer bothersome.

          I was very fortunate that my wound closed without issue. The biggest near-term risk of this injury seems to be related to wound closure, and I feel for you that you are still in that situation. I am hopeful things seal up soon.

          I have a CT scheduled for next week. We are anticipating the Dr wanting to fuse the tibia to the talus, but there may be a chance that he will try to grind off some of the bony callus in the joint instead.

          According to the Dr, ankle fusion should let me walk and get around pain-free and with an acceptable level of normalcy. At this point I’ll take any pain-free mobility I can get. I have come to a place where I accept that I will never be back to the guy I was, but that is ok. I can get very sad about it (like suffering the loss of a good friend) but logically I know that there is more to my life than running & jumping. If I can accept this, I can get happy.

          The prognosis is this… With an ankle fusion I can expect to have a life where I can play with my kids, enjoy my friends and family, go for a bike ride, travel the world, go for groceries, get the garden planted, mow the lawn, and be a well-rounded person who just so happens to have a very stiff left ankle. 🙂 Of course I can be a pessimist and I so I can see the Dr saying “gee, sorry Zach your just one of the rare ones where everything goes to shit at every turn… and we’re going to have to amputate the foot” But I have already looked on the bright side of that “worst case scenario” and have envisioned that I can still be ok with a prosthetic foot! (hell the blade runner guy was in the olympics!)

          Thanks for letting me share my story.

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  2. Well I am glad that there may be another option for you other than just straight to a fusion. Although I have been looking up ankle fusions and so people can do pretty well with them. Obviously not the best but if you can get pain free that would be good.

    So do you have to walk with crutches or a cane still?

    I am curious as I just started putting weight on my foot and it hurts incredibly. I can’t imagine being able to walk on it normally at this point. Also my infection seems to have come back so that could present another issue.

    I see my surgeon again on Tuesday and I think they may suggest removing the hardware or IV antibiotics or both. It seems like the issues from this injury never end.

    I have yet to find anyone who has just recovered and is back to even semi normal which is pretty sad.

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    • I feel for you Jim. The infection has to be hard on the morale. Lets hope the Doc gets it fixed for you soon.
      I don’t use my crutches anymore. I should probably use a cane but I am in denial. I can’t stand up with both feet together (when barefoot)because my left ankle wont dorsiflex enough so I put it about an inch in front when I stand, and I walk by shuffling with the left foot out front and to the left, or I walk on my toes. I can stand on my toes sometimes for a while pain free. The back of my ankle joint is pretty heathy still. I bought tall heeled logger boots to help keep me off the bad part of the ankle. I think the way I broke my tibia, a big amount of the force went through the front of it, so that’s where the cartilage died the most. The heel-lift in the boots really helps. But I can’t just walk all over the place. I am good for 100-500m then I need a big break. So its like parking the car and walking to a store and back to the car is a pain. After that I’m sore for w good while. I walk with a big hobble/limp. I get some relief by turning my foot toe-in or toe-out depending on where it hurts that day. And lots of tape and a brace under my boot. I am going to see about an AFO brace that will immobilize my foot and see if that gets me by. But i feel that fusion is really the pot of gold at the end of this rainbow.

      When you put weight, where does it hurt? My foot felt bad all over at first, but I did not have weight bearing pain in the joint until a couple months of regular use.

      Nobody I have heard of yet has “recovered” from this injury. I found a survey that showed patients ranked this injury worse than brain cancer and aids. The folks with brian cancer or aids would probably trade a foot for a clean bill of health in an instant. In my opinion, people only really recognize what they loose, not what they could have lost. I know I get very sad and sorry for myself…. but I try to snap out of it and thank my good fortune that I did not suffer a spinal injury instead. I’d trade a foot to not have a broken back. Thats for sure.
      Good luck with the next steps! I hope they blast that damn infection to hell with the special reserve antibiotics!

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      • Thanks Zach. I sure hope they get rid of this infection soon too. They start talking about it being limb threatening which scares the heck out of me.

        So did you walk somewhat normally for a couple months and then all of a sudden it started to hurt at the front?

        Sorry for all the questions it’s just our injuries are very similar and when I step now most of the pain is at the front where the bone got hammered. I know everyone is a little different but it is nice to hear how someone similar is doing.

        I still can’t even drive as it is my right ankle so my mobility has been horrible all around.

        Let me know what you find out from your specialist. I really hope he has some good news for you !

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        • Hi Jim.. Ask away! Questions are what this site is all about. I needed to talk to others with this injury to help my sanity but didn’t find many currently active forums about pilon fractures.

          When I started walking it was stiff and weak and never functioned well, and hurt bad from the get go, but not deep inside like it does not. So I’d say I added the deep ankle pain to the always-there dorsiflexion pain. Since I have started wearing logger boots with a tall heel, and taking ibuprofen and ice and such, I can get around short distances pain free. My physical therapy has allowed me to build a lot of strength in the ankle that I believe is stabilizing the joint to allow me to walk acceptably.

          Right foot is a bummer man! I know driving is a big form of freedom and I hope you maybe can (safely) drive with your left foot (I’m hoping you have an automatic transmission)

          I’ll update the site after I see the ankle specialist(s) this and next week.

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