Ankle Arthritis and Riding

[kris0227]

Hello Everyone! About 3 years ago, I fell off my mare and landed bad causing a bad break in my right ankle. I’ve had four surgeries but due to severe post traumatic arthritis, I still live in daily pain. My surgeon has tried everything including injections and we’re at the point now where further surgeries are the only option. At this point, I have to choose between ankle fusion or an ankle replacement.

I currently ride training level dressage, but I hope to work my way up the levels quickly as my mare ages (she’s currently young).

Has anyone on here ever had either of these two procedures, and if so, how do they affect your riding and/or daily life activities? If you had one or the other, do you wish you hadn’t? What about pain, have they helped, or increased?

Thanks in advance for your assistance!

[deacon_s_mom]

I’m interested in any answers, too. I am tired of limping and always have to have someone help me at shows. I didn’t think ankle replacements were reliable yet.

[kris0227]

Ankle replacements have been around for about 30 years based on what I read earlier today. However, initially, they were held to the bone using a bone cement which had mixed results. In recent years, the technology used in knees and hips has been adapted to ankles and there are now 5 or 6 FDA approved ankle prostheses. I can find all the technical information, I’m really interested in personal accounts of both the fusion and the replacement as they apply to riding since that’s my primary activity (outside of work) and my main concern.

[aqhadreamer]

I don’t have much advice but I’m almost in the same situation as you. Broke my ankle in 2003 but I got dignosed with RA 3 years later.

My Rheumatologist, who is not a rider but has a daughter that rides, does not think that an ankle fusion will let me ride effectively. (Right now I have the ability to move my toes/heels up or down, but very little side to side motion) I currently use an Active Ankle brace for everything but riding which helps alot with my issues.

According to the arthritis society of Canada they can now do ankle repacements even after the ankle fuses. I have yet to find anyone who has had an ankle replacement done yet though…

[kris0227]

I’m glad to hear my doctor isn’t the only one that thinks fusion would be bad for effective riding. I actually read your post on a similar subject a couple of years ago about the Active Ankle brace and ordered one last night. I own just about every other brace in existence and none others have really helped much. After I damage it by standing or walking too much, I’ll use a back on track brace and that seems to help some too.

[Couture_TB]

I just had my 5 the ankle and leg surgery. The surgeon took out a ton of scar tissue, arthritis, and realigned my tibia ankle and foot. He was saying a lot of people with ankle brakes their bone shifts over time causing more pain. He is pretty sure I will be able to be more normal and not a limping cripple. He doesn’t like to fuse for people that are active in sports. I will eventually need it replaced but not til much later. I have cool surgery xrays if anyone wants to see lol

[kris0227]

You are lucky if he thinks you’ll return to normal function. I’m one of the few that apparently gets post traumatic arthritis. Within six months of the break, I had arthritis, I’ve had four surgeries, but nothing has worked. I walk with a limp that is sometimes severe and there are days when I just sit in my recliner all day because it hurts too much to walk. I wish I had my X-rays! My original break was wicked nasty… My leg was on one side and my foot was off to the other… I was the freak of the night in the ER that night… Lol.

[azeventer]

I had an ankle fusion last year. I am 49 years old, when I was 23, I fractured/dislocated my right ankle in a riding fall. Had surgery to repair it at the time, did quite well for many years. As time went on however, the post traumatic arthritis that is pretty much inevitable after injuries such as mine, became worse and worse…the the point I was in pain ALL the time…At this point I was doing training level eventing/first level dressage with my OTTB…the funny thing is that RIDING did not hurt my ankle so much, but everything else did. Needed a mounting block to DISMOUNT, as the thought of landing on my ankle from the height of my horses back sent shivers down my spine. Finally decided that I need to do something, as I couldn’t live with the pain anymore.

