Talus fracture and partial displacement, healing advice and support

Blakevanwrote:

Kevin, ouch!  Hang tight and heal up.

Anyone have suggestions for an ankle brace?  My PT guy asked me not to wear one while I was still healing but wondering if now ~18 months post it will help a little while hiking.  Just support and something small and light would be the ticket.

This is similar to what I have ( sourceortho.net/tour-quick-…;gclid=EAIaIQobChMI1N74wqz_6gIVRdbACh1ntQZ9EAQYDyABEgIlW_D_BwE). The lace up with velcro (yay no tying) and with side supports is highly adjustable and definitely provides good support/stability. I only chipped my talus in January and was mainly treated for the severe sprain. I was non weight bearing for 4 weeks, 4 weeks in walking boot, then 4 weeks in this brace and now I only wear it for big hikes or hikes on uneven terrain and then of course while climbing. Its probably a little more than you're looking for but I really like it. 

Thank you and that looks about what I was thinking.

Blakevan, if you're looking for a minimalist/low profile ankle brace, check out the Aso Vortex: https://www.dme-direct.com/medspec-aso-vortex-ankle-stabilizer.

The ankle brace listed above is fine for an acute injury or a highly unstable ankle, but is overkill if you need just a little bit of light support. 

Thank you.  The hardest part seems to be finding the measuring tape.  Need to raid the sowing box.  :)

Samantha Shiellswrote:

What’s up talar team. I didn’t like the prognosis described above for obvious reasons so I found a different doc. He says my pain is coming from the damaged cartilage (seen on MRI) and consequent fluid leaking into the bone. He recommends an OATS procedure, where he’d use bone and cartilage from my knee to replace the useless stuff on my messed up talus. He says this has great results but long term prognosis unknown since it’s a somewhat new procedure. It’s also not covered by insurance, so would be 8k out of pocket.

Has anyone had an OATS on the talus? How’d it go?

Hi Samantha. I’m sorry to hear about your injury. :/ I got an injury that sounds similar to yours back in 2002. Mine was also diagnosed as a sprain, and then 9 months later when I was still having pain the doc said I had something or other that resulted in some AVN and cartilage detachment/ damage. I haveN’t had OATS, but it’s not new. They were doing them back when I got my injury, but some of the bio materials they are using now are newer and I know insurance doesn’t usually cover them. And I do think OATS was always a little harder to get covered...

Did you end up having the surgery? If so I hope you’re healing well. I’ve had 4 surgeries on my ankle over the years and figure I’ll probably have more. 3 microfracture and one bone graft into my tibia because of a cyst that formed due to lack of cartilage cover. Sometimes I wonder if I had had the OATS if I would have had a better outcome, but it wasn’t clearly indicated in my case so who knows.  If you haven’t had the surgery yet, there are a lot of free articles on pubmed.gov about the procedure and new research in the area if you’re interested in that kind of thing.

Quick update. I'm 11 weeks out from my surgery and just got news that everything is looking good and I can start weight bearing in my walking boot. The pain has been pretty manageable for quite a while now, only periodic ice needed for the last month or so. I have 4 weeks in the walking boot then hopefully I can get back into normal shoes. I may need to look at getting some hardware out at the 6 month mark but that is TBD. 

Edubswrote:

Hi Samantha. I’m sorry to hear about your injury. :/ I got an injury that sounds similar to yours back in 2002. Mine was also diagnosed as a sprain, and then 9 months later when I was still having pain the doc said I had something or other that resulted in some AVN and cartilage detachment/ damage. I haveN’t had OATS, but it’s not new. They were doing them back when I got my injury, but some of the bio materials they are using now are newer and I know insurance doesn’t usually cover them. And I do think OATS was always a little harder to get covered...

Did you end up having the surgery? If so I hope you’re healing well. I’ve had 4 surgeries on my ankle over the years and figure I’ll probably have more. 3 microfracture and one bone graft into my tibia because of a cyst that formed due to lack of cartilage cover. Sometimes I wonder if I had had the OATS if I would have had a better outcome, but it wasn’t clearly indicated in my case so who knows.  If you haven’t had the surgery yet, there are a lot of free articles on pubmed.gov about the procedure and new research in the area if you’re interested in that kind of thing.

