So as a back story in 2003 I had an inversion fracture of my right ankle. In 2006 I was diagnosed with Rheumatoid Arthritis. Currently (for the past 6 months or so) the ankle has been getting worse while the rest of my joints improve. I have had cortisone injections done but the pain still exists. I have had reasonably good luck with an "Active Ankle" brace as well as chiropractic which has been helping the underling issues in my back and hip. Basically I have very bad conformation to start with. I do have cartlage but I have uneven joint spaces and swelling which compromises the joint/tendons.
So I saw a new brace specialist today who recommended a 'boot' type brace will little to no flexibility. It will not have a hinge, and it will not allow me to lift my toes 'up'. My foot will basically be in a cast. He believes this will make me mostly pain free however he did agree that it would limit my flexibility of my ankle even when out of the brace. He seems to think that my joint 'may' recover. However with the history of this joint (let alone with RA) I don't have any faith in that diagnosis. This is the same theory that we followed with I was having issues with my wrists and it resulted in both my wrists being fused.
I no longer jump, and I only ride western at this time, however the idea of loosing the flexibility in my ankle that I need to ride/cue my horse on purpose seems stupid to me. I'd much rather have it fuse down the road, or have it done chemically than to wait out this 'boot brace' possibility.
Have you seen a physical therapist? The reason I ask is I suffered the inversion fracture, also on my right ankle more than twenty years ago. Till today, it is much weaker than my left. What has helped is physical therapy plus wearing the Active Ankle type brace for three months. There was a time I had to wear the brace for riding.
Right now I ride mainly dressage and as long as I don't try to get to two-points position for prolonged period of time, my right ankle does not bother me at all. I myself will not consider ankle fusion unless the pain is killing me just from normal living. A mobile yet stable ankle is so important for riding. You lose a lot when your ankle is fused and then the rest of your body will need to compensate for that lack of mobility, and who knows what else might come up because of that.
Maybe it is time to get a different doctor, a doctor who understands how important a mobile ankle is for any kind of athletic endeavor, and maybe a different physical therapist too. A good physical therapist does make a huge difference and just like good riding instructor sometimes you need to search high and low to get one who isn't just reading from a script.
I'm going through a second course of physical therapy myself (herniated disc plus messed up shoulders), and like you I was getting frustrated from my first course of physical therapy: saw no change. And then my Yoga instructor suggested a new therapist, and oh my god, what an incredible difference! I actually feel something changed after each session.
Another idea is, Yoga. I have forgotten how much Yoga has stabilized my ankle after my course of physical therapy for my right ankle eight years ago. I think that physical therapy started the road for stability and Yoga continued building on it. It isn't something that will work in a month or two, but within a few months you should see some improvement. Hope you feel better.
My lower leg bones were both broken. Lots of hardware and scarring. My doctor at the time knew riding was important. I returned to have the cast replaced every two weeks, each time, he'd pull the toe on that foot up a bit more to stretch that tendon out so it wouldn't lose that mobility.
Can I point my toe like a ballerina now? Nope, but my heel goes down. A lot.
Does a sports medicine boot type brace help? a little with stability, not at all with pain.
A fact of my life is that since late December 1992, my right ankle has been very painful, every step, every hour, every day. When it gets too bad, I rest it. It hurts if I'm in two point a lot during a ride or jumping, or on a long ride, it hurts a lot. Driving makes me limp visibly.
Sometimes, bute is my friend, sometimes, dmso and cortisone is my friend. Sometimes, I get a prednisone dose pack for something else and have a couple of days of relief.
I wouldn't fuse mine until they could assure me that I would be pain free or until it absolutely refused to support me.
There are some things on your body that after a while, are just going to hurt until you draw your last breath. No one who is seriously involved in horses is pain free.
If you've ever taken steroids for anything, it's pretty easy to figure out why pro athletes abuse them. If they were legal and didn't have any nasty little side effects, I'd be all over it.
If you fuse it you won't e able to ever change that or have a ankle replacement. You should see a expert foot and ankle orthopedists. On the east coast try Dr Lou Schon in Baltimore, one of the best in the world. There is a new ankle replacement out but thats all I know about it except it supposed to give you good range of motion which the older models couldn't do.
Remember if you fuse it thats it for life, so its a good option when there are no other options.
The ankle clinic at Mercy Hospital in Baltimore is another good place for a second opinion.
I'm a little confused - do they mean putting you in a boot type brace forever or just for 4-6 weeks to let it heal? I've been in & out of a boot for the last year; while my ankle did stiffen (sp?) up when it didn't move, it also loosened back up when I started moving again. The breaks from movement did help relieve the inflammation that was causing a lot of the pain. It didn't help the ligments and tendons heal enough to avoid surgery, but life was definitely better for having used it.
I completely agree that you need to go to a foot and ankle orthopedist at a top clinic. My ankle was crushed in the late '80's. (Darn that 2 yr old colt) Since then I have had 2 more surgeries to remove bone spurs that caused great pain. Finally last year when every step was painful and my ankle throbbed at night, I went to two specialists. After x-rays and a scan, both determined that a replacement was not the right alternative. So, I chose to have a fusion - cleaning the bones of spurs and then stapling many of the bones together around the end of the tibia and fibula, thereby stabilizing them so they could not rub together. No I don't have much flexibility right/left but a fair amount up/down. But I am pain free (!) and the doctor told me it was the last surgery I'd have on that ankle - good to go.
Don't be afraid, get the facts and then you make your decision. For me, fusion was the right answer.
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(former)Chair, USSHBA Positive ID Working Group; USSHBA Steering Committe member
Sorry I've been absent, to follow up, I live in Canada in a reasonably remote area. Although our health care is free, there can be long waits, and access to specialists is not always with who is best at your issue, and more with who is close to you. I have followed up with my Rheumatologist and we will be looking into other options.
I am hesitant to put my foot into any brace that limits movement (toe up/down). We did that to my wrists to prevent pain and it ended up fusing them. This is not something I want to happen with my ankle.