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Tendon & ankle surgery? How long before riding w/out pain?

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  • Tendon & ankle surgery? How long before riding w/out pain?

    So I am in the beginning stages of accepting the inevitable...I got squashed by a dump truck back in November and have bone chips that are working their way out of my skin. There's some tearing in the tendon plus debris in the 'channel' underneath the tendon on the fibula and all that stuff means surgery. I'm currently waiting on the call back from the Ortho to set up my pre-surgical screening stuff to get this mess over sooner than later.

    Dynamic ultrasound - check, MRI - check, X-rays - check, oh and return to work/PT for a month without any of the above did a whole bunch of damage back in January/February, then switched MDs and have started down the road to surgery.

    Anyone have a "I healed a lot quicker than they predicted!" story to share in regards to tendon repair/ankle surgery and returning to riding?

    FWIW - I can't ride and haven't since the accident except for a few light hacks which make me want to vomit from the pain. As of 2 days ago, walking on a flat surface is becoming increasingly painful and something best avoided as much as possible. Oh and did I mention I am a professional FEI Level rider/trainer? And (being totally honest here) stir crazy is an understatement at this point. I have a very high pain threshold normally and if on a horse - pain is usually a non-issue/not acknowledged. This situation is an exception to that though. Unfortunately.
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  • #2
    First, thank goodness you weren't hurt worse! I know that's hard to appreciate when you are hurting as badly as your are, but still ... very lucky.

    I took a bad fall from a horse in which I severely sprained my ankle and suffered a non-displaced fracture of the talus bone -- one of those foot bones kinda under your ankle. I thankfully was able to avoid surgery because the fracture didn't displace, but I did have to use crutches and a walking cast for eight weeks. Your injury sounds more serious, so you can rachet up this story accordingly:

    Once I healed enough that the ankle wasn't painful to move around unweighted, I began riding again without stirrups. I could crutch up to a horse and then, because it was my left ankle, get a leg up without ever having to put weight on it. (Granted, I was riding my TB eventer, not big-moving dressage horses, so I was dealing with a fairly smooth, no-big-trot ride. Fancier horses might have been much less comfortable!) The tough part was getting off, as even with the horse standing like a statue, it's hard to slide off without putting at least a little weight on the bad leg, and that was very painful -- I might suggest asking someone around to help you down, if you are comfortable with that.

    Outside of riding, I began swimming at about a month or six weeks (the resistance created by the water and the movement of my ankle through it was uncomfortable but not unbearable) and lifting weights from a seated position.

    I did obey my doctors' warnings about not rushing the weight-bearing stuff, though, and duly took all eight weeks, as well as PT, to help me come back.

    The bad news? I feel as if I've lost quite a bit of flexibility in that ankle and, more upsettingly, my proprioception -- I think that ankle is down, I feel like that ankle is down, but when I look in a mirror, that foot is practically flat in the stirrup. I've had difficulty getting my weight even in the stirrups and taken to almost pointing that toe -- it's like, since I can't flex that heel enough to sink my weight down into it, I instead try to get the same feeling of security in the stirrup by pressing (pointing) the ball of my foot into it, if that makes sense.

    I notice it most when my left leg is swinging in the breeze while jumping, but obviously being uneven in the saddle affects the flatwork just as much. That's been frustrating.

    Hopefully, as a more advanced rider, you'll find better ways to counteract and overcome those things.
    I evented just for the Halibut.

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    • #3
      I practically destroyed my ankle back in 2008 in a riding accident. Several large bone chips that were blocking the joint, severely pulled ligaments with a small tear, and 4 ruptured extensor tendons (the DR and my PT couldn't find any documented case of an extensor tendon rupture... that's something every patient wants to hear...). All in all I had 3 surgeries within 11 months and then another one last summer.

      I'll warn you, rehab is going to take a little while. I was in physical therapy for months. First surgery was in June 08 and I wasn't even allowed to ride WITHOUT stirrups until late September (orthopedic surgeon was afraid that another fall would reinjure it worse). I was riding with stirrups by November. Surgery #2 was in March 09... I got on my horse (again without stirrups) the first week of May. A couple days later my tendons all ruptured and I was back in the OR the next day. That was a very serious inury / surgery and I was instructed not to ride for a few months (heck, my ortho didn't even want me in school for several weeks as any wrong bump/move could have caused them to rerupture). I went to college that fall and didn't get on a horse again until that next summer.

      Problems that occured:
      -Bad range of motion (ROM). I always had bad ROM in both ankles but after this injury I'm lucky to even have my heel be level with my toes, let alone down.
      -Joint stiffness. Majorly. I still have to stop occasionally during rides and drop my stirrups for a few minutes to stretch my ankle out.
      -Locking up. Especially in two-point. I think my ankle just wasn't strong enough... it would feel like it would lock up and start to roll outwards.

      My best advice... advil, and ice are your friends. Ice your ankle after every ride in the beginning. Find a good physical therapist and orthopedic surgeon that understands sports injuries and rehab. And don't hesitate to ask them questions about what you can and can't do. Good luck.
      "People ask me 'will I remember them if I make it'. I ask them 'will you remember me if I don't?'"

