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Ankle Skiing with Total Ankle Replacement

I had my first TAR in 2011, right ankle, I was 51. Device was Wright Infinity. Original injury was a sky diving accident in 1981.
After 18-24 months I was totally happy. Surgeon said skiing on bunny hills was okay. Doubles tennis, hiking etc. NO! Running!
All was good until 2020 when I started limping again and suffering lots of pain.

when I returned to the Surgeon he said the device was worn out…this is an issue for active people.
in winter 2021 I went in for a TAR revision. This time the device was a Wright In-Bone. Everything has been better this time around. Managed pain completely with OTC NSAIDs. Recovery was easier, faster. ROM is improved over previous TAR. I had a bone cyst about 3/4 inch diameter on my talus. I suspect that’s what caused my pain.
i have not skied since, but that’s because I have no ski buddies. I have done several long hikes including 13 miles into and out of Petra last year.
I‘m good with 10-12 mile hikes but not on consecutive days.

From experience, I caution the OP to think about what you’re doing. These devices do wear. I’m not suggesting you give up skiing but maybe cut back and find more low impact activities.
I was told revisions are never as good as the original TAR. Maybe I got lucky maybe an improved device. I hope to keep this device till the end.
 
@Gallaher Thanks for the reply. Yes, wearing out a TAR is a concern: the data indicate that happens to most. Interesting to me that the In-Bone revision is working better than your original Infinity. I wonder if that's improved device, improved installation tools/protocols/surgeon experience/In-Bone vs Infinity or just kind of random.

I'm at 10.5 months. Doing pretty well, but still pretty stiff with some pain in tendons and other "foot parts" around the prosthetic, particularly after sitting or lying down for a while: it always takes a while to get loosened up.
 
13 month update. I've fought pain in my posterior tibialis tendon and an accessory navicular where tendon attaches to navicular pretty much since I started first walking in a boot after my TAR. Off and on, but got pretty bad at times. After a lot of trial and error KT taping and a redesigned orthotic has fixed much of this issue. Fingers crossed, that issue may be healed or mostly so: recent imaging say it looks pretty good.

The pain I mentioned above (after 10.5 months) has gotten progressively worse to where walking is pretty painful now. I'm riding the e-bike 20 or so miles 3x per week and doing core work but can't walk too well. Even doing yard work is pretty rough.

In the last few weeks, I've had an MRI, CT-fusion scan, and just saw my long-term podiatrist, my surgeon, and an Ultrasound specialist recommended by the surgeon. I have a followup with my surgeon in 10 days. Initial reading is the TAR prosthetic is fine, but I have two bone spurs on my talus near the fibula that is causing the problem. My surgeon and the ultrasound specialist work together at times. The ultrasound doc took a fluid sample (amazing how much fluid I had in there) and is sending it to a lab for a 14-day test to confirm there's no lingering infection (related to my post-TAR infection). After that, it's likely I'll have the ultrasound doc do the Tenex-Bone procedure to remove the spurs. The ultrasound doctor trained at the Mayo clinic under one of the inventors of the technology and has done 6,000 + tenex procedures so I feel better working with one of the best around (Tenex is relatively new with few high quality studies). The ultrasound exam was pretty amazing: he looked carefully at all tendon/ligament/joint/bones in ankle and foot and pointed out all the various thrashed supporting tendons resulting from years of sprained ankles in my teens-40s. The Bone scan imaging report saw some degeneration in Subtalar and talonavicular joint, but my podiatrist and ultrasound docs didn't see much to be concerned about there - huge relief.

Will post a follow-up as this latest adventure progresses: hopefully, pain free in a bit.
 
I love that your team is actually functioning as... a team! How rare!
Fingers crossed your labs are negative and it's onward to the bone spurs.
 
Iski said:
@Gallaher Thanks for the reply. Yes, wearing out a TAR is a concern: the data indicate that happens to most. Interesting to me that the In-Bone revision is working better than your original Infinity. I wonder if that's improved device, improved installation tools/protocols/surgeon experience/In-Bone vs Infinity or just kind of random.

I'm at 10.5 months. Doing pretty well, but still pretty stiff with some pain in tendons and other "foot parts" around the prosthetic, particularly after sitting or lying down for a while: it always takes a while to get loosened up.
Click to expand...
In-Bone (dumb name) and Infinity are both manufactured by Wright. Not sure who owns Wright.
The Infinity is an off the shelf small, medium or large device.
The In-Bone is custom 3D printed for each patient.
The In- Bone is MUCH more invasive. I’ve watched animations and cadaver surgeries. The In-Bone surgery looks like a horror movie.
I was told TAR revisions don’t go well. Not my experience.
More experienced surgeon? Better device? Who knows.
I’ve done great and will take steps to keep this device healthy till the end.
Note: I wish I had taken steps to preserve the previous device. Don’t know what that would have been.
 
