Skiing With Ankle Fusion?

[Brian Finch]

Sorry to hear.

I bet a crafty boot fitter could build you a 2 part zeppa - take a flexible/squishy zeppa for the front, say forward of the calcaneus & a rigid for the posterior part- aka the “PugSki fusion mullet zeppa” business in the front (flexing- initiate the turn) ; party in the back (stiff - drive the ski)

@Philpug copyright that stat!

 

[surfandski]

Hi Brian, thanks for your post. That's an interesting concept I hadn't thought of. One thing I'm trying to understand is what happens to the foot/ankle when the boot flexes with a fused ankle inside. I understand that when the ankle joint is fused that the joints in the feet will do more of the flexing (at least when walking) but if your heel is locked in, how will the foot joints be able to compensate for the lack of mobility in the ankle (the place ski boots are designed to flex)? I have Lange RS 130 boots that do a fantastic job of locking in my heal so it really doesn't allow it to lift unless I left the buckles lose. I really wish I had stiffer boots prior to the fusion because I can flex the crap out of these 130s when pushing it which can be excruciating every time my tibia slams into my talus.

I realize I may need to look at different boots after this season. What would be the best design for a fused ankle? Something like a Full Tilt or Apex? I would think stiffer would be better to limit dorsiflexion. I'm trying to gather as much info as I can to best prepare myself.

Thanks!

 

[Rod9301]

Sounds like you need a very stiff boot with a forward lean angle that matches the one in your ankle.

 

[Brian Finch]

@surfandski - I don’t think it will be as terrible as you envision. The flex out of the ski boot comes mostly out of the deformation of the lower clog as the boot is flexed, not simply the pivot at the ankle on the boot. I would keep your boots as a reference and starting point. You may also want to look at a heat moldable liner like the intuition Pro (or power) Wrap- it’s very tall and give you a lot of contact with the shin.

 

[Susie]

So sorry @surfandski that your ankle continues to worsen. I am now 15 months post fusion and still healing. It is truly a long process. The bone healing part is relatively easy, but the "body now moves differently" part takes a lot of PT and focus to resolve. I have skied about 30 days since fusion, 15 days late Spring and 15 days this season. I have also chosen to ski with outriggers, which permits me more control and comfort. Unfortunately, I developed a nerve condition during recovery, so you may progress faster than me.

When it comes to fusion position, I am at a perfect 90deg. I have heard of other fixation points, but it was because of specific anatomy or injury needs. I think the goal is always perfectly neutral. In my ski boot, I have a small heel lift and the cuff angle was shifted to accommodate the neutral ankle position. The nice thing with the fusion is finding that perfectly balanced, neutral point is really easy. Anything else just feels awful. With lots of PT, you can increase the mobility of the joints in other parts of the foot. To be honest, I have more "effective flexion" now than before I was fused. My biggest issue skiing has been that my leg is somewhat numb from the mid thigh down, since surgery. This makes fine motor control more difficult, which is why I use the outriggers. My leg also gets cold easily. With the extra support of the outriggers and boot heaters, I'm skiing well!

I wish you well with your upcoming surgery. Please do not hesitate to reach out to me by message or phone, if you would like to speak further on the details with regards to skiing or general life post fusion.

 

[Susie]

@surfandski - You may also want to look at a heat moldable liner like the intuition Pro (or power) Wrap- it’s very tall and give you a lot of contact with the shin.

Great advice... I am skiing in an Intuition Liner as well. It was best to accommodate the hardware.

 

[Brian Finch]

Great advice... I am skiing in an Intuition Liner as well. It was best to accommodate the hardware.

Make certain to go old school & cook the liner & then slide it into the boot - much better accommodation than the hot air heat stacks -

 

[surfandski]

Thanks everyone for your input! Things got so crazy getting ready for the trip that I'm just logging on for the first time. We left Florida yesterday with temps in the 30s and are enroute hoping to get to Colorado by 1am.

