Arizona AFO brace to the rescue

I saw a specialist who suggested an Arizona brace. The one they made for me didn’t really fit well. (word to the wise, get the brace sized/made by a clinic who specializes in this and does not make knock-off generic versions in-house)

i have been using this brace with some heel-lift insert and a size 12 shoe (my right foot is a 10) and aside from being a little embarrassed to have one big fat darth vader foot, I get around waaaaaay better than before.

I am getting a new Arizona AFO made (out of pocket $800) because i found a better clinic and a better technician who told me about AZ Breeze material. Its not as durable bt its lighter, thinner, and breathable

This made walking amazing again! (some pain and no ROM but who cares?!)

This made walking amazing again! (some pain and no ROM but who cares?!)

Size 12 left shoe with liner cut out to fit the first AFO brace

Size 12 left shoe with liner cut out to fit the first AFO brace

big black brace- needed way more plantarflexion built in

big black brace- needed way more plantarflexion built in- getting new one soon

I can not stand flat footed with my feet together. If i put my feet together i have to left heel an inch.

I can not stand flat footed with my feet together. If i put my feet together i have to lift my left heel an inch.

I stick these 2 heel lifts together to get the plantar flexion i need (inside the brace) the next brace will be flexed way more

I stick these 2 heel lifts together to get the plantar flexion i need (inside the brace) the next brace will be flexed way more

Anyone have exercise suggestions while recovering from pilon fracture?

While I was in a cast and nonweightbearing I enrolled in a gym that was very similar to a CrossFit gym (no exercise machines just free weights and open floor space to do bodyweight exercises and flexibility work). Those folks put me through a regimen of core work, upper body work & mobility work,  that not only made me feel really good and got the blood pumping but also gave me something uplifting to do.

Since that time, I relocated and, rather than find a new gym, I thought I would get back into bicycle riding and doing other exercise at home.  Of course that’s because I assumed I was almost recovered and ready to get back to my normal life.  Low and behold three months has gone by that I have not done any workouts. My Pilon fracture recovery is taking its sweet time and I am getting flabby and it’s time to start looking for ways to keep the rest of my body fit while my ankle continues to find itself a role in cohabitating with my lifestyle 🙂

 

i’m putting this out there to everybody for ideas on things to stay fit without abusing the ankle. I will round up a bunch of the workouts that I did before and share them because they felt good and they didn’t require a lot of equipment and they were very stable and safe for the week ankle. Most of them were nonweightbearing.

Ankle Fusion – A Good Looking Option After Pilon Fracture

I am becoming more and more excited for the day I can get this ankle fused. My pilon fracture destroyed so much cartilage, as well as the joint surfaces were so damaged, that the healing of the tibial plafond is not allowing the ankle to re-form into any sort of useful joint.  I think folks with ankle fusion have about as much ankle mobility as I do now anyway, so why not eliminate the pain?

Videos like these make me optimistic:

Youtube on ankle fusion after motorcycle accident

Man walking barefoot with fused ankle

Youtube video animation of how ankle arthritis and fusion works

Video of a person’s 1 year post-fusion walking demonstration

Ankle replacement not an option, Fusion needs to wait too

Pilon fracture recovery is all about re-setting my expectations, and remaining hopeful.

I saw Dr Roger Mann and Dr. Nicolas Gay and they both say there is no way an ankle replacement will hold, the bone is only “a 5 out of 10” in quality and could take 1-2 years to “turn over” which means the tibial plafond was fractured in so many directions that the bone is now disorganized and spongy and will need significant time to get itself sorted out and turn to mature hard bone. At that time I can have it fused.

In the meantime I need to baby the ankle joint, keep pain under control however I can, and wear an Arizona AFO brace. I got fitted for the brace on Friday. http://www.arizonaafo.com

The Doc said I may be able to have cortisone shots if my pain gets too bad. But the recommended limit is 3 shots a year, and the shots last about a month. I will wait. For now my boots, advil, and turmeric/ginger/rosemary cocktail seems to get me by.

Getting CT Scan next week to see what can be done with the collapsing ankle joint.

I found a highly regarded specialist and paid for his opinion even though he i snot in my insurance network. I figured he would help me understand my situation (8 month “healed” pilon fracture) as well as it can be understood. The person I saw is Dr. Roger Mann and he said though the joint has lost its space due to cartilage degradation, there may be an opportunity to clean up some bony growth and get me some results.
If not, I am looking at an ankle fusion. He feels I am too young and active for an ankle replacement. Apparently the ankle replacements have a polyurethane bearing surface that will not last long enough for m and I’d ned future surgeries to maintain it. He also said a fusion is a good straightforward fix that will allow me to be pretty active.