I had my Tenex-bone procedure yesterday to remove 2 bone spurs on the lateral side of tibia. Amazing to me how this procedure works. No anesthetic other than lidocaine around and into spurs. Procedure took about 20 minutes. With this procedure, ultrasound "zaps" bone and saline suction removes particles.

I took two tylenol last night, nothing today. Boot for 3-5 days for protection and antibiotic course for precaution because of initial infection during TAR. Almost no pain 24 hours after procedure. WAY less invasive than traditional arthoscopy by surgeon (as noted above, my TAR surgeon recommended this route). Only downside I see is doctor doesn't bill insurance: many insurers still view this as "unproven": Tenex-bone got FDA approval in 2019 I believe. I'll submit to medicare and medicare supplement insurance to see if I get some repayment.

We'll see if this gives me some pain relief in ankle. Will check back later.
 
I missed your update. How interesting - to learn about this! How are you doing now?
 
2 weeks after Tenex procedure, I have a little relief, but not that much. Was told originally it could take 4 weeks. Seeing my Ultrasound doc tomorrow. Will update in a bit.
 
5 weeks after my Tenex procedure. During meeting with ultrasound doc 3 weeks ago he was pleased with the procedure (did what he wanted it to do). There he said it could be 4-6 weeks for recovery. He showed me a new way of taping using Leukotape-P that could help heal from that procedure and give added support to posterior tibial tendon / accessory navicular pain I've been fighting ever since original procedure.

I don't feel "healed" per se yet. Still quite a bit of pain when I first walk after sitting. Wearing orthotics and cushy Hokas I can walk pretty good once I get going. Still get pain trying to walk more than 1-1.5 miles, not bad, but.....

With luck another week or two and I'll be better. We'll see.
 
@Newhip_Pol . Thanks for the thoughts. Now 6+ weeks out, it doesn't appear that the Tenex procedure to remove bone chips helped much. Perhaps a tiny bit. I still have quite a bit of pain when walking. As always, it’s painful after sitting for 20-50 steps. When I wear cushy HOKAs with orthotics I can walk with little to no pain for a bit. Once I get going, I’m able to walk 1-2 miles in HOKAs and orthotics pretty well i.e., little to no limp or pain. Day to day on the 0-10 pain scales I see online, I’d guess it ranges from 3-5 after moving from sitting position: 6 or 7 after an attempt to do light PT for accessory navicular / tibial tendon.

Looking back at my notes, my pain is pretty similar now to where I was at 4-6 months. Less swelling but still fighting pain after 15+ months.

Reaching out to my surgeon to see if there's any way to figure out what's going on and where to go from here.

Good news is cycling isn't much of an issue. Enjoying the last bit of e-biking before it gets too cold here - off to Arizona soon to get a couple more weeks of warm weather before turning to winter activities :)
 
I'm sorry you feel stuck and hope your surgeon has some ideas.
If not, and he thinks it may be a soft tissue problem, a physiatrist (physical medicine) or a sports medicine doctor might offer a fresh assessment and some ideas.
 
Well, I'm at about 16 months now and unfortunately it's looking like I may be one of the 10% or so patients where the TAR doesn't work. In quite a bit of pain now. The Tenex procedure to remove bone spurs didn't help. 2 recent CT fusion scans not showing obvious loosening or settlement: a few cysts. I'm going to grit it out for now, but I'm probably going to need revision surgery before long. We'll see. The taping seemed to have finally fixed the tibial tendon/accessory navicular issue, but overall soreness in multiple regions is the problem now.

Currently seeking second opinion from doc with revision surgery experience. See how it goes.
 
Sorry to read this, @Iski. Please let us know what the new surgeon says. When will you see him?
 
@benne68 I'm still trying to get second opinion arranged, so not sure. For a variety of family and location reasons, I'm hoping I can hold out for 6-7 months. See how it goes.
 
I'm sorry. Do stay in touch.
 
I thought it might be helpful to report back. I elected to do revision surgery (Wright Invision) at Seattle's Harborview Foot and Ankle clinic. Surgery was May 7, 2025. 7 weeks into recovery now. My revision surgery is night and day better than initial one. This surgeon pointed out a couple of angles I was misaligned: that and the infection I caught in initial TAR likely led to the loosening and need for revision.

The Invision system is a much "beefier" implant both with the Inbone system into tibia and a wider plate on Talus. My recovery has gone much more smoothly and I'm slowly doing my rehab twice a day and getting better daily. A long ways to go yet, but I'm quite optimistic that with continued PT and time, I'll have an ankle that performs much better than after initial TAR.
 
Thanks for checking in, @Iski. I've updated your signature to reflect your recent revision. Glad your recovery is going well and that you are optimistic about the outcome.

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