Skiing With Ankle Fusion?

[Susie]

It doesn't appear that my pesky ankle will make it through another winter season... though, I may very well try! I am hoping to find someone with personal experience or knows of someone that has skied after an ankle fusion? The reason for my fusion is post traumatic arthritis from a compound tib/fib fracture back in 1997. My ankle joint is bone on bone and now anatomically deforming. My ankle really skis well in it's current state, with the boot like an awesome cast. However, it's everything else like walking and such that has become the bigger issue. That being said, I would hate to lose the ability to ski, which is the one thing I can actually do in its current state. Thus,I would love to speak with someone who has experience with the ankle fusion surgery, recovery, and of course skiing!

 

[Jilly]

My husband had his ankle fused. He used a heel lift in his ski boot to give him more flex in his knee. Best thing he did was get the surgery. He couldn't walk far unless he was in some type of supported boot, like his steel toed work boots or ski boots.

 

[Philpug]

I am paging Robbie Huntoon on Facebook to see if he can chime in. Robbie does have a fused ankle and it's not slowing him down at all.

 

[neonorchid]

I know a 30 somethingish guy snowboarding with it. He does ok, goes pretty much everywhere on the mountain.

 

[Philpug]

Per Robbie Huntoon...

I have a "naturally" fused ankle which is an ankle where the bones have fused due to paralysis. It is essentially the same as a surgically fused ankle. I can ski, bike ride and do just about anything with little limitations. I don't ski like I used to, especially in difficult snow conditions because there is no movement in the ankle but it is really just kind of "oh well". I also have a fused big toe in the same foot. Walking up hill is difficult with a fused ankle because the foot does not dorsiflex (bend up), but you just end up walking duck foot style. Also a normal walk might take a little more lifting of the foot as you don't quite roll over the toes as normal. As for treatment, cortizone shots are temporary for pain management and must limited in number (they tend to breakdown ligaments/tendons), ankle fusion is not a bad option as it takes away pain and is a long term fix, ankle replacements are very successful but they really don't know the long term life of them. Dr. Roger Mann is perhaps the best foot and ankle surgeon in the world and the pioneer of prosthetic ankles, Luckily he is just in Oakland CA. He has treated men anumber of times. I recommended him to a friend who had a painful ankle for decades from a car accident. Dr. Mann did an ankle replacement and she is a new person and very very happy. Be very careful about the doctor chosen for ankle replacement, it is a difficult surgery, FYI Dr. Roger Mann is soon to retire. He also has a son (Jeffery) who is a foot and ankle Dr in the same office. I have experimented with countless ski boot mods, as it has been 21 years of ankle fusion. I have tried in boot heel lifts, external boot heel lifts, toe lifts, cants, behind the calf shims, in front of the calf shims etc. I basically came down to the idea that artificially tilting the lower leg forward through heel lifts or behind the calf shims in the boot is the best thing. Since the ankle does not bend this is a way to get the knee in a more forward, over the front of the boot/ski position. Some boot fitters will say that a toe lift (called a gas pedal shim) will get more power into the shin and front of boot/ski. In a normal ankle this is true but with a fused ankle it actually sets the lower leg in a more rearward slant. Ankles are extremely important, those two little joints hold us upright and are the key to balance. Without ankle movement it is not possible to balance on that one leg. If you cross country ski the effect is bigger than downhill skiing because without balance on one leg there is very limited glide, I guess it would be the smae for ice skating etc. Hope that helps, sorry to hear of your ankle difficulties

Robbie is a good friend, and ski buddy. He was Harkin Banks stunt double in Hot Dog:The Movie. Skiing with Robbie, you wouldn't know that he has a fused ankle.

 

[Susie]

Thanks everyone for the helpful insights!

 

[Kneale Brownson]

I have a friend with a fused ankle from an accident when he was a kid who skis well enough to have been a PSIA examiner. I think he uses some form of heel lift in his ski boot.

 

[surfandski]

Hi Susie, sorry to dig up an old thread but I didn't see much information posted here and wondered if you ever went through with your ankle fusion and how it has affected your skiing? I think I can hold off awhile before needing mine fused but I've thought it meant the end of skiing as I know it so I'm glad Phil and others commented that it's not a skiing death sentence like I assumed. My ankle feels pretty good skiing but I've been especially active lately skiing, mountain biking and riding motocross and I've angered it enough recently that I'm in pain just walking around the house. Honestly I'm hoping I can make it 9 more years until my son is 18 so that I can be as active as possible before the fusion but it's a tradeoff because it means dealing with the everyday pain of walking. I'd love to hear your experience if you went through with the fusion and what changed with your skiing.