Saw a great orthopedic surgeon. As it turns out, due to the fact that I had pretty much no cartiledge left in my joint, it was already basically functionally fused. The movement that I had in it was mostly in my foot joint. As I had been actively riding this way for some time, I had already unconciously begun to compensate for this. I was given the choice between ankle replacement and ankle fusion....at the time, he was not as eager  to recommend the replacements to younger, active patients, as the current replacements had a tendency to fail/wear out in 10-15 years, requiring repeat surgeries. He said that there is a new artificial ankle out that show promise for lasting longer, however it hasn't been out long enough to have the data to be sure. He left the choice to me, not pushing one or another. After much consideration, taking into account the fact that I had not had much movement in the joint for a long time anyway and had still been able to ride and compete, I opted for the fusion.

 Fast forward to this year...I have NO regrets. I had no idea how much pain I had really been in until it was gone! It was noticeable immediately...while of course i had the post op surgical pain, the deep, aching bone pain that was there CONSTANTLY before surgery was gone....such a relief! I started riding again about 9-10 weeks after the surgery...I was out of shape of course, but progressed pretty quickly. Now, I am still able to do dressage without noticing much difference than how I was before the surgery. I still jump a little, not much more than 2'6" - 2'9", but that is more because my horse is 21 and semi retired. I do feel that I would probably not feel comfortable doing big jumps, as I cannot shorten my stirrups as much as before, but I think 3' would be a very reasonable goal for me....I am also close to 50, a younger person may have the flexibility/agility to adjust even better, I am sure! 

 Anyway, sorry about the novel, that is my experience. Feel free to PM me with questions! When I came on here before my surgery, I soon found that there were not really a lot of people here who had had the fusion surgery...I would be glad to answer any questions from a riders perspective, as I did not have the luxury of knowing other riders in a similar situation before MY surgery.   I again say...I do not regret it at all. I was in so much pain before, my quality of life is so much better now. I wish I had done it 2 years earlier, before the pain got sooo bad. It also has been a lifesaver for my job...I am a cardiac surgery P.A., I spend HOURS on my feet in the O.R. every day. I would have not continued like I was for much longer. Hope this helps. Again..feel free to PM!

[azeventer]

[QUOTE=kris0227;6887881]
You are lucky if he thinks you’ll return to normal function. I’m one of the few that apparently gets post traumatic arthritis. Within six months of the break, I had arthritis, I’ve had four surgeries, but nothing has worked. I walk with a limp that is sometimes severe and there are days when I just sit in my recliner all day because it hurts too much to walk. I wish I had my X-rays! My original break was wicked nasty… My leg was on one side and my foot was off to the other… I was the freak of the night in the ER that night… Lol.[/QUOTE]

My original break sounds very similar to yours, although luckily the arthritis took a while to set in. I remember rolling over after I fell and seeing my foot/lower leg sticking at an angle in the completely WRONG direction…not a nice feeling! My xrays were the talk of the ER, although I never saw them…I should try to find them, but this happened in 1987, so they are probably long gone or buried in some vault in a hospital cellar somewhere…

From what I understand, whether it is soon, or years down the road…any fracture of this kind that disrupts the joint capsule will develope post traumatic arthritis at some point. The only question is how long it will take. Just the nature of the injury…

[aqhadreamer]

As an update, last week I had an MRI done which confirmed my thoughts (I hate being proven right!) that my ankle was toast. Good news is that the tendons, and joint support ligaments are all fine and in good shape. Right now options from my Rheumatologist are to think about joint fusion/replacement. I have referrals in to two specialists. One a general orthopaedic surgeon, and one to a foot/ankle specialist. The general guy will see me sooner (and is only an hour from home), and can ‘bump’ my referral to the foot guy (several hours from my home with a longer wait list).

The problem is that I am 31, my Rheumatologist did not want to discourage me but she thinks that ankle fusion is better than putting me though surgeries every 10 or so years. azeventer I’m going to send you a message if I can figure it out!

