Ankle injured in a harsh lead fall

Today I was out sport climbing and took a short, but harsh fall and spiked into the wall pretty hard. When my foot impacted the wall, it hyper-dorsiflexed (the top of my foot and toes came closer to my shin than they should have).

At the time, it was barely painful and I continued to climb for a good half hour afterwards with only very minor discomfort, but within one hour of injury, it was quite tender. Now I can't weight my foot at all. There is no discomfort whatsoever unless I'm weighting my foot and I have pretty much 100% range of motion in all directions. No deformity and no swelling or discoloration either.

Any ideas?

I've been hitting the RICE routine pretty heavily. Going to get X rays in the morning, I'm just curious to hear perspective from climbers because this strikes me as a fairly uncommon injury. It wouldn't be the first time I had a climbing-specific injury misdiagnosed.

I had a similar thing happen almost 2 months ago except add that i inverted my foot as well as dorsiflexed it. I couldn't climb on it immediately afterwards but i did retrieve my gear and hike out on it. Had very minimal swelling with no bruising of any nature. I braced it up and could barely walk for the next week or so. Had X-rays with no broken bones after a few days to get some piece of mind. Seven weeks out, i still have instability and some discomfort in the ankle but am back climbing and biking, with running and mtn biking starting in a week or so.

Take it slow, lots of ligaments down there...most of the time from what i've read, just takes time to heal. Probably stretched or partially tore one of them..most common in ankle sprains is the Talofib but there are plenty of other ones to tweak.

Keep on RICEing it and do your best to stay off it. Try writing the alphabet with your foot to maintain that range of motion.

T

Jon H- I had a very similar fall this weekend. I took about a 20 foot whipper onto some gear, and hit the wall pretty hard with my ankles. Finished the climb, brought up my second, then we rapped down. It wasn't until I was on the ground 30 min or so later that I realized I was injured. Still walked out, and am hobbling around less than 48 hours later. Have not been severely hampered by it, but it hurts in some positions.

Can you tell me what came of your injury? Did it resolve itself with time, or did you need brace/crutches/etc? What did your X-rays show?

Thanks!

Did the same thing two years ago in Tahquitz. There's an algorithm for broken ankles that my ER doc buddy walked me through via phone the next day; you can find it on the internet (it's three questions which, if you answer them all in the affirmative, you have a 95% chance of no breakage). I had no break, but it took me several weeks to be able to bear full weight. Even then, it was painful. I limped around for about a month or two. It took about a year for the ligaments to feel OK enough to run on, and it's only been in the past 6 months or so that I feel like everything is about back to its pre-fall state. Take it really easy. RICE it. Don't push it. If it's what I did, ankle functionality will ultimately come back, but baby the heck out of it until then. I took a month-and-a-half off climbing. First couple times back on a wall were pretty painful.

Here's the ankle algorithm-- called the Ottawa rules: en.wikipedia.org/wiki/Ottaw…

My ER doc buddy tells me he's never seen one that passed the Ottawa rule actually show a break on X-ray, so I just passed on the radiation and the hospital/doc $$. Not to say it couldn't happen, but . . .

Thanks for your post Jonny d- that's very helpful! Based on the ottawa rules, I don't need an x-ray. I am going to keep babying it (crutches, ice, rest) and see how things progress. Sounds like you had quite a long recovery, but I'm able to fully weight bear, so maybe my injury is not as extreme. Thanks again, and glad you're able to get back at it.

I'd forgotten all about this thread... gave me a chuckle to see it at the top of the "What's New?" page.

I'm back at 100% since the accident. It was quite some time ago so my memory is hazy, but I can definitely recall not being able to weight the ankle whatsoever. I don't think I left my apartment for 4-5 days... I was hopping around using furniture for balance. Driving was out of the question.

I never wound up getting X-rays. Had a phone conversation with a doctor buddy who surmised that it wasn't broken, but I went to the ER anyway. There was going to be a 3-4 hour wait, so I just went home and that was the end of it.

I recall using NSAIDs, ice, and elevation for just under a week, and after that, just wrapping with an ACE bandage and being careful. I figure it was back to 95% within 2 weeks of injury, and at 100% by 3 weeks.

In skateboarding i used to do that all the time. Usually it made me walk funny for a few days and would eventually heal up. If its anything like mine it should heal up in a week or two. I used to stretch it the other way (extremely painful) reaaaallly slow every now and again to keep it from tightening up. Ice.

...of course im no doc. Good luck though!

EDIT: Juss realized this was from Jan. Read your new post... Happy it worked out!

Great! Thanks Jon! That makes me very hopeful. I can handle three weeks. Here's to hoping for a short recovery.

I had the same injury many years ago from jumping off a boulder onto the ground - hips, knees, and ankles flexed, but my heels stayed pasted to the ground. Hurt like an SOB on the hike back to the car, but healed up completely in a short enough time that I don't even remember how long it took. Zero lingering effects.

If you fractured your talus [and there are many ways to fracture it], you could really f your ankle up if you dont get it treated. As in, f it up, really, really badly.

Get some x-rays for sure. Wouldn't it suck if your injury wasn't like these people that recovered fine and you ended up with a fused ankle 5 years later?

RICE, xray, take it easy. props for keep going but sometimes taking it easy works the long run. have fun be safe, feel better

Jon H wrote:I'd forgotten all about this thread... gave me a chuckle to see it at the top of the "What's New?" page. I'm back at 100% since the accident. It was quite some time ago so my memory is hazy, but I can definitely recall not being able to weight the ankle whatsoever. I don't think I left my apartment for 4-5 days... I was hopping around using furniture for balance. Driving was out of the question. I never wound up getting X-rays. Had a phone conversation with a doctor buddy who surmised that it wasn't broken, but I went to the ER anyway. There was going to be a 3-4 hour wait, so I just went home and that was the end of it. I recall using NSAIDs, ice, and elevation for just under a week, and after that, just wrapping with an ACE bandage and being careful. I figure it was back to 95% within 2 weeks of injury, and at 100% by 3 weeks.