I'd also like to know from some of the experts here what all changes for a skier post fusion. Are most people still able to use their pre-surgery front entry boots or is it necessary to switch to something like a Full Tilt. Do you have to request the surgeon fuse it in a specific angle that is optimal for skiing? God willing I have plenty of time to research this but today was a particularly bad day thanks to going way too gnarly mountain biking in NC yesterday. Next ski season can't get here soon enough!

Thanks!

 

[Philpug]

I actually saw @Susie out there on the hill today!

 

[Susie]

@surfandski... I had my ankle fusion back on August 23, 2016. I skied for the first time, with the help of Achieve Tahoe back on March 3. Since then, I've skied just a handful of times for a few hours each outing and with the assistance of outriggers. From a fusion standpoint, my ankle bones were fully fused by mid February. However, I had developed a nerve condition a few weeks after surgery, and it has not fully resolved yet. Hence, the use of outriggers at this time. I do expect to be fully functional by next ski season.

From a skiing standpoint, I actually have more flexion with the ankle fusion than before it, though the motion comes from different joints. I think once I get full feeling back in that leg, skiing will be fine. While I haven't yet been able to fit in my very low volume plug boot (Lange ZJ+), I've had no problem getting in and out of my standard boot (Lange RS 120).

I'd be happy to share my experiences before and after and with the recovery itself. As far as skiing goes though, I think things will eventually be just fine with the fusion.

 

[Skidad63]

So far so good on my ankle replacement. I'm skiing day 6.... 5 months after surgery. It was a hard decision between fusion and replacement, but my surgeon told me I would be happier with a replacement, and I could still ski. So far so good.

 

[surfandski]

@surfandski... I had my ankle fusion back on August 23, 2016. I skied for the first time, with the help of Achieve Tahoe back on March 3. Since then, I've skied just a handful of times for a few hours each outing and with the assistance of outriggers. From a fusion standpoint, my ankle bones were fully fused by mid February. However, I had developed a nerve condition a few weeks after surgery, and it has not fully resolved yet. Hence, the use of outriggers at this time. I do expect to be fully functional by next ski season.

From a skiing standpoint, I actually have more flexion with the ankle fusion than before it, though the motion comes from different joints. I think once I get full feeling back in that leg, skiing will be fine. While I haven't yet been able to fit in my very low volume plug boot (Lange ZJ+), I've had no problem getting in and out of my standard boot (Lange RS 120).

I'd be happy to share my experiences before and after and with the recovery itself. As far as skiing goes though, I think things will eventually be just fine with the fusion.

Thanks for sharing your experience and so sorry about the nerve condition you've experienced. I tell you, the nerve pain I went through during my recovery was way worse than the pain in the bones themselves and those nerves take so long to heal. Heck, I'm 2 years post op and still get zingers where it feels like I'm getting electrocuted. I'll be excited to hear back how it's going next season so please update us as you progress. Speedy recovery!

 

[surfandski]

So far so good on my ankle replacement. I'm skiing day 6.... 5 months after surgery. It was a hard decision between fusion and replacement, but my surgeon told me I would be happier with a replacement, and I could still ski. So far so good.

That's good to hear and I'll be interested to see how your ankle does long term. I inquired about an ankle replacement but the surgeon and PT both said no way for someone my age (43). Supposedly, with the current technology they wear out too quickly in such an active person and I'd be going through new ankles every 2-3 years. Of course, technology changes faster than some surgeon's experience so this is good news that your surgeon felt it was the better option. Where did you have it done? The technology continues to develop but I was told it would never get to how knee replacements are because of how complex the multi-axis ankle joint is plus it bares so much body weight. I'm very encouraged that you are skiing on a new ankle.

 

[Skidad63]

I will be interested in the long term performance as well. Even though I have the surgeon's blessing, I still feel like a guinea pig. If you think about it, my ankle sees a lot more motion riding my bike, then it does skiing. The things that effect my ankle skiing, are hard (frozen) pack, and gloppy thick snow, and bumps. Skiing groomed and good powder, and smooth corn snow is not a problem. I'm sure some of this will get better with time, as my ankle continues to strengthen. I can pretty much ski anywhere.... carefully. I had it done in Walnut Creek Ca at Muir Orthopedic.

