External Fixators Anonymous

I got this comment on the blog yesterday from a fellow boarder with a bad break.

"Hey man I shattered my ankle april 14th riding in Vail. I had 2 surgeries, an Ex-Fix installed as well as a plate and 10 screws. I thought my break was the worst ever but apparently you got me beat. I was just wondering what your recovery time has been like. its been almost 5 months for me total and 3 months or so since I got the ex-fix out. I still can't bend my ankle past 90 degrees and my toes wont fully out stretch. im kinda getting concerned im goona be a 26 year old pirate myself. I've been doing the PT and all but I just cant get this damn thing to allow my foot to bend up (it goes down and side to side fairly well, although not as well as before). so my question to you is how long did it take yours to start bending naturally? and how was your overall recovery/how functional is your ankle compared to how it used to be. Please answer and be honest even if it only took your ankle a couple weeks or something. Im kinda freaking out. thanks alot man any info you could give me would be much appreciated... and yes I plan to shred again also, even if it has to be at half speed and with weak style."

First of all -- I feel your pain. Going from being active to sitting on your butt all the time is awful. It's good that you're starting physical therapy, because at least you can start doing work and celebrating minor results.

Second -- don't panic. It can be extremely difficult to see past your recovery. Keep your eye on the prize: returning to the slopes.

My recovery has basically restarted since I'm back in an external fixator. I'm not back to normal yet. Here is how it's gone up until now.

• February 13th - Initial injury. ORIF of fibula with external fixator. One plate with eight screws. Not bearing weight. No PT.
• March 1st - Second surgery to remove external fixator and ORIF of tibia. Second plate with 11 screws. Not bearing weight. No PT.
• April 2nd - First physical therapy session. Therapist says, "I can't work with this ankle in the condition it's in, see me in a month."
• April 15th - Infection discovered. Not bearing weight. No PT.
• May 5th - Wound vacuum installed to heal the wound from the infection. Bearing 25% weight. No PT.
• May 19th - Skin graft. Bearing 25% weight. No PT.
• June 11th - Start Physical Therapy. Bearing 100% weight. Driving!
• July 18th - Ankle really starts to bother me.
• July 28th - Ankle and plates are broken. Time for more surgeries! Not bearing weight. No PT.
• August 16th - Third surgery. Hardware removed. Second external fixator installed. Not bearing weight. No PT.

On my first visit to PT on April 2nd, I got a giant list of exercises. Check those out and make sure you're doing those. I was able to work on these until we found the infection.

It took a very long time to get the strength back in my foot. At first, it felt like a lead weight hanging from the end of my leg. I couldn't move it, and when I tried, it hurt really bad. That feeling went away after doing those exercises every day for about two weeks. I was already getting a little flexibility back, but nothing past 90.

While I was in PT from June 11th to July 28th, I was seeing small but steady results. I was constantly working at it, even when I wasn't in PT. My biggest concern, like you, was dorsiflexion.

I was eventually able to get about 10 to 11 degrees past 90 with my dorsiflexion. This was sometime around the end of July. However, my fracture never healed, and some of that could have been contributed to some bending at the fracture site. Physical therapy hurt -- bad. But again, the fracture never healed so all of that pain was due to a broken ankle.

Ask your physical therapist about a Dynasplint. I only wore mine for about a week since we discovered my ankle never healed. But I think these things work.

You might also want to look into orthopedic shoes or Skechers Shape Ups. While your flexibility is bad, these shoes will help you walk.

Finally, I'd recommend you start taking videos of your flexibility every month so you can compare the small changes.

As far as my toes go, my great toe was really my only concern. On April 2nd, I couldn't move my toes at all. There are several exercises in that list that address toe movement. I highly recommend them, because I had some movement in both directions by the time I started PT up again in June.

My physical therapist said getting the great toe to bend up is the key goal, while bending your toes down isn't as big of a deal. Right now they're starting to get stiff again, so I'm working on my great toe every day while I'm in the external fixator.

If you're fighting any swelling or edema, it's absolutely critical that you work every day on it to get rid of it.

Above all else, don't panic. This injury has been a true test of my patience. Keep working at it. As long as I can walk, bike, and put my foot into a snowboarding boot, then I consider my recovery a success.