[kris0227]

Hi aqhadreamer! I also had an MRI this past summer that showed bone on bone wear and no cartilage left. I found a good podiatric surgeon and we discussed the options. I am 31 as well and we decided the best option was the STAR total ankle replacement. I’m on week seven of recovery at the moment and starting to weight bear now! It’s unusual feeling no pain in the joint, there’s pain in other areas because of the damage in the joint that he had to repair. I had calcified tissue holding my foot and leg together that wouldn’t allow any movement. After all the repairs and the replacement were put in, he was able to get full range of motion!!! I am very optimistic.

Here’s why I went with the replacement, the STAR specifically. The fusion can cause arthritis in the bones of the hindfoot when they have to assume the movement of the ankle which they are not designed to do. From the research I found, arthritis and further fusions are common within ten years of the initial ankle fusion. The STAR would offer me full range of motion and they have longevity studies available showing the joint still in place after ten years in over 90% of patients. My surgeon additionally told me that they have just revised their plastic piece and in the lab, the data shows the piece will last 20-30 years versus the previous 5-10. He felt despite my age, the replacement was really the best bet. Since most surgeons will try to dissuade you, I wanted to let you know about the fusion complications because most won’t mention it, my surgeon confirmed it after I voiced my concerns. If you fuse, you could still have issues (as you could with the replacement as well), but you are most likely not surgery free if you fuse, with your age, other joints are bound to fail in your foot. I’m ok with a revision to the joint in twenty years if necessary, but I didn’t want fusion, my leg was effectively fused before and it was horrible.

[aqhadreamer]

Thanks Kris! More good info for me to think about :yes: It’s going to take a while before I see anyone but I want to go into it with all my options, and with my eyes wide open!

[kris0227]

Sounds like an excellent plan. I read a lot of research articles on pub med to get an idea on ankle fusion vs ankle replacement and also found some studies for the various replacement prostheses. I went to two different surgeons, my original surgeon did not want to do the replacement, but couldn’t give me good data as to why it would be worse than the fusion. And when I mentioned the very real arthritis risk with fusion, he switched the subject refusing to discuss it. I, then, went to a podiatric surgeon who discussed both options with me. I asked him about the arthritis risk and he said this was common and definitely a concern based on my age and activity level. Basically, in your early 30’s, there are no good options, so you have to decide for yourself which is the lesser of two evils. This surgeon happened to believe that while the fusion used to be the gold standard, he no longer prefers it because of the advances in replacements. Also, to make sure you have this info, while a surgeon has put a replacement in a few patients post fusions this is not recommended and was only marginally successful. He basically told me that if I chose fusion it was permanent whether it succeeded or not, if I went with the replacement and it fails, I can always fuse later. My surgeon does all sorts of seminars and such about ankles and helped bring the STAR to the US so he is well versed in the newer techniques.

As anecdotal evidence, I have several people that I know personally with ankle fusions and the results were very mixed, mostly negative. A family member lived in constant pain even after the fusion which was done several years ago. She still walks with a noticeable limp and has to have special braces and shoes on at all times. I know there are others with very positive results, so it likely depends on the person.

[aqhadreamer]

Again great info Kris, thank you so much! Its nice to ‘talk’ about this with someone about the same age! I have had both wrists fused already (they fused on their own due to the damage from RA) and they still hurt occasionally, and even 5 years past fusing still hurt BIG time if I hit my wrists on anything.

From what I have seen, most Dr’s want to do the ankle fusing with screws to hold the bones into place and I knew that couldn’t be good for possibly installing an artificial joint in the later years.

I have referrals in to two surgeons now, and found another that will be added next week. The newest one is actually my second cousin, so I’m hoping to get in to see him sooner than the others (he also understands our family history of autoimmune illnesses very well). Somewhat unfortunately I live in Canada so I will be put on a wait list at some point for any type of surgery. Thankfully my day to day pain is still very minimal, but we know that surgery will need to be done, so its best to start the research and waiting now, rather than waiting. (And yes it sucks to wait sometimes, but its free!) I’d love to chat off of coth, but can’t get the PM’s to work, if you would like email me at justaplainsam at hotmail.com.

