Calcaneus Surgery ORIF Success Stories?

Redacted Redactberg wrote:

Ditched the crutches entirely for the first time today, 4 days shy of 3 months post ORIF. 

How soon did people start TR’ing again? My PT thinks I shouldn’t until I can run and jump, but my surgeon thinks I can start back again 4 months post ORIF.

Also, did your climbing shoe size/brand change? I have this boney bulge on the lateral aspect of my calcaneus because my bone got kind of compressed. I like la sportiva shoes, but I know people can have different brand preferences based on their foot shape/type, and maybe miuras and tc pros won’t work for me anymore.

I was still on crutches when I started to toprope. I didn't use my foot and climbed on my knee at the beginning. When I was cleared for weight bearing my PT told me to climb as much as humanly possible because it would be good for ankle mobility. I still can't run and it has been 3 years, so I'd take that with a grain of salt. Go to the gym and start small. Trust yourself and don't do too much at first. You will limp badly the following day, rest and ice.

I am 2 EU sizes different. I had to use 2 different sizes for two years. I tried Acopa and they make split sizes, but I didn't feel they climbed as well as Scarpa/LS. It's worth buying two different shoes in the short term. I use the same size now, but one is tight and one is floppy. I am hopeful that I will be the same size in a couple more years.

Hi all, thanks for sharing your stories - giving me a lot of hope.

Just hit a gap in the pads and the ED doc said it looks like there might be a calcaneus fracture on the xray - waiting on a referral to a specialist. 

Did you all see a podiatric surgeon (DPM w/ additional surgical training) or orthopedic surgeon (MD/DO) w/ foot and ankle specialty?

TIA 

Trevor Kraus wrote:

Hi all, thanks for sharing your stories - giving me a lot of hope.

Just hit a gap in the pads and the ED doc said it looks like there might be a calcaneus fracture on the xray - waiting on a referral to a specialist. 

Did you all see a podiatric surgeon (DPM w/ additional surgical training) or orthopedic surgeon (MD/DO) w/ foot and ankle specialty?

TIA 

A gap in the pads is how I got my fracture. My X-ray barely showed a fracture, while the CT scan showed the calcaneus in 5+ pieces. 

I can't say I know much about podiatric surgeons' expertise, but I saw an ortho with feet/ankle specialty and my recovery after surgery exceeded everything I've read about

Peter Y wrote:

A gap in the pads is how I got my fracture. My X-ray barely showed a fracture, while the CT scan showed the calcaneus in 5+ pieces. 

I can't say I know much about podiatric surgeons' expertise, but I saw an ortho with feet/ankle specialty and my recovery after surgery exceeded everything I've read about

Well that's encouraging I suppose, the last part at least, haha. 

I am going to see an ortho w/ foot/ankle tomorrow wish me luck!

Trevor Kraus wrote:

Well that's encouraging I suppose, the last part at least, haha. 

I am going to see an ortho w/ foot/ankle tomorrow wish me luck!

For sure dude, good luck! my ortho told me to expect a 93%  return in functionality when i'm at 99.9%. They often lean conservative so hopefully that can be motivation coming out

I have only seen orthopedic doctors for surgery 3 so far but podiatrists for everything else but none of the podiatrists in my area do serious ankle surgery. I do however do know about the patience required for recovery from surgery as I sit here after total ankle replacement surgery 3 weeks ago. 

Kevinmurray wrote:

I have only seen orthopedic doctors for surgery 3 so far but podiatrists for everything else but none of the podiatrists in my area do serious ankle surgery. I do however do know about the patience required for recovery from surgery as I sit here after total ankle replacement surgery 3 weeks ago. 

hope you are healing up quick! I'm beginning to understand what you mean about patience - only post op day 6 and I am already bored out of my mind! 

Trevor Kraus wrote:

hope you are healing up quick! I'm beginning to understand what you mean about patience - only post op day 6 and I am already bored out of my mind! 

Well the cast comes off next week and into a boot and then weight bearing by degree. I have broken the same bone in the same leg twice in different places and now the ankle replacement so I have had practice in sitting around. They call them lazy boy recliners for a reason. 

I've read through 42 pages of replies in this thread, and it's been helpful to get a wide variety of perspectives and shared outcomes- the positive mental attitude vibe here is super inspirational.

