Total Ankle Replacement: Advice on beginning weight bearing?

@flachon3 Hello and welcome to Connect. I have been through an ordeal with my ankle too, not a fusion, but I had a bad ankle fracture with surgery for fixation. I had many days of elevating my leg because swelling increased the pain inside the hard cast. Then when you have the appointment and they saw off your cast, your leg is probably smaller because of not using the muscles, so it will be weak. There was a lot of skin to slough off with scrubbing, and that made the skin tender for a bit. Where the iodine was used, the skin was hardened, but also sloughing off. I remember some of the stitches hurt when they were pulled out, but that was over fairly quickly. My surgery was also at Mayo, and my surgeon asked me to start weight bearing by just putting 25% weight on my foot for the first week or 2, and then increase to 50%, then 75%, then 100% etc so when I came back for the next followup, I would be at 100% weight bearing. I was using one crutch with the weak leg for awhile to put partial weight on it and taking a short step, so my good leg could come to the rescue. It will hurt, so just do this in small doses as you can tolerate and don't plan on events where you will need to do a lot of walking. By now, you should have excellent skills in how to rest, relax and baby your ankle. It will take time for the swelling to subside, and it was months before my ankle returned to a more normal size compared to it's partner.

It's been 4 years, and my injured leg isn't as strong as the other, and I've worked on the muscle imbalances that cause tightness from compensating. There is a weak side of the leg from the way it was injured, and the stronger side puts too much pressure on it causing the tightness, So when I work that out with massage to equalize the muscles, I am now walking without pain, and the weaker side is trying to catch up and rebuild endurance.

Recovery is going to be slow and maybe a bit frustrating, but you'll get there. Your surgeon will give you instructions, and I agree, Mayo rocks! I had spine surgery there, and a few years later, the ankle fracture, and my spine surgeon gave me a good orthopedic trauma surgeon who fixed my ankle. The ankle hardware bothered me, so after a year and a half, I had the surgeon remove it.

Good luck with your upcoming appointment!

Jennifer

Good luck, as someone with ankle issues I hope all goes well for you! Slow and steady progress will likely be the plan

Thank u so much Jennifer. Sounds like u have been thru it, too! I have had 3 casts. Had the ankle fused by Dr. Haupt. He’s the best ever! Had a lot of hardware added to the ankle & stretched my Achilles & several other tune ups in there so I’m sure that will be alot of hard work & patience. I can tell it’s healing cuz the pain is changing. U are right about the swelling. I’ll loose this cast this Thursday…YAY! Then the hard work starts in PT & I’m ready! My surgeon was the 10th surgeon that I’ve been to. My issue was from a botched plantar Fasciectomy (sp??) back in ‘88. With life & work & caring for my parents, well that took precedence over getting my foot fixed. That must be why ‘life’ is a four letter word! Lol! Thanks for ur kind words and sharing your experience with me. I think hearing about someone else’s similar experience just makes me feel like I can really do this!! 👍

Jennifer, how’s the ankle now that the hardware is out? Do you have stability or any pain? Hang in there!
Thanks again
Flā

@flachon3 You have been through a lot and ankle injuries are extremely painful. My ankle fracture and related surgeries hurt more than spine surgery and for a much longer period of time. I am still learning how to improve.

I had 3 surgeries. First there was an external cage screwed into the front of the tibia and sides of the heel bone. It was a compound fracture and the wound was cleaned and closed, but bones were not fixed. I had this for a couple weeks to let swelling ease. Surgery 2 removed external cage and fixed fracture with plates and screws. Surgery 3 removed all hardware after a year and a half.

My ankle would collapse as I was stepping off my toes and pinch in the front with pain. Recently, I figured out how to loosen the scar tissue that caused this because of increased pressure on the joint. I have it moving better and I am slowly trying to build strength and endurance gently and without causing pain. What would happen is my ankle would give out and I would spend a week staying off of it. It is like living with a sprain all the time. I now have the tension more equal between the stronger side of the leg and the injured side and that is making a big difference. My ankle is not collapsing now. I hope to be able to hike this summer.