Missed this reply so apologies for the delay!

The misdiagnosis part really sucks! Sorry you had to go through that as well; it is incredibly frustrating. And four surgeries, yikes! Did the surgeries help at first but then fail later? How are you doing now?

I did go in for the OATS. I got a couple of additional opinions - none of which agreed that the OATS was the best approach, actually - and did a lot of the fun pubmed research you mentioned (I am interested in that kind of thing!) and ultimately decided it would be worth it in the long run. It is not covered by insurance but I was able to negotiate down the price.

However, when the surgeon actually got in there, it wasn’t as bad as it had looked on MRI. Instead of one big hole in the cartilage, I had a number of smaller holes that weren’t suitable for OATS. I’m honestly not even sure the name of what he did. On my chart it just says “talar OCD repair”. He described it as cleaning up the cartilage and injecting stem cells taken from my hip to promote healing. Biocartilage maybe?

I’m a little over three months post op. I’m not quite at the point yet where my ankle feels better than it did before the surgery - I still have swelling and some pain while walking - but it’s getting better as I continue PT and my muscles strengthen. Doc says that my level of progress is normal and max improvement isn’t reached until 12 months, so I have a ways to go. He is also confident this will last forever (surgeons are always so confident!) Notably, if I press on the spot where the OCD was, I no longer feel pain, so I’m hopeful that’s a good sign.

Happy to share more about the various opinions I got and why I chose this option. And of course I will update here as the healing progresses!

Marisa Shapirowrote: Hi Court,
I am 14 months post type 4 talus fracture and seem to be having some similar issues as you. I also can't seem to make much progress with dorsiflexion. I've been doing the same exercises you mentioned above, along with a PT manually distracting the joint to try and break up adhesions. I am still at 0 degrees for dorsiflexion. Unfortunately, that makes me limp pretty significantly, which affects my hips and other leg. I have 2 plates and 9 screws in my ankle, and I've decided to have them removed in the next month or so. Likely some of the pain I'm still having is related to the plates digging into my malleolus, plus the surgeon thinks I "have a 50% chance" of regaining some ROM with the hardware removed. My fingers are crossed!
Side note - I had avascular necrosis of the talar dome for for most of the past 14 months, but it is actually is getting better. The AVN is barely visible on an x-ray anymore. For anyone who has AVN... there is hope that the bone will revascularize. I was non-weight bearing for 5 months,  then "limited" weight bearing for another 5 months to try and keep the bone from collapsing. It sucked, but it was worth it. 

Marisa, did you get the hardware removal yet? If so, have you seen any improvement in the ankle (mobility or otherwise), or is it too early to tell? I'll be at the one-year mark in a couple weeks and will see my surgeon so any insight into what questions to ask or what to consider regarding hardware removal would be great to have if you're willing to share here or by messaging me separately.

Kevin L, you mentioned possible hardware removal at the six-month mark - any details that you can share regarding your surgeon's advice on getting them out? (Also wow - two talus fractures/surgeries...)

General update as someone about a year out from surgery: I can hike decently steep terrain (did Angel's Landing recently) and for decent distances (8-9 mi). It's pretty comfortable until around four or five miles, when the ankle doesn't necessarily start hurting but I do start feeling it a bit - maybe more like swelling that reduces joint space/restricts mobility, combined with fatigue as my entire right leg is still regaining strength. Pre-hike and mid-hike mobilizing, hiking poles, compression sock, and going at a moderate pace all help. Mobility is still limited off the couch but it definitely mobilizes more quickly compared to when I wrote in a few months ago. Sometimes the mobility remains for a good bit after working on it; other times, it seems to return to stiffness very quickly. I can jump around for PT exercises and have taken small lead falls on vertical or slightly overhanging walls without issue but have yet to take a bouldering fall (partly due to the mental hurdle, and partly due to still working on the right leg strength so I can land evenly when I do fall).

