I have just had surgery to repair a longitudinal split in peroneal tendons, remove a bone piece or pieces from an avulsion fracture of the distal fibula and debridement of other tendons. I’m non weight-bearing for 2 weeks, then partial weight-bearing for 4 weeks, then maybe another 2 to 4 in a boot. I’m hoping to get back to riding, hiking, cycling again, though my age (late 60s) may be against me. I would love some sound orthopedic advice about if and when and how to start riding again, from an orthopedist or PT ankle rehab specialist who knows the ankle stresses of equestrian sports. It would also be nice to hear some ankle success stories.
I had two screws placed to correct a minor isolated medial malleolus fracture. I did manage to rip the ligament off as well.
As I explained to my ortho, technically riding is a non weight bearing activity - I am sitting and not putting weight on it 
All teasing asides, I was pretty aggressive with my mobility, treatment and recovery. New ortho standards recommend immediate weight bearing after surgery (depending on fracture) and would be worth discussing with your surgeon. Remember that their goals and yours aren’t exactly the same - they want to protect surgical site; I want a working ankle.
https://www.aaos.org/News/DailyEdition2016/Tuesday/013/?ssopc=1
i was extremely aggressive and lucky it worked out. I also consulted with a physio as soon as staples came out (looking to prevent adhesions at the surgery site) and worked with a structural integration massage therapist to prevent bad habits. Best $1000 spent as my ankle feels great, swelling resolved and I have full range of motion. I can even wear 4 inch heels when required.
I am just on the other side of ankle surgery #2. The first one was in 2017 for an internal fixation of a tibial pilon (joint surface) fracture in my medial malleolus. Realistically I have been riding on a much lesser level, ie, dressage on a young horse, no jumping, short and easy rides. Not riding professionally at the point again, nor am I jumping.
There certainly have been soft tissue ligament and tendon issues that went along with the break, although none of these where surgically corrected. I was back to extremely easy rides on my old very safe dressage horse at approx 7 weeks post surgery - basically as soon as I was released to weight bare. (Done while I went back to my hometown to visit, followed by no riding for another 2 months when I returned to where I live now).
I had had hardware removal last week, so am supposed to avoid impact and risky activities for 4-6 weeks so no riding for awhile again.
Thanks, Mouse: interesting article. My surgeon may be familiar with it, as she has prescribed a shorter NWB period than I was given to expect.
I did, like you, try to pretend that riding was a NWB activity, but in time had to admit that it aggravated the ankle-- increased pain and swelling, perhaps due to sprained damaged tendons. However, not riding didn’t make it get much better.
The massage therapist sounds like a good idea. How did you find a good one?
I just fractured my left ankle, right knee and broke my left collarbone (my horse slipped on ice and fell. Luckily she is okay). I had a second opinion on the knee (no surgery, thank God) with the head of Orthopedic Surgery at Mass General Hospital and his recovery recommendations were much more aggressive than the original orthopedic doctor I saw. He wanted me to use the left leg as much as possible (weight bearing in a boot), take the sling off my arm and use my left arm within a comfortable range of motion. It made the folks where I was doing rehab blanch, but he’s very well known in the field and very current. I’m going to follow his advice as much as possible.
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I had pretty extensive peroneal tendon surgery (both were torn) and a debridement of the posterior tibial tendon thrown in for good measure in 2013. I was non weight wearing about 5 weeks then partial WB with a boot for another 7-ish weeks. My tears were down in the foot and not in or above the fibular grove. I did not have any tendon dislocation although the surgeon did a retinacular release to make sure the tendons stayed put. Once, healed, the foot has been no problem for riding. It is stiff. I do have decreased range of motion. It has never been a hindrance to riding. I ride dressage though…no jumping.
Do the physical therapy. Mine was a long term injury (ten years before I got it fixed) and even with P.T., my peroneal muscle just didn’t come back. It works but is atrophied and weak. That presents problems walking and balancing on one foot but not for riding. I finally got another round of P.T. about 6 months out that did help strengthen things a bit further.
I started riidng slowly and carefully when I got out of the cam boot (I was 54). Boots were problematic but I found a pair of lace up work/paddock boots that I could get on my fat foot. The boots rubbed the incision which was uncomfortable but I was able to pad the area and the tenderness went away fairly quickly with a little time.
Jingles for speedy healing.
Susan
Physio and massage are so individual. Do not fear tying a couple - you want someone who gives you one on one attention (no group PT classes). My massage is trained in “structural integration” also known as ROLFing. She is excellent.
For physios, each state has different rules. I’m in Canada, mine is certified in active manipulation (a further masters level Physiotherapy degree), as well as GUNN intramuscular stimulation. That was not required for my treatment but will maybe help you find someone qualified? She is also a trained gait assessor if that helps.
Mens Health recently had a very interesting story regarding Alex Guerrero (Tom Brady’s guru). Also involved a busted ankle if you can look it up: https://www.google.ca/amp/s/nesn.com/2017/05/mens-journal-reveals-alex-guerreros-secret-techniques-at-tb12-center/amp/
I had some similar work done 6 years ago. I had ligament issues besides the tendon ones. I had a relatively easy time through the rehab (surprised everyone). I wouldn’t push riding; I wouldn’t expect to do it until at least 4 mos post op.