I mean this with total respect, but you should politely request that your belayer learn to catch more softly and jump with the catch right as you are about to pull the rope taut; if he/she declines or decides to give you attitude, find a new belayer. I almost injured my good friend before he told me the technique for eliminating the shock loaded force. I view a hard catch like this as entirely the belayers fault and something which can seriously reduce confidence, even when the bolt is at my waist.

I'm week one into a class 1-2 ankle sprain and I have been able to walk on it the entire time, but with pain. The swelling is still there, but I am hoping this is pretty good after another week like it took when I sprained it two years ago.

From what athletes tell me, it's important to rehab the tendons afterwards to tighten them up so it doesn't roll out again as easily. One friend suggested using therabands.

Like Jon H, I also hyper dorsiflexed my ankle in a lead fall. Being a Physiotherapist, I am very interested in my own injuries, and this is one I haven’t seen in the clinic, hence why I am on this forum. I took the fall 2x in a row with soft catches. For some reason on my third attempt, either my belayer didn’t give a soft enough catch or just having climbed a little to the left, I was whipped very hard into the wall. Most of my fall was broken by the ball of my Right foot which felt hyper flexed. I immediately had quite a bit of pain in the achilles, but ascertained with self tests it is fully intact. As I hiked out I found it increasingly difficult to weight bear into dorsiflexion with pain through the ankle joint. By the time I got into town to go to my clinic the ankle joint was mildly swollen.
My self-diagnosis is that I have a bit of talo-Crural bone bruising from the impact and likely a bit of stretch to the deltoid (medial) ligament. Mild achilles strain.
My treatment will include: To start limited WBAT, crutches for any distance. 
4x cold laser treatments X 3 rounds, to the ankle joint with 1-2 days between rounds, for 12 total treatments 
Heel lifts in both shoes to slightly off load the achilles, and ankle taping to approximate any stretched ligaments X 2-3 weeks Gentle ROM, Standing single leg balance exercises, isometric heel raises on 2-legs to start, progressing to one when able. 
I will post again to inform how this protocol and my healing progresses. Hoping to finish of the season strong still!
FYI: The old RICE formula has been replaced with POLICE (Protect—i.e.: heel raises and ankle taping, Optimal Loading—i.e.:isometric heel raises, ROM, Ice, compression, and elevation) 

Stephanie Skoreyko wrote: Like Jon H, I also hyper dorsiflexed my ankle in a lead fall. Being a Physiotherapist, I am very interested in my own injuries, and this is one I haven’t seen in the clinic, hence why I am on this forum. I took the fall 2x in a row with soft catches. For some reason on my third attempt, either my belayer didn’t give a soft enough catch or just having climbed a little to the left, I was whipped very hard into the wall. Most of my fall was broken by the ball of my Right foot which felt hyper flexed. I immediately had quite a bit of pain in the achilles, but ascertained with self tests it is fully intact. As I hiked out I found it increasingly difficult to weight bear into dorsiflexion with pain through the ankle joint. By the time I got into town to go to my clinic the ankle joint was mildly swollen.
My self-diagnosis is that I have a bit of talo-Crural bone bruising from the impact and likely a bit of stretch to the deltoid (medial) ligament. Mild achilles strain.
My treatment will include: To start limited WBAT, crutches for any distance.
4x cold laser treatments X 3 rounds, to the ankle joint with 1-2 days between rounds, for 12 total treatments 
Heel lifts in both shoes to slightly off load the achilles, and ankle taping to approximate any stretched ligaments X 2-3 weeks Gentle ROM, Standing single leg balance exercises, isometric heel raises on 2-legs to start, progressing to one when able. 
I will post again to inform how this protocol and my healing progresses. Hoping to finish of the season strong still!
FYI: The old RICE formula has been replaced with POLICE (Protect—i.e.: heel raises and ankle taping, Optimal Loading—i.e.:isometric heel raises, ROM, Ice, compression, and elevation) 

So how's going now? I had the similar thing two weeks ago. I've taped it for a week, and still walking around. I was able to do most of the sport climbing with no pain in the 2nd week, but the dorsiflexion is limited due to the pain at the front of my ankle, definitely cannot jam in the crack at that time. But the healing process seems stopped now, that I have no improvement after the 2nd week.

It’s going well, though it got much worse after I posted that. I had a diagnostic ultrasound done by a colleague, which showed partial tear if the interosseus ligament (between tib fib), and tear of the posterior portion of the deltoid ligament.

I have only tested it climbing once and had more pain on the inside where I had deltoid ligament damage.. May try again next weekend. I am doing lots of strength training and skipping rope, to help get back to running, but I can’t run yet. My dorsiflexion is still 1/2 of the other foot. 

Still taping daily to help with approximation of the tib-fib, as I would advise any patient with a high ankle sprain. For you, If it’s only been 2-wks I’d say that is a good thing you’re stiff in DF—you need to lose some range of motion for ligaments to heal. My advice would be, IF/when you can stretch your calf (in weight bearing or not) or do mini single leg squats in a limited range without pain, then do them. Do this test to see (painfully slow) daily progress, which is good to see—if you are overdoing it, as you will go backwards in your range.  youtu.be/rulADo6OOLs