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      • Original Poster

        #4
        Thanks you guys. I go for some nerve assessment late this week and then meet with the surgeon again to discuss my options. All the research I have dug up implies a lengthy recovery and moderate-high levels of pain when it's all said & done. Honestly, after 4 full months of not riding, if I could get my heel down without wanting to scream, I would just skip any/all surgery - (yes even as selfish as it sounds). I have had enough of not doing anything and need to ride for sanity's sake. The horses are itching to do more than they have been and with warmer weather coming around, so am I.

        So for now I'm experimenting with different braces/wraps starting tomorrow to see how riding works...but like I said, I've had it with not doing 'normal' things like walking, chores and riding. Something about growing up on a farm makes sitting in a house 24/7 into an impossible challenge.

        My ROM was horrific back in January when the walking cast came off - now it's decent and getting better with use. They sent me to PT (in Jan)without any MRI's or new xrays, so all the PT did more damage to the tendon than was already there as there are bone spurs in the 'channel' where the peroneal tendon lays, so there is clicking, tearing and bits getting weird tugs every time the ankle flexes. The most high tech brace they recommend squashes the tendon onto the spurs and inflamed nerve area, so that makes walking nearly impossible & very painful and riding completely impossible. If I go sans brace - walking is fine (but done cautiously) and riding - well see above... The more I sit and do nothing, the worse the pain is and then the foot starts to be numb or painful in cyclical waves.

        But thanks again for the input and experiences. I'll check back after I know more next week.

        A bit of no matter what I do - it is going to hurt. A lot.
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        • #5
          Tasker. PM me. I don't know if you would go out of state for the surgery, but I have a surgeon who worked beyond miracles on me. Still have pain some days and riding, but it is not unbarable

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          • #6
            Sorry for your pain!! I had a bone removed from my foot years ago. Surgeon had to cut tendons to get to it. It's a long painfull recovery. I also had 2 elbow surgeries in 1 year requiring tendons cut and debraided and a nerve released in the last one. 6 month recovery for first surgery, a year for the second one because the nerves take a long time to heal. Ice and anti inflammatories are your friend. Also the PT is very important. The surgeon told me if it doesn't hurt, I'm not doing it right. Good luck and I hope you are pain free sooon!!

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            • #7
              Six years ago

              I broke my ankle....slipping in the garage!!!!! I don't even have a good story to tell.

              It was a tri malleolus fracture and needed a plate and a half dozen or so screws. The surgeon really laid down the law to Mr P(and maybe to me but I was to drugged to remember) My foot was not to touch the ground for 6-8 weeks. Turned out to be 11 weeks. I was not to even wiggle my toes. He said if I did this I would get full ROM. The PT kinda gulped when I showed her what my other ankle can do and what I needed it to do but while I can't get on pointe I've got everything else back.

              However it DOES hurt.

              Often

              A lot.

              And I still do calf raises and toe circles and sometimes the ankle cracks spectacularly.


              For the non weight bearing time I went from walker to electric scooter to golf cart. I went up and down stairs on my butt.

              Ice is your friend. For months after I was cleared to ride I would put a cooler of ice packs on my mounting block. When I got off there were many days when I would loosen my mare's girth remove my boot and ice my ankle before I could walk far enough to put her away.

              My mounting block is called my handicapped access. Mr P built me a platform at stirrup height so all I have to do is swing my leg over.

              MDC Intelligent stirrups are also a huge help.

              And Smart Wool socks. I don't understand, while ice was great for initial swelling COLD is miserable for general mobility.

              I swear a lot, especially forst thing in the morning.

              Good luck. I never had any IDEA that ankles could be such a problem
              I wasn't always a Smurf
              Penmerryl Sophie RIDSH
              "I ain't as good as I once was but I'm as good once as I ever was"
              The ignore list is my friend. It takes 2 to argue.

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              • #8
                My little secret is as soon as the Dr. tells you to start moving the ankle- get in the bathtub and point your toes and pull your toes up in warm/hot water. This will hurt...but it will help with your ROM. I have almost 100% ROM back and I broke and dislocated (foot hanging off leg) my ankle 3 years ago. I also had a cranio-sacrial therapist work with me on my PT. It worked wonders...Good Luck and you have many miles of riding ahead (just heal up first
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                • #9
                  This is a timely thread for me, I sprained my ankle 6 weeks ago after wearing the wrong pair of high heels. Went to the ER and well... Let's just say I'm not a happy camper.

                  They said I had no broken bones, however, they only took X-rays of the front and inside of my ankle even though I complained of pain on the outside. They told me it's a sprain, you'll be healed in 4 weeks, you can start jogging in 2.

                  Well... it's been 6 weeks, still can't go down stairs, can't jog, and my ankle is STILL swollen. Yes, I've been doing the PT. My mom, an NP, says to go to my primary and ask for more x-rays and an MRI. Said it's either a partially tore ligament or a fracture. I'm just mad at the ER, they waved me aside and charged $3000 for it.