I'm 45, not a climber, but I've been a lifelong cyclist, former skier, and generally active and athletic. Had a ladder slip out under me April 7th and fell 10' onto concrete. Right calcaneus shattered, diagnosis was "Acute traumatic, displaced, extensively comminuted calcaneal fracture (series 4, 43) with intra-articular extension to the calcaneocuboid and subtalar joints"

Here in NYC we have one of the best orthopedic surgery centers in the world, the Hospital for Special Surgery, and I was fortunate enough to be able to see a doctor there. He has scheduled ORIF for this coming Friday the 18th, 11 days after injury.

I know the road ahead will be fraught with pain and obstacles, but I am heartened by the stories of the people who have traveled it before me.  I'll update as my journey proceeds.

With a good surgeon and the right meds your pain should be minimal. I had a bag of nerve blocker for 3-4 days after surgery at home and had no pain only discomfort of the splint. Everybody’s pain tolerance is different so you may have some. I don’t like opioid drugs and they don’t really work for me. Do not push your recovery too much and you will be fine. There is a lot doctors don’t know, it’s called practicing medicine for a reason but they do know how long this kind of stuff takes to heal. 

Get a knee scooter, one with air tires. It makes all the difference for getting around.

welcome square, wishing you the best. my top use items have been a wedge pillow to elevate and a shower bench + removable shower head. I tried the iwalk (peg leg) and knee scooter, but personally preferred crutches unless I needed to carry something.

Kevin, I hope your new ankle is working out.

as an update it was exactly as Peter said, while my xray didn't look so bad the CT showed multiple pieces - luckily mine were all large enough that my doc didn't need to use a plate. 

I am 6 weeks post op and cleared for partial weight bearing, my calf is smaller than my forearm, I am back to desk work, but otherwise still bored out of my mind. been mega jealous of my wife when she leaves to go climbing, but I do plan to start hopping on TR soon.

cheers

Had surgery on Friday- 9 screws and a plate. Doc had to add some bone putty matrix as there were some blown out parts as well, but he noted the subtalar joint was well aligned and movement was good after fixation.

Kevin, I was able to kick the opioids quick; I don't like them either. Just needed them to sleep for a couple nights after the block wore off. Was looking into knee scooters but I think they may be too bulky for NYC streets- I ordered some forearm crutches to try out. Total ankle replacement sounds absolutely wild- hope you're healing up.

Trevor, I'm super worried about atrophy. Doc says there's really nothing to be done about it. I upped protein and creatine intake, and am trying to figure out a NWB exercise regimen. 10-12 weeks can't pass quick enough haha.

Had follow-up today- not as bad as I expected. Surgery notes had 9 screws in the materials list but I see only 7 in the floroscope images the doc showed me. Pretty minimal plate and the incision didn't look like the standard ELA "hockey stick," it was more like a 3" straight cut a bit higher lateral to foot and a lot of stab incisions. Sinus Tarsi approach maybe? Doc is great but bedside manner doesn't include a lot of explanation.

Splint off and just in a compression wrap + air boot. Next appt in 4 weeks. Has anyone here had this less invasive type of ORIF and if so, do you know if that means NWB period is lessened?

square taper wrote:

Had follow-up today- not as bad as I expected. Surgery notes had 9 screws in the materials list but I see only 7 in the floroscope images the doc showed me. Pretty minimal plate and the incision didn't look like the standard ELA "hockey stick," it was more like a 3" straight cut a bit higher lateral to foot and a lot of stab incisions. Sinus Tarsi approach maybe? Doc is great but bedside manner doesn't include a lot of explanation.

Splint off and just in a compression wrap + air boot. Next appt in 4 weeks. Has anyone here had this less invasive type of ORIF and if so, do you know if that means NWB period is lessened?

hey square, my doc also doesn't do much explaining and I noticed he had done this minimally invasive approach as well. good news is if they're doing that then they are probably very comfortable with this type of surgery and were able to plan well from the CT.

I still had 6 weeks NWB total, but after two weeks I was in a boot and allowed to start ROM exercises. 

so far as PT goes doc seemed to think I would go from PWB to FWB after a week, but let me tell you it ain't happening! ankle is so much more painful putting even partial weight than when I was just wallowing on the couch. but ymmv, I think there was a lot of damage to the soft tissue in my case from the nature of my fall.

Hi Trevor, awesome to hear you are at least PWB - I know that phase is gonna be painful and challenging. Good luck with your recovery and keep us informed with your progress!

There's nothing minimally invasive about ORIF for impacted, comminuted intra-articular extra-articular calcaneal fractures. That being said, I am 16+months past the initial surgery. My heel and ankle are fine, but my toes on the affected foot are still numb and tingly at times. The injury also aggravated my hammertoes, which I can correct by taping. Can't complain....

