Anyone have their ankle fused?
 

Long term ankle injury, looking like fusion is in my future. Cycling might become an issue. Thoughts?

I don’t know anything about this myself, but remember reading about Bill Walton, both ankles among other things but he still rides.

https://www.denverpost.com/2013/08/1...with-bicycles/

Get a second (or third ...) opinion. Even a joint replacement would be far less drastic.

Mind if I ask the nature of the injury? I'm six years out of an ankle break, but it never lets me forget.

I am one year post an avulsion fracture of my left ankle and while healed by now, it too never lets me forget. :(

I really needed to see that tonight, thank you!

The joint replacement is far more invasive, and nowhere as proven as other joint replacements. But that is a discussion I intend to have...

March of 2017, I was much much heavier. About 360. In the middle of the night, bathroom trip, I somehow rolled my foot under. And sprained the ankle. But now, it looks like I did a lot more than that. I seem to have ruined ligaments and tendons and at that weight, I wasn't able to heal well. Now in my 240s, and losing, It is holding me back from more exercise.
https://cimg5.ibsrv.net/gimg/bikefor...bf85caba5c.jpg
Needless to say, these "blocks" aren't stacked well any more...

I've watched some YouTube videos tonight that show fusion and life after. So I am feeling a bit better about the process. I had my left knee replaced 9 years ago, and need to my right done too. I know pain. I know how to do PT.

https://cimg0.ibsrv.net/gimg/bikefor...24f3d9eb9e.jpg
And of course, I have a complication that needs to be tended to first. The joint circled was damaged more than a few times over the years, the collapsed space meant the big toe was no longer protecting the 2nd toe. Now it has an ulcer that isn't healing after 3 months. I'm going to have the tip removed at the last knuckle joint. Not a fun thought. But I don't see many choices, and damn it hurts right now.

Seriously, the videos I've watched are making me pretty comfortable with the idea. One guy even jogs... The toe? If it heals now, it is only going to do it again at some point. I've already had a staph infection, treating with antibiotics. Last thing I need is a MRSA infection. If it gets to the bone, I could lose that existing knee implant, not to mention the 2 rods and 10 screws in my spine.

There's not that much ankle motion with cycling. I doubt that fusion would interfere. It just sets the ankle at a fixed position fore and aft.

A year ago I was facing ankle fusion due to end stage osteoarthritis with pain too severe to walk comfortably. I was told that ankle replacement was risky and often just a temporary (10 year or so) fix and not a routine procedure such as hip, knee or shoulder replacement.

I had the initial consultation with a surgeon and he asked if I'd want to try an "Arizona Brace", a custom made ankle/foot orthosis (AFO). I did and that gave slight relief. My orthopedic doctor then suggested a newly approved time release cortisone injection called "Zilretta". Previous conventional cortisone shots did nothing. The Zilretta has been truly a wonder drug for me. The pain is gone.

An expensive shot but Medicare will cover up to 4 injections per year. One every 3 months is typical. Website says intended for knees but my doctor used it effectively on my ankle. Also says "not intended for repeat use" but it is now approved for repeat injection.

Not sure if your pain is from osteoarthritis but if so Zilretta is something to consider to avoid fusion.

I'm open to whatever options are available. Considering the Orthopedic center I'm using is with University of Utah hospital, and caters to some Olympic athletes, I'm sure they will have up to date ideas. Even so. I am giving a lot of thought to a third opinion in an orthopedic specialty hospital.

I will get the the AFO brace, and ask about Zilretta. Thank you.

The only cycling shoe I've found that fits over the AFO is the Shimano SPD sandal. That said, I can cycle and walk comfortably from the relief of the Zilretta alone. I continue to use the AFO for extra support.

https://cimg8.ibsrv.net/gimg/bikefor...99a31ff8ec.jpg

Some folks I ride with occasionally have some pretty obvious impediments to cycling, but they manage despite it. One fellow has toothpick legs with atrophied muscles and wears braces. He spins easily and keeps up with most casual group rides of 10-12 mph.

Another fellow appears to have a deformed leg, not really sure of the details. He has some modifications to his shoes or cleats and pedals. It looks awkward but he's young and generally stronger and faster than I am.

Another fellow my age has some kind of knee problem and occasionally flares it outward like a chicken wing. Not sure what the issue is. He's also a little stronger and faster than I am.

I've seen a couple of older fellows using e-assist road bikes too. Kinda fun because when one of them pulls ahead it's very smooth and easy to draft. I've set a few new Strava PRs drafting those fellows on e-bikes.

With orthopod devices, physical therapy, anti-inflammatories and bike mods, you should be able to continue riding. Might just require some adjustments to pedaling style -- spinning easily, and either compromising on a slower speed or using an e-bike to assist on climbs and into headwinds.

I only use cycling shoes on the trainer. I'm terrified of not getting unclipped. Conversely, I always hated toe clips, but might go back to them next spring.

If you are clipped in with the sandals, did you change the cleat position much?