I would be very thankful at this point to have a strong-yet-imobile joint instead of what I have now. (Tibia crashing into talus and 0 dorsiflexion.

7 Months Post Op and 3 Months of “Walking”, An Update

Well… my surgeon walked in the room after I got out of x-ray and didn’t look very excited to see me. Her first words were “you’ve lost the joint space, the cartilage is gone. With pilon fractures, there can be total cartilage death after 6 months. This is very typical.” She went on to say that the impact of the initial injury (the talus bone ramming upward and shattering the plafond of the tibia, ripping the cartilage to pieces in the process) leads to cartilage death many months after. In some cases (those luckier than me) the cartilage survives enough t allow pain-free walking and much normal use of the ankle.

I almost cried. While I knew that the likelihood of pilon fracture-related cartilage loss and joint collapse was very high, I was very hopeful that I was going to be one of the luckier patients and get a few years of fun in before I had to deal with arthritis, more surgery, etc.

I tried to convince her that I had some good results from PT, and massage, but she ignored me and said it was time I find a ankle specialist who was skilled in post-pilon fracture treatments, and explore my options. She said my lack of dorsiflexion was from the bone at the front of the tibia hitting the talus, and that wasn’t going to stop happening through more physical therapy. She said ankle fusion or ankle replacement were her assumptions of my next procedure but that it wold not be her that did the surgery (Dr Herzog is a orthopedic trauma surgeon and the person who fixed me up when I came into the ER on March 6th.) (She is also very awesome)

So with this horrible news on my mind I drove home contemplating more surgery and no good thoughts. I have been studying up on ankle fusion and replacement, assuming that was where I’d eventually end up, and the downsides of those solutions had me very sad indeed. While they fix the pain of walking, they are by no means the return to normalcy. I still remember the first time I learned what a pilon fracture really was…and that it spelled the end of running, and in many cases, walking for those of us unfortunate enough to receive this injury.

I see the surgeons this week and I am seeking more specialists to talk to before I take the plunge into more surgery.  I am hopeful that I find some good news.

Not to be a total downer, here is a story about things I CAN DO while hobbling around on this ankle.. https://www.strava.com/activities/413271549/embed/ddf196e6cd9d52343e4c9b9651d9dd63ba126def” target=”_blank”>Click here for a glimpse of the possibilities for those of us with a bad ankle.

My Pilon fracture can't stop the bike riding

My Pilon fracture can’t stop the bike riding. My ankle feels pretty good with a brace and tape. Glad for what I can do.  

Sunsets are just as pretty post pilon fracture

Sunsets are just as pretty post pilon fracture, In fact…I’m glad to be alive

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.

Ankle dorsiflexion limited after 6 months post injury at 2 degrees

Frustrated to say the least, I’ve been full weight bearing for 2 months without boot or crutch but still walk like my ankle is broken. I have shooting pain in the front of the ankle whenever I walk so that I can’t step normally. The side effect is that my knee tries to help by hyperextending a little with each step, causing wear and tear to the knee.

Pt 2x a week, had to change pt because the last one was way too conservative, would not manipulate the ankle, just had me doing gentle exercises. I can do those myself, what I can’t do is get the tib & fib to loosen up or the calcaneous to flex or the tibia to glide over the talus. That’s what my new pt is doing. She gets the whole mess down there to click and clack and flex and loosen up. The goal is to break down scar tissue, and get the joint to move and we are making progress, albeit very small progress.

A big problem for me is the psychology of all this. There is the two-part sadness of day-to-day limitations, coupled with the long term doubts of ever returning to normal. I fear there will be more surgeries ahead as well.

I tell myself that many people get hurt much worse than me and I should be grateful for where I am at but the reality is I can’t comprehend anything but my current situation. I feel very bad

for folks who get hurt worse for sure and there’s nothing ruling out that I won’t get hurt worse in my life from another accident. All I can do is try to stay positive day to day.

It has been 5 and a half months after my pilon fracture surgery

I am still feeling very stiff and sore in my left ankle, primarily in the front of the joint and behind the malleolus. The Dr. and PT say this is expected because the surgery cut through a lot of the fascia in this area. They say the pain should lessen when these wounded tissues loosen up (presumably through PT)

It gets me down because (pilon fractures being so rare) I have few other people to compare my progress to, and I worry that the pain will not get better. I also worry that the doom of arthritis in the ankle will set in soon, or perhaps is setting in.

My wife tells me to give it a year before I begin to worry. I try to not judge.

For now I can not do a calf stretch because the front of the ankle, and the area under and behind the medial malleolus hurt pretty bad.

I find videos of how this injury is caused and how pilon fractures are repaired helps keep me grounded.