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Ankle Skiing with Total Ankle Replacement

Iski

junior member
Joined
Aug 13, 2023
Messages
40
Age
65
Country
United States United States
Gender
Male
TAR, Wright Infinity, 7-7-23. 65 yo male. I've learned a lot on this site. Thanks to all for the information!

Ankle bone on bone arthritis after too much basketball and serious skiing. Last 2 years wintering in Sun Valley Idaho with 75 days each on slopes, mainly downhill, some XC and backcountry. Pretty decent condition but not peak, workouts 3x/week, hiking, backpacking, just starting e-biking.

2 hr surgery. In and out of hospital in 10 hours. Had cast with 24/7 ice-water machine for a week. Worked from laptop on Monday after. Oxy and Tylenol in descending amounts for ~2 weeks. Check-up and boot at 2-week mark, stitches needed 3-4 more days before removal. At week 4 started progressive weight bearing 25lb, 50 lb etc. moving up every 2 days. Fought difficult soreness in the tibialis posterior tendon (inside of ankle) when in boot. Started PT week 5 and began to get discharge around incision at the 90d bend tibia to ankle area. Started 2-week antibiotic course "to be safe".

At 6-week checkup implant healing great, but now "bend area" opening into a wound and he referred me to wound care. At peak, opening was roughly 2.5" long x 1" wide x 5/16" deep). Wound care has me putting Hydrofera Blue "patch" onto wound with gauze wrap, change 3x/week with weekly appointments to debride wound. At week 8 cleared to walk in shoe. Flew Seattle to Denver for wedding walking through airports, did some short walks, 30 min rehab exercises daily, 2 e-bike rides, and flew back. Outside ankle and calf quite swollen: yes, I overdid it but was told to let pain be my guide and never had too much pain - just stiff, but after loosening up felt good for quite while before it got sore.

At 9-week wound care appointment, surgeon who did debriding was a foot/ankle DPM who cautioned me to back way off rehab to let wound heal - that should be my priority. Both wound care surgeons said "good that no metal is showing", Yikes!! Gave me a compression "sock" from toes to bottom knee to limit swelling: that helped a lot. So, for a while I'm doing only "4-quadrant" band exercises and trying to limit walking to get wound to heal. Use HOKA rocker shoes which help a lot. A bit frustrating because implant seems really good for 9 week mark, but I need to slow down to try and get wound to heal. Wound is healing, smaller now, but slow process. Hoping this clears up in a few weeks.
 
Welcome to BoneSmart, @Iski. Please let us know which ankle was replaced so we can complete your signature.

I'm so sorry to read about all the difficulties you are having with your recovery, but it sounds like you have a good direction now.

Many of us have found ourselves on the ODIC (over done it club) bench during our recoveries -- especially if we've been really active before, it can be hard to "back off" when we should.

You are still very early days in this long recovery. Please do listen to the wound surgeon and let that poor ankle heal for a few weeks!
 
Left ankle.
 
A bit frustrating because implant seems really good for 9 week mark, but I need to slow down to try and get wound to heal.
Welcome to BoneSmart! Please take this very seriously! You don't need infection on top of a slow recovery. Any limitation is a short space of time for a lifetime of activity. For now - baby that new ankle!
 
11-week update: Wound healing well, much smaller on 9/20 appt, getting closer. OK'd for non weight-bearing rehab and e-bike. Just don't stress wound or let ankle get sore and swollen: no lunges or active weight bearing exercises. Doing daily core/hip/let/upper body band work and simple ankle movement exercises to get back in condition and trying to get ankle to loosen up. Ankle still pretty sore and not able to be on feet too long and minimizing walking.

Last week my PT measured my ROM as follows:
Left Ankle (9/15/23), 10 weeks

DorsiflexionPlanterflexionInversionEversion
Active (me) ROM
0​
35​
30​
10​
Assisted (pushing by PT) ROM
10​
40​
35​
20​
 
@Iski. I'm a bit concerned that you are letting the PT push you to achieve ROM -- especially since you say:
OK'd for non weight-bearing rehab and e-bike. Just don't stress wound or let ankle get sore and swollen:
Forcing a joint to bend beyond what it will do on its own (you actively moving it) is going to cause inflammation -- even if you don't see swelling on the outside, it WILL be swollen in the joint. And that can slow your healing.