8 years ago, when I broke my back, I thought I'd be needing a tadpole trike. I'm collecting things to build one from Atomic Zombie's website, as a just in case.

I've seen some incredible people, with seemingly debilitating issues, able to ride. My concern yesterday was more wrapped in my own self wallowing. I'm past that now after watching a bunch of videos, and talking with my favorite Physical Therapist. Basically, I have a lot of new questions for any surgeon I talk with now...

I stopped at my local bike shop yesterday, took a fat bike for a spin. I was pleasantly surprised. Might be a good recovery tool...

Those Shimano sandals have rather wide clunky heels so I have the cleats set as far to the inside edge as possible for maximum clearance to the cranks and back towards heel to keep foot directly over pedal spindle and minimize ankle flexion.

They had been sitting in my closet unused as they were a bit too big...had replaced them with the narrower, lighter, more shoe-like Keen sandals. The oversize Shimanos however were just the ticket to fit over the AFO! Thought I might have to use platform pedals with conventional athletic shoes. You'll need slightly oversize street shoes with an AFO also. Teva sandals with velcro straps are a good choice for summer street use.

At size 13 shoes, I'm hoping there is enough extra room in my sneakers. My work boots are probably not going to fit then. I bought some Chaco sandals a couple months ago, and pretty sure there will be room. I'll find out soon enough.

I've only got a couple options in front of me. Do nothing. Use a brace. Seek fusion or see if replacement is an option. Lost way too much sleep this weekend over this. I had less trouble deciding on knee replacement. Or deciding on the other knee. I need the ankle stable before I can get the other knee done.

I understand, especially the occasional wallow. As I often say in passing my neighbors who ask how I'm doing, "Oh, I could complain. Doesn't do any good. But it feels good."

I'm still kinda surprised I can ride a bike at all. My neck and back were broken in a 2001 car wreck. For years I needed a cane to walk. I resumed cycling -- slowly -- in 2015. By 2018 I was able to keep up with the local club B-group pace.

Then I was hit by a car in May 2018, breaking and dislocating my shoulder and re-injuring the neck. My C1 and C2 are permanently screwed up. Feels like bone on bone grinding some days. Took awhile to recover, and a lot of physical therapy. PT is a daily thing now, with massage and stretching at a minimum. Body weight calisthenics about twice a week.

I'm back to B-group pace, and on a good day I can hang for awhile with the A-group although over distance I get dropped. I'm still competitive by nature, but I've learned to adjust my expectations and feel better about just hanging on for awhile, even if I'm not even fast by old guy standards. I'm still the slowest of the strong guys in the 60+ age group. But Strava says I've improved from dead last on every segment in 2016 to the upper third, pretty typical for the 40-60 y/o men and women locally.

Gotta admit, I'm surprised I managed to improve that much. If anyone had suggested in the early 2000s after my first bad injuries that I'd be riding a bike again now, I'd have laughed.

Some days the pain is so bad I can hardly get out of bed and hobble to the bathroom. But even my oldest cat (I think she's 17 now) manages to get out of my lap long enough to hobble to the litter box. She's much older than I am now.

And the good days are good.

Today started kinda slow. Lotta aches and pains. But by this afternoon I'm feeling pretty okay and plan to do a 20-30 mile ride.

Complain? What's that? Hahaaaa... My usual response to how am I doing, is I've been better, but I've been a hell of a lot worse...

Not sure if I'm too stubborn or stupid to know when to stay down! But for the short time I was paralyzed, I can't imagine staying down... (post op swelling on my spine)

After losing over a 100 pounds, it's just good to be back on my bikes. Before seeing positive proof fusion won't make me stop riding, I'm feeling better. My reward bike for my weight loss shows I can be fast... 39 mph in a chase, I didn't catch whom I chased though... And I'm not on the bottom of local club challenges anymore...

Well, that was quick and painless. I got fit for an AFO brace today. I have to wait till nearly Christmas for the brace. After walking on uneven surfaces yesterday at work, I am wondering how the brace, and later the fusion will improve things when I do that. I work in the desert, so, needing to walk on uneven surfaces is pretty important.

brace and ride. you can always explore other options if that doesn't work

I have done just that. A few days in an Air Cast boot...
https://cimg9.ibsrv.net/gimg/bikefor...e22c89386c.jpg
It wasn't easy, but managed...

Just got my AFO brace today...
https://cimg4.ibsrv.net/gimg/bikefor...483796028f.jpg
I hope it fits in more than these shoes, but will have it checked again in 2 weeks. Right now, I feel I could walk a mile. Easy. And yes, I need tall socks in it...

It fits in my cycling shoe!
https://cimg5.ibsrv.net/gimg/bikefor...a8db32de58.jpg
I can lay down some power pain free! Now I need to ask myself, how will this do OUTDOORS...

looks good! pedal on

Had a couple adjustments to my AFO brace today. Feels so much better now. I had a great discussion about possible replacements when it is time. The guy has 44 years experience, And works with world class athletes, and top shelf developers. He mentioned that he worked on my brace based off the initial diagnosis and prescription he was sent. But after talking with me 2 weeks ago and looking at my foot and ankle today, he gave me a few more things to discuss with my surgeon in two weeks. He was more specific which tendons I need to have looked at, especially the posterior Tibial tendon. He also suggested a different strategy of shopping for shoes, something I've been looking into already.