Hope everyone's recoveries are going well. This injury is a rollercoaster of good days and bad days but stick with the PT and work on whatever else you can while you heal. It's an opportunity to come back stronger and better not just as a climber/athlete but as a person.

I had a visit with the doctor on Oct. 16th and got full clearance to go to normal shoes and ditch the walking boot. The doctor was pretty happy with the look of things and said I can work my way back into normal activity and impact over time. I just need to balance pain and swelling with activity levels. I don't have any other follow ups scheduled unless I start running into issues with range of movement or pain. He said there is still a fair bit of inflammation in there so I won't really know if there is an impact from the hardware or just a nature of the injury for a few more months. He said I should for sure know if the pain is from hardware at the one year mark and he'd avoid getting it out unless it's really bugging me, in his words it is "certainly not something to do electively". 

My PT has recommended that I avoid plyometrics and much impact until I'm able to do 30 consecutive single leg calf raises on it and a stable single leg squat (with a bar to stabilize on, not a full pistol squat). Has anyone else heard any metrics to use before/as getting back into higher impact activities?

Kevin Lwrote:

I had a visit with the doctor on Oct. 16th and got full clearance to go to normal shoes and ditch the walking boot. The doctor was pretty happy with the look of things and said I can work my way back into normal activity and impact over time. I just need to balance pain and swelling with activity levels. I don't have any other follow ups scheduled unless I start running into issues with range of movement or pain. He said there is still a fair bit of inflammation in there so I won't really know if there is an impact from the hardware or just a nature of the injury for a few more months. He said I should for sure know if the pain is from hardware at the one year mark and he'd avoid getting it out unless it's really bugging me, in his words it is "certainly not something to do electively". 

My PT has recommended that I avoid plyometrics and much impact until I'm able to do 30 consecutive single leg calf raises on it and a stable single leg squat (with a bar to stabilize on, not a full pistol squat). Has anyone else heard any metrics to use before/as getting back into higher impact activities?

I don’t have any exact metrics. My PT had me doing supported high-step marches in place, which I was not able to do without pain unless I moderated the impact, which told me I’m not ready for running quite yet (4.5 mo post-op).

I’m thinking of trying an AlterG treadmill (my PT doesn’t have one but they have another location that has it). Has anyone used or heard of that? Seems like a good way to get back into high impact activities.

No metrics but my body certainly tells me what I can and cannot do.  I wasn't able to run again until almost 1.5 years and then it's really just a fast walk but hell I'll take it.  I've been able to hike about 5 miles depending on terrain and while it hurts towards the end the next day is typically just fine.

All you young'ns should keep this connection.  As an older guy who has broke my share, with less than now knowledge, I want to warn you.  Stay active, push off the hurt, and expect the pain to come back in one form or another.

Court Ewrote:

Marisa, did you get the hardware removal yet? If so, have you seen any improvement in the ankle (mobility or otherwise), or is it too early to tell? I'll be at the one-year mark in a couple weeks and will see my surgeon so any insight into what questions to ask or what to consider regarding hardware removal would be great to have if you're willing to share here or by messaging me separately.

Kevin L, you mentioned possible hardware removal at the six-month mark - any details that you can share regarding your surgeon's advice on getting them out? (Also wow - two talus fractures/surgeries...)

General update as someone about a year out from surgery: I can hike decently steep terrain (did Angel's Landing recently) and for decent distances (8-9 mi). It's pretty comfortable until around four or five miles, when the ankle doesn't necessarily start hurting but I do start feeling it a bit - maybe more like swelling that reduces joint space/restricts mobility, combined with fatigue as my entire right leg is still regaining strength. Pre-hike and mid-hike mobilizing, hiking poles, compression sock, and going at a moderate pace all help. Mobility is still limited off the couch but it definitely mobilizes more quickly compared to when I wrote in a few months ago. Sometimes the mobility remains for a good bit after working on it; other times, it seems to return to stiffness very quickly. I can jump around for PT exercises and have taken small lead falls on vertical or slightly overhanging walls without issue but have yet to take a bouldering fall (partly due to the mental hurdle, and partly due to still working on the right leg strength so I can land evenly when I do fall).