I urge not to let any therapist force you to bend or straighten. You are not in training for the Olympics -- you are still healing from major surgery -- and an open wound. It's much too soon to worry about your ROM, you need to focus on full recovery first.
 
To be clear, I am following the recommendations of the foot and ankle surgeon responsible for my wound care NOT my PT. I am waiting on load bearing exercise until cleared by wound care.
 
Had 12-week followup today. Because of the slow-down in rehab while letting wound heal, I'm a bit behind schedule in range of motion, but my ROM is still "within the bell curve". He agreed with my wound care specialist that I'm maybe 3 weeks out for wound to fully heal. Until then a little bit of weight bearing PT is OK, but go very slow with any weight bearing to ensure wound continues to heal. Best thing is band work 2-3x/day to get joint moving mainly dorsi-plantar flexion (up/down). Biking much better than walking: don't walk more than needed until wound heals. Considering I've been focused on wound healing from weeks 6-12, I'm doing OK. Just a slow process. My surgeon thought I'd want to hit PT hard for about 8 weeks after wound heals to "catch up" on my ROM.
 
That all sounds positive - more exercise for the patience muscle. Go carefully - wishing you all the best.
 
After 8 weeks (14 weeks post surgery), wound care gave me clearance to resume full rehab activities. Ankle feels pretty good, but have a long ways to getting dorsi-plantar flexion back to normal. Have a good routine from PT and now stepping up to weight bearing exercises.
 
Well done for working through all this! Easy does it with the exercises - slow and steady for now.
 
Thanks for the update. I'm having a TAR on Jan 4, 2024 and will also likely get the infinity inplant. I'm also a skier. What did your surgeon say about returning to skiing?
 
Hi El Oso. My surgeon said the obvious: no jumps or pounding in moguls. The basics of skiing should be OK. He said it would be OK at 16 weeks - I'll have 21-22 before I start this season. I'm along ways now (at 14 weeks) from having full movement but I'm improving every week. I'm very curious about how boots/edging works out: We'll see.

I live at a resort and downhilled 65 days last year (plus some XC and backcountry). The problem he sees is repetitive movements wearing out the polyethylene spacer and increased potential for aseptic loosening of metal pieces. He wasn't aware of any hard data, but as best as I understand, the more you load it, particularly in one position (edging), the faster the poly spacer will wear out. As he explained, when the poly wears, microscopic particles get released which the body will "attack" and form cysts/spurs around the joint causing pain and the need to remove them and/or replace the poly spacers. He did say that assuming the metal/bone interface is solid, replacing the spacers and removing cysts is far less invasive than the original TAR.

So, my understanding is I'll need to be extra cautious to avoid banging into moguls or unseen obstacles in trees/powder and ski downhill a bit less and spend more time XC and backcountry which put way less stress on the poly spacer and metal pieces. For example, when light is flat and it's kind of a "meh" day, I'll go XC or backcountry.

That said, skiing is my "thing", and I'm working rehab and conditioning daily (with occasional recovery "off days") to get my ankle and the rest of me in good condition. In time, I hope to get back to the same level of technique and fitness and keep enjoying the mountains with compromises to hopefully avoid revision surgery. Recovery from initial TAR is tough and I don't want to go through revision surgery if I can avoid it. Fingers crossed.

Good luck with your TAR! This community here has been VERY helpful as I've gone through my journey. Reach out and keep us posted!
 
Does anyone have experience related to orthotics adjustments after TAR? I have flat, pronated feet and have worn orthotics since I was 20. I suppose I should go to my podiatrist, get gait analysis and adjustments but I haven't yet heard much about people needing to adjust/change orthotics after a TAR. 3.5 months after TAR and I'm walking good and working on rehab but my old orthotics feel odd on my TAR (left) ankle: maybe it's just a long time since I wore them. Feels better if I go without, but then I have more of a lift on my right foot with orthotic than with typical shoe insert on left.
 
I suppose I should go to my podiatrist, get gait analysis and adjustments
Yes, I think that would be wise. Joint replacement can change your pronation and it's best to get reassessed. You might also need to get new shoes.
 