 

[Don Duran]

Dec 2015 I shattered my right ankle. By April 2016 I was back in a ski boot and slowly sliding in the beginner corral. Two hours was too much and it made the ankle swell and ache for a month. By fall I was skiing and teaching with very little restriction but not without two Aleve an hour before line up. Hard impacts are still causing shooting pains and require a few days of recovery. I find some ice and elevation nightly manages the swelling but I can tell more PT is needed. So even though I regained 94% RoM my Ortho warned me that arthritis is going to be come a big issue over time. The only way to maintain ankle function is to continue doing my rehab work daily. What I didn't expect was the alignment issues adding wear and tear to the right knee and the left hip. Body balancing exercises have become a second type of gym exercises added to my regimen.
As far as equipment, many of our coaches with ankle issues have recommended Apex boots but I love my race boots and in spite of them causing a lot of pain I am still using them. I may be forced to switch if that pain persists next fall and if like my peers it allows me to still teach our high end bump lessons without the pain I most likely will get a pair.

 

[surfandski]

I will be interested in the long term performance as well. Even though I have the surgeon's blessing, I still feel like a guinea pig. If you think about it, my ankle sees a lot more motion riding my bike, then it does skiing. The things that effect my ankle skiing, are hard (frozen) pack, and gloppy thick snow, and bumps. Skiing groomed and good powder, and smooth corn snow is not a problem. I'm sure some of this will get better with time, as my ankle continues to strengthen. I can pretty much ski anywhere.... carefully. I had it done in Walnut Creek Ca at Muir Orthopedic.

I know what you mean about soft snow vs hard. I was out in Colorado the 2nd week of April during freeze/thaw cycles and early morning was really painful skiing the refrozen reef to where I was wincing in pain every turn. Once it softened up I felt almost no pain even steep off-piste. We have a big trip planned next year to spend the winter in Colorado (already purchased multiple season passes and rented a house) and I figured I wouldn't have to make any decision with my ankle before that trip but the last few weeks have been very painful.

I'm now starting to wonder if I'm going to even make it to next winter before needing to do something as the joint seems to be deteriorating fast. I'm sure it's the impact from riding motocross and mountain biking over roots and rocks that is jarring the joint because it flares up after these activities. I either stop all that activity and hope that I can make it to next ski season where it should be ok once locked in my stiff race boots or I get it fused this summer so that I'm able to ski next year. Ideally I can wait until after next ski season but I just don't want to find out a couple weeks into the season that it's unbearable because we will have already spent thousands on family season passes and house rental and closing down my business for the winter so if I can't ski, it will be a tough pill to swallow. Plus the whole purpose of this trip is to teach my 8 and 12 year olds to ski (they got introduced to it this past winter and loved it the 5 times the went in NC) so I guess I could at least ski greens and blues on one leg if need be.

I'm sure with enough ibuprofen I imagine I could get by but I know how bad that stuff is for me. I suppose being in Colorado I could always try medicinal as I've heard that can alleviate joint/nerve pain but I've never tried it so I have no idea. A month ago I figured I had 5-10 years before needing to do something with this ankle but things have sure changed quickly and it has me nervous for next season. I wish they could just someone numb that nerve in the joint.

 

[Pierre]

I always read these types of threads because I have been through so much with my wife's condition. Always looking for ways to cope. In 2012 she had a triple arthrodesis of the left foot and the same on the right foot in 2014. Still has some pain on right foot.

 

[Skidad63]

I know what you mean about soft snow vs hard. I was out in Colorado the 2nd week of April during freeze/thaw cycles and early morning was really painful skiing the refrozen reef to where I was wincing in pain every turn. Once it softened up I felt almost no pain even steep off-piste. We have a big trip planned next year to spend the winter in Colorado (already purchased multiple season passes and rented a house) and I figured I wouldn't have to make any decision with my ankle before that trip but the last few weeks have been very painful.