Hope everyone's recoveries are going well. This injury is a rollercoaster of good days and bad days but stick with the PT and work on whatever else you can while you heal. It's an opportunity to come back stronger and better not just as a climber/athlete but as a person.

Hey Court, 

Yes I did get the hardware out about a month and a half ago. It has helped with the pain. My plantar flexion has definitely improved (I can point my toe now, which helps with climbing!) but I still can't dorsiflex whatsoever. The hardware was impinging on both sides of the joint, which explains the sharp pain I was feeling with walking. The surgeon also did an arthroscopy to clean out the tibiotaler joint and get a sense of what was happening in there. There is some collapse from the AVN and significant arthritis/cartilage loss...so it probably won't be my last surgery. We talked about doing a bone graft down the road or trying different procedures that help restore cartilage.

 But so far, I'm happy with the progress from the hardware removal. My pain isn't gone but it certainly has improved. I'm a nurse and I can now work a 12 hour shift with minimal ibuprofen. That's a step in the right direction! Good luck with everything!

After suffering chronic pain for 5+ years due to a misplaced talus fracture injury that healed wrong, I would say anyone who had a fast recovery, great, you are lucky. If your friend recovered fast, or you broke your tib/fib once, that IS NOT THE SAME, nor nearly as serious as a talar break. For a displaced talus neck fracture, 70% of patience have chronic disability after. A normal ankle break would be a breeze in comparison to the more serious talus breaks that happen.

My suggestion, if you broke your talar neck fully in half (not just cracked), and are going to go to a doctor to get your talus fixed, GO TO THE BEST DOCTOR, and get screws, DO NOT LET IT HEAL ON ITS OWN. I've read so many reports of the talus healing misaligned (as what happened with me b/c I didn't get surgery initially bc "it looked aligned", and then I had to get another surgery a year later to cut the talus in half (again) and realign it. This has helped drastically, but its not fixed and I can hardly dorsiflex at all on one foot. In addition, if your doctor screws your talus together even 1 mm misaligned (which its really hard to tell in surgery), you will likely have chronic disability and pain. I recommend going to a specialist who has written scientific reports on talar alignment and rebreaking the talus to align it. There are a few good doctors in California, NewYork, and Colorado (steadman clinic is ideal, but has a 3 month wait list. I WISH I had gone here initially. You might get in sooner if it's a recent break). Good luck, and do your research. I went to 13 doctors who all said I needed a subtalar fusion or triple fusion for the pain, when I was arguing my talus was misaligned and I wanted it fixed. It took flying to NYC from Texas to finally get someone who knew what they were talking about, and referred me to a doctor who would actually do my surgery. I can hike 8+ miles a day now. Before I could hardly go grocery shopping and they told me nothing was wrong! Yet even still, I wish I had gone to the steadman clinic and just waited, as I think Would of gotten my dorsiflexion back.

Dear All,

I am from Europe, and I had a talus injury at the end of august 2020.

Now I had an MR control on 2020-11-05: drive.google.com/drive/fold…

It looks like I going to have no good outcome. I read and seen videos about the 3D talus replacement surgery. (eg.:  lrsimplants.com/post/lrs-he…;)

- Can anybody please help me if there are any hospital in the EU (european union), where have total (3d) talus replacement surgery?

- What is the price of the surgery in the USA or EU and in which hospital(s) and what is the price of the 3d printed talus bone? (I have no insurance in the USA)

Or do somebody has other idea what can be the next step if i would like to hold all of my ankle function? 

You can write me here or can send me e-mail as well: 3d.talus.szim@gmail.com

I started to collect hospitals here:

https://docs.google.com/spreadsheets/d/1kfPJM0kkL5MZZSG7njkookpshQlvNMWLftBf4RZMCK8/edit?usp=sharing

Thank you for your help in advance,

Marcell

Dear All,

Do anybody have experience / information about what happens if MRI detects AVN of the talar dome after 2.5 month of the injury?