No personal experience but to me it would make sense to have new orthotics after surgery. My podiatrist advises new shoes and inserts if required after any surgery that may affect the way you walk.
 
Update: One week short of 4 months. Last week I had long flight from US to Australia. Wore compression sock, but still arrived pretty swollen and a blood blister popped up where I had my wound. Grrrrr!! It popped and looked ugly, but after consultation with surgeon and wound care I'm keeping compression sock on and using antibiotic ointment and gauze. One week after it's healing up nicely - just superficial skin stuff.

Ankle continues to improve in fits and starts. Hitting rehab hard, swelling is down to starting to resemble a normal "bit larger" ankle, and am feeling optimistic about where I'm at in recovery process. Still a LONG ways to go, but much better. Most of the time, ankle has less pain than prior to surgery, so I just need to get the adjoining tendons and ligaments stretched back out and healed and add strength and ROM. Those two elements seem to be increasing slowly - a little better each week.
 
Thanks for the update, @Iski. I'm so sorry you wound up with that blood blister, but glad to read it is healing.

Ankle continues to improve in fits and starts. ...am feeling optimistic about where I'm at in recovery process
Yes, this recoveries are a roller coaster ride, but keep that positive outlook. I does get better!
 
I'm now 20 weeks after TAR. Skiing is my passion - mostly lifts, some cross-country, some backcountry; I'm mostly retired living in a US Western ski town. I'm interested in any data or "reasoned opinions" about TAR risk factors associated with skiing. I've asked my surgeon, spent countless hours on google, searched every thread on this forum and have only very high level information about do's and don'ts related to skiing after a TAR. The obvious ones:
  • Jumping and mogul skiing are out - like running and jumping, high stress activities risk aseptic loosening and/or osteolysis, and future revision
  • Severe crashes, particularly at high speed result in a similar risk
My central question relates to the risk associated with performing expert-level carving turns on groomed slopes. A performance boot limits the flexion of the main "replaced" ankle joint (talocrural). That said, a high level turn requires many subtle inversion/eversion motions both from the ankle/talocrural and the subtalar joint, and the ankle moves in all three planes of movement – Sagittal (plantarflexion and dorsiflexion), Horizontal (or Rotational) and Frontal – with muscles controlling the joint movement. I would think repetitive carved turns would tend to increase wear of the prosthetic components somewhat, but how much? Here's a few specific questions I have:
  • Does anyone here have experience of skiing for many years?
  • Has anyone seen a study, or a noted TAR surgeon's informed opinion, about the relative risk of aggressive carved turns on groomed slopes?
  • Is wear and the risk of future revision surgery a function of the number of turns or number of years or something different?
  • I've been told replacing plastic components or eliminating bone spurs from "gutter impingement" is a much less invasive surgery. That's much less of an issue that a full revision which I know is much more challenging. What is likely reasons for less invasive "cleanups" from skiing vs full revision?
For me a logical approach is to spend more time cross-country or backcountry skiing vs lift served skiing, but the more information I have, the better I can weigh the risks and tradeoffs. I'd appreciate any insights anyone has.
 
Last edited by a moderator:
@Iski I think if you spent hours researching your questions your gut feeling is probably to take the most cautious approach to skiing post TAR. Yes it's your passion. But there are particular aspects of skiing that just don't mesh with post op TAR. Why put yourself through more procedures and ruin all the work of your surgeon?
For me a logical approach is to spend more time cross-country or backcountry skiing vs lift served skiing
I think even the most avid skiers would agree with this approach.

You will notice that I merged your newest post with your original recovery thread. For several reasons, we prefer that you only have one recovery thread:
  • That way, we have all your information in one place. This makes it easier to go back and review your history before providing advice.
  • If you keep starting new threads, you miss the posts and advice others have left for you in the old threads, and some information may be unnecessarily repeated
  • Having only one thread will act as a diary of your progress that you can look back on.
Please post any updates, questions or concerns about your recovery here. If you prefer a different thread title, just post what you want and we will get it changed for you.

If you need an urgent response to a question, just tag a member of staff.

Many members bookmark their thread in their computer browser, so they can find it when they log on.
 

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