I bought some used cycling shoes to use indoor only. The right one is a perfect fit at size 47 for my right foot. But not the left, for my brace and foot. As a result, I bought them specifically to cut the toe box open...

An update. A few days ago I had bike fit, through orthopedic physical therapy. Specifically for my current ailments and issues with my ankle, brace and some knee pains. Unlike a professional fitting shop, with lots of parts to try on your bike, this revolved about fitting your bike to your issues.

I took my 2006 Cannondale CAAD8, it was fit to their Tacx Neo T2 (I got a glimpse of the value in a smart trainer over my "half smart" trainer!). I was evaluated for mobility, flexibility and stretching. Then we got to the bike.

In short, I'm not really doing anything wrong. It might be in my interest to use a shorter stem, maybe 10mm less. Proved I'm not rocking in the saddle like I thought I was, so I CAN raise my seat a little. Strongly suggested I switch my 53/39 crankset for 50/34 and choose shorter crank arms. The shorter arms are as more for my AFO brace than anything else. The next one is to swap to larger flat pedals. Think, BMX and downhill style with the pins for gripping your shoes. And a more midfoot position over the pedal spindle. The larger pedals support the foot, and provide stiffness, instead of in the shoe. I've watched a bunch of videos, and there is a lot of merit. Oh yes. Learn to spin more. More than I have so far. Too bad I'm not especially a fast twitch muscle sort of guy...

Changes made to my CAAD8 will be reflected on my bike on the trainer (52/42/32 and 175mm arms), and my other roadbike (which is already compact and 165mm crankarms)...

Then I had my consult with the surgeon. Ligament and tendon damage is not easily repaired, would take longer to heal, and require more time non weight bearing, than fusion. Due to the tendon damage, and my age and activity level, ankle replacement is not a good option either. It still has a high failure rate, and is nowhere near the maturity of process as knees. On the other hand, as long as I am doing ok with the AFO brace, there is no rush to fusion. As long as I can tolerate it. He does want to see new xrays in a year if I wait that long or longer. I think this buys me time for my right knee replacement first.

So. Not a bad day, not a great day. But tons of great info. Now, to take all that I learned, and do something with it.

In case anyone was on pins and needles to see how this tale progressed... An update.

I hate the AFO brace, but it does what it is meant to and I tolerate it. I can not walk well without it.

Last summer I had a follow up with the ankle surgeon and asked about replacement versus fusion. He really doesn't think replacement is a viable option. But didn't explain why. Regardless, he wasn't interested in working on the ankle until I got my right knee replaced. Which I had done October of last year. Which set up a discussion with my knee surgeon.

My knee surgeon gave me the names of two surgeons HE sends ankle people to (he doesn't do the more involved surgery I need...). He also explained that perhaps, I'm not a good candidate for ankle replacement because I am younger and fairly active. Ankle replacement is not a very mature process and isn't very robust, compared to knees and hips. OK, now I have a clearer understanding.

Took some time to get my insurance to agree with my desire to see a specific surgeon for my pending ankle fusion. Not sure this debate is complete yet though. I do have a surgical consult next month with one of the two surgeons my knee surgeon suggested. I'm anxious, nervous and ready...

zjrog- I moved my post from the knee thread over to here for continuity with the previous discussion ...

Well 1 1/2+ years after originally posting above, my injections stopped working. I had successful arthroscopic fusion surgery on May 25. I'm recovering now after 10 days in a splint and 30 days in a cast. I'm now in a removable boot for another 4 weeks.

I'll be on crutches/scooter + boot until July 20. At that time crutches get discarded. On August 3 the boot comes off and I can wear real shoes. At that time I'm permitted to ride a stationary bike on trainers. The next x-rays on August 13 will tell if fusion is complete enough for normal road/trail cycling.

The procedure was totally pain free. I was prescribed narcotics for the recovery but never had to take them. Just a little tylenol. I foresee no issues returning to normal cycling when fusion is complete. I'm not permitted to put full weight on the ankle until next week but I have zero pain at this time. Being the left ankle I was allowed to drive just a few days after the procedure as I wasn't taking narcotics.

I just thought you might like to know a possible scenario should you have to proceed with fusion. I'll post an update after the August x-rays.

I'll take all the positive news and experiences I can get!

@BobG I've allowed my weight to crepp up these past couple months. Only 10 pounds. But I'm envisioning that losing more weight will hopefully make recovery easier. I had gastric sleeve surgery almost 3 years ago, lost nearly 140 pounds. I've found a comfortable spot in the 240 to 250 range. I had never set a real weight loss goal, other than healthier, more active and off meds. All of which have been met.

225 to 230 seems reasonable. I do have a high protein and fiber, lower carb diet. But considering stricter measures, and Hopefully not jeopardizing healing later on.