                  I'm worried I've screwed my ankle up so badly I won't be able to run or have the chance to ride again... I've had to cancel running in 2 5k's and 1 10k already.

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                  • Original Poster

                    #10
                    Oh Dancing Appy - I am so sorry. Go get some more xrays/MRI...

                    Fingers crossed it's just swelling and not lots of broken bits.
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                    • #11
                      Tasker, Wow. I just looked at the picture of your truck You were sooooo lucky!!! Best wishes for a successful surgery and hope you are pain free and riding soon!!

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                      • #12
                        Wow, you are blessed to be alive after that wreck.

                        I had a riding injury last summer, broken medial malleous and all lateral ligaments were destroyed. I had hardware installed to correct the fracture and the ligaments rebuilt with a screw to anchor them back to the bone.

                        Went through PT. Got my range of motion back. However, it is a struggle to maintain the ROM w/o pain. I am riding again, but my feet and ankle gets numb and I have to drop the stirrups. It hurts a lot still. My ankle is at least 25% larger than the good ankle and it has been almost 9 months from the surgery. I am strongly considering surgery to remove the hardware to see if that helps.

                        My advice is ice at the end of every day. Forever. Continue the PT at home even when you "graduate" from rehab. I was back in the saddle on a very quiet horse 4 months after surgery and 5 months from the original injury. Honestly, I am changing disciplines and horses because mentally I am still screwed up from my fall that wasn't even my horses fault. It should be easier for you because your injury was non horse related.

                        Healing prayers sent your way.
                        "Right is right if nobody is right, and wrong is wrong if everybody is wrong."

                        -Archbishop Fulton Sheen

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                        • Original Poster

                          #13
                          My apologies for not updating you guys for a while. All of the Dr. visits came to the same conclusion - learn to live with the pain and get on with my life with meds to cushion what I want/need to do vs. what I can. I am totally not ok with living in a fog around the horses, so it's a bit of ibuprofen to start the day if I can't bear weight on the leg and then go from there. The long term damage to my organs scares me but not quite enough to do nothing for the rest of my life.

                          So there have been some milestones. Last week I was able to sit a bit of trot - more than 4 strides. The next day I worked on it on 3 horses off and on for 20 minutes each. The day after that I couldn't walk with the much abused muscles that were dormant protesting quite loudly vs. the ankle that just hurt a bit more than normal.

                          I went to a schooling show yesterday on one of our 2007's. He spent the winter in Aiken with Ryan Wood @ Phillip Dutton's, so he is a very seasoned traveler who is not spooky...just 17.2. We knocked out an 8.1 in the 4 year olds test and I am really pleased with how he went. My position is all wobbly and I am not doing him any favors with that but I am riding again which is the most important thing, right? The ankle is fat and painful today, so it's a 'take my meds' morning and take it easy kind of day with an icepack and elevation for the entertainment.
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                          • Original Poster

                            #14
                            One quick question for everyone - does anyone have any ideas for cardio that does NOT need the ankle to flex? Swimming is out, running is out, walking is out, Nordic track is out, an elliptical is out...and you can see I'm out of ideas. My core strength is coming back but I need cardio!

                            The MDs all voted against any more PT as it was doing more harm than good, so I'm stumped.

                            TIA.
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                            • #15
                              How about water aerobics?

                              FWIW the elliptical does not hurt my ankle. And I have gone back to spinning (wool, with a spinning wheel), treadeling with my bad ankle.
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                              • #16
                                the seated elliptical (you can use your arms and sort of place your feet wherever it works best for you) at the ymca in Kennett and working out there in the pool work well for me. I broke both talus and smushed both heels. For pool there are various gizmos to let you swim without kicking and also stand in water and get a pretty good workout.

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                                • #17
                                  Try a rowing machine at the gym. It works a lot of things but it's great cardio as well. I don't notice a lot of ankle flexion when I use the rowing machine.
                                  "People ask me 'will I remember them if I make it'. I ask them 'will you remember me if I don't?'"

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                                  • #18
                                    Originally posted by Tasker View Post
                                    One quick question for everyone - does anyone have any ideas for cardio that does NOT need the ankle to flex? Swimming is out, running is out, walking is out, Nordic track is out, an elliptical is out...and you can see I'm out of ideas. My core strength is coming back but I need cardio!

                                    The MDs all voted against any more PT as it was doing more harm than good, so I'm stumped.

                                    TIA.
                                    I don't know if anyone has suggested this one but here goes. Rowing machine? Your feet stay planted but arms, shoulders, calf muscles, thighs get a work out. I also broke my ankle, so recently I am not yet out of a hard cast, but try the rowing, tell me how it goes.
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                                    • #19
                                      Luckily we have a back yard pool and I spent hours in it when I was allowed to put weight on my foot. The water supports some of your weight but provides resistance. I did a lot of walking in circles (both directions) and side passes in 3-4 feet deep water
                                      I wasn't always a Smurf
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                                      • #20
                                        Recumbent exercise bike worked for me.
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