I'm in the club!     Thank you to everyone who posts with their stories. The long term recovery is the hard part for me so it's great to hear the 1-2 year recovery successes. I took a 35ft ground fall while being lowered when the end of the rope went through the belay device! Luckily bounced off a ledge in the middle, which slowed me down. Non-displaced tailbone fracture and shattered right calc. Had ORIF surgery 10 days later with a plate and 11 screws. I was 37, very fit, very active. Here are the things that worked for me so far (currently 8 months out):

-Stop any drinking/smoking, and take lots of supplements (collagen protein, fish oil, bone supplement, vitamin, caster oil rub). Easy on the pharmaceuticals. 

-Work on ROM as soon as possible, including massage (I was put in a lightweight removable cast at week 2 and never wore it while at home)

-Upper body exercises immediately (pull ups, pushups, sit-ups) to promote growth/blood flow in the whole body and prevent lung/heart atrophy.

-Acupuncture is amazing. great for the initial healing and amazing for tendonitis later on down the road. Amazing. 

-I started VERY lightweight PT exercises before the standard recommendations. Im fit, 37 years old, and heal very quick.

-Take great care of the incision, a beeswax type salve helps a bunch. You DO NOT want an infection. 

-As soon as the incision is healed and you're cleared to soak it, put ice, water, and epsom salt in a bucket and soak the foot. Really effective for swelling/discomfort.

-You'll need a knee scooter and a peg leg (like Tommy Caldwell used for his achilles injury!), they're $170, made by iWalkFree.

-Lightweight shoes with footbeds when you start walking. Makes a huge difference with tendon fatigue.

-Read adventure books about the good old days of dirt bagging. Endurance will remind you how good you have it. Also listen to all the Patrick O'Brien novels on Audible (best books ever?).

Here's where I went wrong. At 3 months I was cleared to weight bare and I went hard on it. 2x the PT = 2x the healing, right? Wrong. About a month in I started getting more and more pain in the ankle and finally identified it as tendonitis, especially on the peroneals (outside of the leg, used to push through your big toe area.) It took aggressive massage 3x/day and days of total rest. Then acupuncture really got me back on track. All the healthcare professionals have been using the phrase "life changing injury", which I really didn't appreciate, but I am coming to terms with it. Different for sure, but I still have hopes for "full" recovery.

Anyways, I'm 8 months out, and here's the good news. The calc is great, no pain pushing through my heel. Pushing through the outside of my foot is about 80%, and I can walk on flat surfaces with some spring in my step most days. I can ride the shit out of my Peloton and will MTB soon. BUT, pushing through the inside of my foot is pretty much a no go. 20% function, and any targeted PT at all leaves me in pain for days. Basically, the tendons that run through the incision area are very unhappy. I will be seeing a foot specialist in a month or so after insurance kicks in. (this accident cost me $55k b/c I wasn't insured). Hopefully my subtaler joint doesn't have too much arthritis and doesn't have to be fused. I met a friend of a friend who broke both calcs 3 years ago climbing. He was in lots of pain at 1 year, had the hardware taken out, still was in pain, and had both subtalar joints fused, which he says was very helpful. He's finally back climbing 5.10 (used to climb more than that!) Another friend took 2 years to recover from a different foot surgery. I'm not afraid of falling to my death anymore! The fall happened so fast I now realize that type of death would be easy. yay. Kinda thought I was going to die when I glanced over my shoulder as I fell. But now I'm more scared ro aware of how little quick accidents can be life changing, so pay attention. 

I would love any insights on peroneal issues and I'm more than happy to talk with anyone (millersilas@yahoo.com, or this thread). I'm expecting and hoping to be able to climb and ski again some day, but it won't be the same, there's just no way. Thanks for the stories, best of luck and success to everyone!

All of this is great advice, Silas.

Working on ROM all day, also not wearing the boot unless venturing out, and lots of massaging esp. the plantar fascia which is very tight and sore. Certainly concerned about peroneal tendons as they were "released" from their sheathing and moved out of the way for the surgery, and I'm sure there will be some longer term effects.

12 week update:

I limped my way to the DMV the other day wearing normal shoes and I'm not sure which part was more painful - my foot or being at the DMV.

in any case, I can walk pretty okay in the boot, but shoes are still quite painful. PWB was slow at first, but weight tolerance rapidly improved at week 3/4. calf is weak, ankle stiff, tendons inflamed, but PT is moving along. hoping to ski or snowboard this winter and be sport climbing outside again next spring.