My cousin is a radiologist and when I showed him my x ray , he said I was lucky I can walk after that injury. It sounds like you have been through a lot too prior to fusion. My mom went through surgery lengthening Achilles and moving ligaments and avoided an ankle fusion. She doesn’t walk now and uses a wheelchair.

Walking will be different for you now. There are some shoes that are not totally flat and rock. That might be question to ask if that could help. Pay attention to your knees because you can get wear and tear there because of the ankle. A physical therapist can help direct that. Alignment issues and abnormal movement can cause knees to wear out which you want to prevent. Pelvis alignment affects this too.

Jennifer

@flachon3 Fla,
Getting the hardware out was definitely an improvement. Prior to this, I had pain and throbbing all the time where the plates were, kind of like getting kicked in the ankle. I was also getting big patches of hives, so likely I have some metal allergy or sensitivities. It also improved my breathing because I have less congestion in my lungs and I have allergic asthma.

I can walk pain free now for the first time in 4 years and I'm trying to build back some strength that was lost. Releasing the tightness from the surgical scar tissue and the fascia equalized the tension and took the extra pressure off the ligaments and tendons on the injured side. That was always the issue that it started to hurt like a sprain if I walked on any uneven ground. My ankle is stable and I've started walking trying to increase the distance before it fatigues. I need to start on hills. Progress is slow and I can't rush it or I'll spend a week having to stay off my ankle.

Jennifer

Thank you for your words. I sure hope u can hike soon. Sounds like u r on ur way. I can already feel my knees. What kind of shoes do u wear? I always had orthotics and am worried that now that this ankle has been re-arranged inside and won’t be the same shape, do I need to get new orthotics will be one of many questions for him on Thursday! ONLY 2 MORE DAYS to I loose this cast! The pain is so much better now & the cast is very loose(swelling is going down) Do u have any suggestions on questions that I could ask the doc? Thsnks for your help, Jennifer.
Later, Flā

@flachon3 I have been getting good sturdy shoes from Caterpillar (the company that makes bulldozers). They got into footwear for their employees to protect them on the assembly line. I get the leather ankle high work boots with composite toe protection because I want protection around my horse and ankle support . I get wide widths and they have some that are unisex. I got a couple sets of custom orthotics made by a podiatrist. Orthotics take up space in shoes and shoes need to bigger to accommodate and not be too thick and squeeze your foot. My orthotics are trimmed to be thinner. get shoes first, then take them with when you see a podiatrist about orthotics. I have found the padding in the front and tongue of leather work boots to be better than that on high top shoes. Cat makes those too. I have the Intruder model shoe (good traction) in regular and high top (but this needs more padding and you may need to add padding for comfort). The front of my ankle is very sensitive from my injury. I want a stiffer shoe ankle height as protection against twisting my ankle. You don’t have that situation since you are fused, and the regular shoes may better. You can also get them with composite toe protection. The website is catfootwear.com. Merril hiking boots are good and you can get them in fabric and mesh so you feet breathe. I think they are actually made by same supplier at Cat Footwear. Some are more like a very supportive hiking shoe. I think Cat does have some shoes with a rocker bottom and that might be easier to walk in with a fused ankle..I’m guessing.

I would ask to work with a physical therapist on prevention of other joint issues that could happen because you will move differently now. Ask how to prevent a knee or hip replacement and what type of shoe can help given your present condition. If there is a Suggestion on walking to lessen strain on other joints, you need to know what to do, and when to ask for therapy if you are getting wear and tear.

Jennifer

Both of my Achilles tendons ruptured at Christmas, so I was non weight bearing for 2 months, wearing walking boots. Finally I was told to be partial weight bearing - how do you do that when you're talking about both feet. I started walking, in the boots, with a walker. Very clumsy! Even with one foot, I imagine your balance might be affected. Don't fall.

Once I get surgery done on my Achilles tendons (one at a time), I need to have a sub talar joint fusion on my left foot and my right knee replaced. I guess I'll be learning more about partial weight bearing than I care to.

I had a bunch of work done on my left ankle, so I know how anxious you are to get moving again. It does heal, and eventually it doesn't hurt anyone. Hang in there with PT.

Jim

It would be helpful to know more about the sub talar joint fusion. What’s happening there to get to that point? I might need one. I’ll see the ortho again soon.
You definitely have lots to deal with!