I hadn't noticed my pain level change with the weather but the past few days I've hardly been able to walk even with a cane buy it has coincided with temps in the 30s in FL and 20s last night in TN. The 2 cortisone injection don't seem to have had any effect pain wise even though inflammation seems to be way down.

It's good to hear that fusing the joint in a neutral position seems normal even for skiing since that is what my surgeon is planning on. The way it has hurt the past week I'm actually looking forward to getting it fused. 2 months ago I was looking so forward to this ski trip and felt confident I could charge fairly hard this season and now I'm thinking more about getting thru the trip so I can get it fused and get relief. Bad timing as it seems the cartilage just gave out right before the trip. I've been wearing a walking boot the past couple days so maybe going from walking boot directly into ski boots and taking it easy will allow me to at least accomplish my #1 goal of teaching the kids on moderate terrain. If they progress and have a blast than the whole trip will be worth it. I probably didn't need to bring my 3 pairs of off-piste skis as it is looking like it will be mostly groomers for me but maybe deep pow will provide enough cushion for my Blizzard Spurs.

Thanks and I'll keep you updated.

 

[surfandski]

So sorry @surfandski that your ankle continues to worsen. I am now 15 months post fusion and still healing. It is truly a long process. The bone healing part is relatively easy, but the "body now moves differently" part takes a lot of PT and focus to resolve. I have skied about 30 days since fusion, 15 days late Spring and 15 days this season. I have also chosen to ski with outriggers, which permits me more control and comfort. Unfortunately, I developed a nerve condition during recovery, so you may progress faster than me.

When it comes to fusion position, I am at a perfect 90deg. I have heard of other fixation points, but it was because of specific anatomy or injury needs. I think the goal is always perfectly neutral. In my ski boot, I have a small heel lift and the cuff angle was shifted to accommodate the neutral ankle position. The nice thing with the fusion is finding that perfectly balanced, neutral point is really easy. Anything else just feels awful. With lots of PT, you can increase the mobility of the joints in other parts of the foot. To be honest, I have more "effective flexion" now than before I was fused. My biggest issue skiing has been that my leg is somewhat numb from the mid thigh down, since surgery. This makes fine motor control more difficult, which is why I use the outriggers. My leg also gets cold easily. With the extra support of the outriggers and boot heaters, I'm skiing well!

I wish you well with your upcoming surgery. Please do not hesitate to reach out to me by message or phone, if you would like to speak further on the details with regards to skiing or general life post fusion.

View attachment 36126 View attachment 36127

Susie, what do they think caused the nerve issue and is there something they could have done differently to avoid it. I've heard many good experiences with fusions so now that it doesn't appear to be the skiing death sentence I assumed it was I'm looking forward it! Thanks and I hope your nerve issue goes away.

 

[surfandski]

I wanted to check back in and give an update. I had my ankle fused last Friday the 13th and it appears to have gone well. My surgeon was young but very good and worked at the VA and said my injury was similar to land mine injuries so he has performed many similar fusions with good success.

The recovery has been surprisingly easy so far with very little pain or numbness compared to my original 2 surgeries right after the injury.

The hard part is trying to plan for next season with all of the unknowns as we had planned on getting Ikon passes and traveling next winter thru Co, UT, MT, Wy and CA but figuring out how to make my boots and ankle work together may be a project so I think it makes more sense to reduce my expectations and spend next season parked in Colorado so I can work thru whatever challenges I will face relearning how to ski on 1.5 legs. I won't know if I'll have complications like a non-union until after most passes jump in price which makes pulling the trigger more difficult. I'm thinking of taking a minimalist approach with just Loveland passes next year and then go big the following once I get my mojo back.

 

[LiquidFeet]

Curious... will you no longer be able to bend your ankle at all, in any direction? If so, will you need to wear special shoes (rockered) to walk?