[kris0227]

I wanted to provide a quick update in case anyone else out there is considering an ankle fusion or replacement. I am now about 12 weeks post-op with a STAR ankle replacement. The pain is GONE! I no longer can tell you when the weather is about to change and it’s a beautiful thing. I rode for the first time today since the surgery and it went really well. I did not have the pain I’d had before, but I did have to lengthen my stirrup leather, especially as my leg relaxed. There was no post ride pain, and I’ve not experienced any increased pain the next day from activity. So, if you’re out there and experiencing pain in your ankle due to arthritis, I certainly suggest that you consider the ankle replacement, I’m thrilled that I’m now essentially pain free with full mobility in the joint.

[EEventing]

Hi… I understand what your going through. I fell off about 2 years ago and broke my tibia, fibia and shattered my ankle. I had two surgeries within the first 7 weeks. The first one was basically to save my ankle and put it back on and then the second one was to add more hardware and try to get it to realign. I eventually made it through that and went to physical therapy but was in a ton of pain and had very little movement. I then saw an ankle specialist who once again tried to realign my ankle, lengthen my Achilles (to gain more movement) and basically cleaned out a bone chip and had to take out all the damaged tissue. After the 7 weeks I was put in a walking boot and started therapy again. I was back to walking but had a slight limp and was extremely limited. I couldn’t run, walk down stairs, had a hard time walking up or down a incline. I was miserable, and at 20 years old there was just no way I was ready to give up on being even close to normal again. I was actually riding a bit but it hurt so much and I couldn’t put my heel down at all. I went back and they told me my only options were a ankle replacement or a ankle fusion but they didnt suggest either of them. I am way to young for an ankle replacement that if I wanted to be active I was going to need a new one within 10 years and they dont want to do and ankle fusion on a 20 year old because you are seriously limited in what you can do and how active you can be. I was so bummed and felt so hopeless.

My mom knew someone at work who’s sons arms where 4 inches different in length, she called him up to just ask where he went. Thinking that if they worked miracles for his son and made his arms the same length, maybe they would have someone that could help me. They did!! We went on the website and found these specialists who do amazing work. Back in january I ended up having surgery and I have a ankle distractor on my leg. Its kinda crazy and I can tell you more about it if your interested. but, what they are doing is they cut a chunk of my lower lower leg and they are regrowing the bone so it grows back correct! my leg was not aligned well and no hardware was going to be able to straighten it. So, they are regrowing my bone so that it is straight and correcting the deformity. Also, they took stem cells from my hip and put them in my ankle joint so that all new cartilage could grow. I had major arthritis in it already and because they had to take out all the cartilage in pervious surgeries they are completely regrowing it. Its AMAZING!!! So I am only about 5-6 weeks out from surgery but I already have more movement now then I did before this surgery. I am extremely hopeful that I will make a full recovery to riding and be pretty darn close to normal again. They do amazing things and I have heard and read some insane cases and they are so proud and confident about what they do. I cant wait to get my frame off in April and see all my improvement.

Its pretty hard to explain but if you are interested or have any questions send me a private message. I would love to explain better or answer any questions!

[kris0227]

Thanks for the info! I had actually spent a large amount of time researching the possibilities for the surgery and this was one that I found. However, because of the damage and the end-stage arthritis that I already had, it was deemed that the ankle distraction arthroplasty would not be a viable option. I had my ankle replaced in September and I just finally finished all of my physical therapy. I still have some contraction of the achilles, but the belief is that this will resolve with time and exercise. The new replacements (research the STAR) are rated for longer than 10 years, my surgeon was one of the ones that helped bring the STAR to the U.S. and he said that the newest revision which just came out was lab tested for 20-30 year life span. I’m 31 and he said he would be hesitant to do the replacement on someone much younger.

The results? My pain is very minimal at this point and usually related to the soft tissues that haven’t moved in four years including my achilles. The joint itself is no longer a point of pain and I can no longer predict the weather. Woohoo!!