I had additional debridement (just ligaments, not tendons; tendons were horrible the first time)done in 2016. I did the basic rehab & didn’t do more than walk for about a year, 18 months. It feels better now than it has in 10 years. (I will probably sprain the hell out of it on the way to the bathroom now, having said that. :lol:)
I recall discussing riding with one of the PTs in the group I went to. He assured me that riding wouldn’t be much of a problem, unless I was a posting a trot. He was a looking at from a foxhunter perspective, so not a huge deal. I rode saddleseat - there are lot more miles posting a trot!
Soft sneaker boots were my friend.
I had a peroneal graft (both peroneal tendons removed and the ends sewn to a donor tendon; a brostrum procedure (ligament tightening) with implantation of internal braces; and arthroscopic debridement of the joint and scar tissue from three previous surgeries (avulsion fracture with tenodesus of bravis 17 years ago and then internal fixation for bimallolar fracture and hardware removal in the last two years). The recovery from this most recent surgery has been the easiest: I was nonweightbearing for two weeks then in a walking boot (relieved on the knee walker from time to time); at four weeks, ditched the knee boot and started riding again. I definitely had no strength in the that leg, so did quite a bit of work without stirrups to be fair to my horse. I also started physical therapy two weeks after surgery. We worked first on range of movement; then on inflammation; now we are focusing on strength and working on the scar tissue (graston method). I have had ALOT of therapy–massage, taping, electrical stimulation, cold laser, ice, heat, manipulation, vibration plate and micro current therapy. I am now about 9 weeks out from surgery (surgery was November 20, 2017) and walking very well, inflammation is mostly under control, am back in my normal riding boots, and gaining strength week by week. I am back to riding at the grand prix level (dressage) and believe I will be pretty good in a month or two. I am 60. Doctors were impressed with my recovery on this one, but I think early intervention and faithfully doing my exercises and therapy (i did a lot of icing, laser, soaking, etc. myself) was key. Start PT as soon as you can!
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I had ORIF surgery on my ankle in September for a Weber Type 3B fracture (both medial and lateral malleolus sheared, as well as an avulsion fracture on my fibula). Not the same as you, but I wanted to share that I have been testing out various jointed/offset stirrups in an attempt to relieve some of the pressure on the soft tissues in the saddle and have found that the MDC S model works pretty well for me.
I think it’s a combination of the 45 degree angle offset and the wider footbed more than anything else, but it really does make riding more comfortable. In normal stirrups, I was only able to post around the ring two or three times before I had to stop because of pain…in these I am up to 5-6 times around. Still not normal, but getting there.
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Thanks, Mouse, Red Mares, Cowgirl, and ecileh for thoughtful, detailed, and rather encouraging responses. I have heard good things about MDC stirrups elsewhere on this forum and will definitely be looking in to these. Before surgery trotting was the problem; I could walk or canter indefinitely, but pain set in after only one or two trot circles. Hoping walking on uneven ground, hiking, dogwalks, etc. will come back too.
I also think I have a great physical therapist; tho my first course with her was doomed to fail, with my split tendons too beat up to strengthen, Now, just let me tolerate another week of cast claustrophobia in this suffocating surgical splint!
Hopeful stories of good outcomes are a big help.
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One big tip I can give you is advocate for yourself! My PT has tried to cut me off twice, since I reached like 60 % of function. I whined to my doctor and she ordered a whole new PT plan and he got on board. The Graston Technique on my surgical scar (starting at 9 weeks post surgery) has made all the difference. I gained 3% in one direction and 10% in the other direction (side to side mobility) and lots of strength since the scar treatment. I did not have this after the first two surgeries and it took much longer to heal. Also the electrical stimulation has been fantastic.
I ride in the Sprenger 4f with the offset eye, but I did a lot of stirrupless riding while my strength between my left and right legs were so different. I just felt that was more fair to my horse and would prevent us from me training imbalances into her.
I am not running or hopping yet (11 weeks post surgery) but I think I am nearly even in the irons. I can also walk on uneven ground.
In terms of stirrups . . . I’m almost positive that my tibial plateau fracture was caused when my right foot did not come cleanly out of my stirrup. I think the torque fractured my knee. The right stirrup was on the left side of my horse when she stood up. I will never ride again in conventional stirrups – will do a complete review of all the new safety stirrups out there. I used to think they were too expensive but if I could have avoided the knee fracture for $400, sign me up.
I am back to 10 and 8 degrees of flexion in my ankles. It’s taken A. Long. Time. Literally years. If it were added up, I’ve spent hours on a slant board. I didn’t buy one because my gym has one, but it’s been a big part of recovery.
One of the reasons I’ve stayed at my gym is their little collection of therapy/balance aids. With access to a wobble board, slant board, bosu and closed cell foam pad, I could do almost exactly the same things I did at PT. I have to go out to do it though; I won’t use the stuff at home.
When you get strong enough and it’s not painful, you can ride with only a stirrup on your surgery side to help strengthen it.