 

[surfandski]

One thing I'm wondering is how likely it is I'll be able to use my current Langes as they are super tight even after lots of work. They are dialed in now but I still lost my right big toe nail and my left was black and half loose but didn't fall off. The reason I ask is because if I knew these wouldn't work then I'd maybe seek out a boot fitter that has a good bit of experience with fused ankles.

I should be able to try to get my foot in my boots in 6 weeks. Who knows, with a heated boot bag maybe they will be soft enough to get into with a locked ankle.

Thanks for any advice!

 

[surfandski]

Curious... will you no longer be able to bend your ankle at all, in any direction? If so, will you need to wear special shoes (rockered) to walk?

Rockered shoes are an option but I don't think they will be a requirement. No I won't be able to move ankle in any direction as the tibia and talus are now one but all of the other bones in my foot will move so I should be able to roll off my foot somewhat. Honestly, I don't know exactly how things will be until I start weight bearing. I had almost zero cartilage left in their and could hardly walk before aurgery so I have no doubt I'll be in much better shape. Every bump I hit this season I groaned like Venus Williams serving a tennis ball.

This Summer will be mostly kayaking and road cycling and then add in the MTB and motocross hopefully in the fall which should all be a lot less painful moving forward. I'm cureently pulling into Asheville as my wife drives and I'm already getting really excited for my future with this new ankle!

 

[LiquidFeet]

It's so good to hear you are pain free.

 

[Jilly]

My husband had his ankle fused too. He had heel lifts in that boot to get him forward as all he could bend were the toes. Now he did dial his skiing back a bit as he didn't want to injury it again.

He was finally pain free and actually liked to walk.

 

[surfandski]

It's so good to hear you are pain free.

Well, I haven't tried walking yet but yes, so far so good!

 

[surfandski]

My husband had his ankle fused too. He had heel lifts in that boot to get him forward as all he could bend were the toes. Now he did dial his skiing back a bit as he didn't want to injury it again.

He was finally pain free and actually liked to walk.

That's encouraging and seems to be a common result of the fusion.

Anything besides heal lifts? I already have heal lifts in both boots but I'm trying to wrap my head around what it's going to feel like the first time I clip into skis in my living room and flex forward. My left leg will go much further than my right. I skied most of last year with most of my weight on my left leg so I'm familiar with skiing each ski independently but just wonder if I'm going to feel like my right leg wants to throw off my balance when I expect it to flex forward but it just can't.

The more people share experiences the better I'll be equipped to try out different things next year. So thanks!

 

[Jilly]

I'm trying to remember...seems to me he still favoured the fused leg. So not as independent as should be. Can't ask...he's been gone for almost 5 years. And he wasn't a young man. Although he skied for 8 years with it.

 

[LiquidFeet]

.... but just wonder if I'm going to feel like my right leg wants to throw off my balance when I expect it to flex forward but it just can't.

If the flexing difference between ankles gives you trouble skiing, you might try stiffer boots that don't let the ankle that works flex so much. I would think you'd need the cuffs on your boots to match as close as possible the angle the surgeon created at the front of the fused ankle. I've read that some bootfitters are equipped to change the cuff's forward lean angle.

 

[PTskier]

A friend has ankles that flex very little. It's a congenital thing, not an illness or injury. He cannot get balanced fore & aft on skis without pain, he's always back. Speaking with a very good boot fitter, the direction he'll go is new boots (which he needs anyway) with sufficient room inside for heel lifts. Cabrio boots may offer that heel space, and either Full Tilt or Dalbello are likely the first ones to look at. He may also need shims under his heel bindings to finally get him to the balance point. A boot like the Dalbello Panterra 130 or Full Tilt First Chair or Decendant might be his starting point...subject to width and all the usual concerns. LF's points about stiff boot flex and cuff angle are all things the specialist boot fitter will deal with to get the skier comfortable and balanced and high performing. My friend also knows that he needs canting alignment. His first day on the snow on those totally new boots will be something to watch...he'll be totally unfamiliar with the new set up. A day or two and he'll be skiing better than he ever imagined.