I'm now starting to wonder if I'm going to even make it to next winter before needing to do something as the joint seems to be deteriorating fast. I'm sure it's the impact from riding motocross and mountain biking over roots and rocks that is jarring the joint because it flares up after these activities. I either stop all that activity and hope that I can make it to next ski season where it should be ok once locked in my stiff race boots or I get it fused this summer so that I'm able to ski next year. Ideally I can wait until after next ski season but I just don't want to find out a couple weeks into the season that it's unbearable because we will have already spent thousands on family season passes and house rental and closing down my business for the winter so if I can't ski, it will be a tough pill to swallow. Plus the whole purpose of this trip is to teach my 8 and 12 year olds to ski (they got introduced to it this past winter and loved it the 5 times the went in NC) so I guess I could at least ski greens and blues on one leg if need be.

I'm sure with enough ibuprofen I imagine I could get by but I know how bad that stuff is for me. I suppose being in Colorado I could always try medicinal as I've heard that can alleviate joint/nerve pain but I've never tried it so I have no idea. A month ago I figured I had 5-10 years before needing to do something with this ankle but things have sure changed quickly and it has me nervous for next season. I wish they could just someone numb that nerve in the joint.

The last season that I skied on my ankle, I got a cortisone shot in my ankle at the beginning of the season. Initially it helped ALOT, but by the end of the season my ankle,was done. You might get a cortisone shot before your trip to get you through. My shot last for about 3 months.

 

[surfandski]

That's a good idea. I'm going to schedule another appointment to see if they can scope the ankle or at least go in to see what is the problem. I've had many x rays, bone scans, mris, etc and they can't see anything causing an issue in the joint yet something is wrong in there. With all the metal in my Tibia they really couldn't see much in the mri but I'd love for them to go in with a camera and see what the issue is.

The frustrating thing is we've already bought multiple season passes for the family, 8 new pairs of skis for the 4 of us and paid to rent a house next winter assuming that my ankle would be find based upon how if felt skiing a month ago. Now, only a few weeks later after a lot of outdoor activity, I'm wondering if I will even make it to the ski season without some sort of surgery. Based upon how it swells up after mountain biking or motocross for a couple days, I don't think there is any way I'll be able to ski 5-6 days a week next year.

If a cortisone shot or something could get me by for a couple of months that would be great as our goal with this trip is to get at least one legitimate ski season in with the kids before my ankle is toast.

 

[surfandski]

It's been a while so I wanted to check in with Susie and others to see how things are progressing. How have the ankles been doing skiing this year? We were supposed to leave for Colorado for our 2 month "last hoorah before ankle fusion trip" a couple days ago but my ankle has been so bad the past month that my Dr and I have been going back and forth about having surgery before hand. I finally left his office just a couple hours ago and he gave me a 2nd cortisone shot (first one last week did nothing) and a prescription for heavy anti-inflamatories and pain meds as he thought it would be safer to just fight thru the pain as opposed to the risk of even a minor surgery to try to grind down the bone on bone issue.

It's been an emotional roller coaster as we went all in buying multiple season passes and renting a house based upon the assumption my ankle would hold up until after the trip but I just ran out of time before the joint deteriorated. Hopefully this 2nd cortisone shot and meds will allow me to push thru it and we will definitely make the most out of this trip regardless as my 9 and 13 y/o kids are so excited to get out of Florida and head to the mountains.

No matter what I will be having surgery when we get back in March. My surgeon who worked at the VA hospital for a long time said my ankle is very similar to soldiers who have stepped on land mines. He has done a lot of both fusions and replacements and said in my case the fusion is the way to go because of all of the hardware in there and because my Talus is now sloped either from wear or the injury. A 3rd option is amputation and a prosthetic which sounds crazy but he said he could fix me up with great mobility but that's a little more than I'd want to try before giving the fusion a go.

So Susie and anyone else with experience, is there a specific angle that the surgeon recommended doing the ankle joint at with skiing in mind? Skiing is obviously important but I also do a lot of cycling and hiking in and out for kayaking and I understand that going up hill is tough with a fusion (can't be worse than now where I'm painfully walking on my tippy toes to avoid dorsiflexion) so it would be good to find out what angle is best for what sports as I'd hate to fuse it more flexed for skiing if it makes other things more difficult. My surgeon is neither a skier nor has he done any fusions in other than the normal 90ish° angle so I'm curious if any "ski Dr's" would do it differently. I wish their was more information out there on ankle fusions for active people. Regardless it will be a huge improvement over wincing every step I take now.

I'm excited that Colorado finally got some snow and I'll be making some turns in a week......albeit mostly on only one leg.