Do I have chance to the revascularisation?  I am non weight bearing since the injury. I have no pain (yet?!)

What do you offer for the next step? My doctors are not definite in this topic as I feel. They said I should be non-weight bearing for 1 year. It can help? 

Non weight bearing ? Fusion surgery? Is it possible that the bone remodelling?

These are my CT pictures (with the fracture): (sept 17, 2020)

https://drive.google.com/drive/folders/1rbmqOljZWQT991zNR2yvKI49IdZU9i4F?usp=sharing

These are my MRi pictures (with the AVN): (nov 5, 2020)

https://drive.google.com/drive/folders/1lVTqxANfYe-dVFCafSR0sF_Wo-HXexyu?usp=sharing

I think the fracture does not healed absolutely on the MRi. What do you think?

Do anybody have similar story? What happened 6 months, 1 year, 2 year.. later?

Can you walk? Is this talus useful somehow? 

Do I need to move my foot without weight bearing? Sholud I have a PT now, or just one year later?!

thank you for your help in advance

Sarah Trudeauwrote:

István Marcell Székelywrote:

Dear All,

Do anybody have experience / information about what happens if MRI detects AVN of the talar dome after 2.5 month of the injury?

Do I have chance to the revascularisation?  I am non weight bearing since the injury. I have no pain (yet?!)

What do you offer for the next step? My doctors are not definite in this topic as I feel. They said I should be non-weight bearing for 1 year. It can help? 

Non weight bearing ? Fusion surgery? Is it possible that the bone remodelling?

These are my CT pictures (with the fracture): (sept 17, 2020)

https://drive.google.com/drive/folders/1rbmqOljZWQT991zNR2yvKI49IdZU9i4F?usp=sharing

These are my MRi pictures (with the AVN): (nov 5, 2020)

https://drive.google.com/drive/folders/1lVTqxANfYe-dVFCafSR0sF_Wo-HXexyu?usp=sharing

I think the fracture does not healed absolutely on the MRi. What do you think?

Do anybody have similar story? What happened 6 months, 1 year, 2 year.. later?

Can you walk? Is this talus useful somehow? 

Do I need to move my foot without weight bearing? Sholud I have a PT now, or just one year later?!

thank you for your help in advance

Hi

I’m 4,5 months into a very similar talar fracture (signs of AVN in talar dome and a 1-2 mm misalignment - fissures crisscrossing the talus and a more prominent fissure line going up through the middle). MRI showed signs of AVN after 8 weeks - blood thinners from then on - weight bearing after 14 weeks and free of crutches now (16,5 weeks from fall). Range of motion is pretty good and I am using the rowing machine and my trainer again - I’ve been told to be patient - no skiing or long hiking days or climbing until at least 6 months post fracture - and to pace myself based on how tired the ankle gets and how much pain I feel. And that I will have to see how this develops - for the next 6-8 months at least. Trying to keep a level head under the circumstances to varying degrees of success... 

PT helps a lot I feel but am very worried as to how much accumulated weight I can but on the ankle per day - how much to rest / use the crutches.

So happy to have found this thread - finally.

Inga Hjaltadottirwrote:

Hi

I’m 4,5 months into a very similar talar fracture (signs of AVN in talar dome and a 1-2 mm misalignment - fissures crisscrossing the talus and a more prominent fissure line going up through the middle). MRI showed signs of AVN after 8 weeks - blood thinners from then on - weight bearing after 14 weeks and free of crutches now (16,5 weeks from fall). Range of motion is pretty good and I am using the rowing machine and my trainer again - I’ve been told to be patient - no skiing or long hiking days or climbing until at least 6 months post fracture - and to pace myself based on how tired the ankle gets and how much pain I feel. And that I will have to see how this develops - for the next 6-8 months at least. Trying to keep a level head under the circumstances to varying degrees of success... 

PT helps a lot I feel but am very worried as to how much accumulated weight I can but on the ankle per day - how much to rest / use the crutches.

So happy to have found this thread - finally.

I'm 27 months post talus fracture, 1-2 mm displacement. Feel free to pm for my thoughts/experience