Sunday, April 1, 2012

My Ankle's Sad Sorry Story

It all started when I decided to lead a climbing route that, in hindsight, I clearly was not experienced enough to lead. The route is called no nuts and it found up Ogden Canyon in Utah. It is pretty much a vertical wall of gneiss (metamorphized granite) with two small roofs. A roof is a big chunk of rock that juts out from the wall, they are challenging to climb over. I was a little more than halfway up working on clipping into a bolt on the second roof. I tried to get my quick-draw clipped in twice and missed then on the third try my left hand fatigued and I fell down. It probably looked something like this:

The difference between my fall and the girl in the photo above is the amount of rope between the climber and the last anchor point. At a glance it appears she has 3-4 feet of rope between her and the anchor. I missed the anchor at head level so I pulled more slack line out to try and get it the second time. This resulted in 7-10 feet of rope between me and the last anchor. So I fell 15-20 feet. I hit the wall hard with my right foot. It happened so fast that I was not able to absorb the shock by bending my knees so instead I absorbed it by crushing my ankle. I have pasted the x-rays taken at McKay Dee  Hospital's ER below. These were taken about 1 hour after I fell.
Anterior view pre-surgery 2004

Lateral view pre-surgery 2004

Mortise view (I think) pre-surgery 2004
I don't think you need to be an experienced radiologist or orthopedic surgeon to see some if not all of the breaks in my tibia and fibula. No, it didn't feel good, but I can honestly say I didn't shed a tear. I think I went into shock immediately. I remember being lowered down, tearing my climbing shoe off and wondering why my leg was bending in a way that it never had before. 

I have to take a minute to point out that I had a good friend on belay below me. Jana Mcdermott, now Cook, reacted quickly to arrest my fall. She was quite a bit smaller than me so when I fell it sent her up the wall a few feet and gave her some pretty bad rope burns I believe. If she hadn't reacted quickly and withstood the abrasion from the rope I would have fallen another 20 feet and who knows what  shape I would have been in in that case. Thanks Jana.

The fall occurred on June 19th 2004. I had surgery on June 24th of the same year where the pieces of bone were put back in place and held together with titanium screws and plates. Here are the x-rays just after the surgery while in a cast or boot of some sort.
Anterior view post-surgery 2004

Lateral view post-surgery 2004
That is more how an ankle joint should look, minus the metal. I then hobbled along for the next eight years. It would get really sore when seasons changed and if I tried to run very fast/long. Here in Iowa I had a friend in church who is an orthopedic surgeon. I talked to him about it and he said I should get it looked at. I did. 
Anterior view 2012

Lateral view post 2012
If you compare the lateral viewing angles taken just after surgery in 2004 and the one taken in 2011 you may notice a difference. The anterior (front) part of the ankle joint in the 2011 image shows a bunch of junk that is not there in 2004. These are osteophytes (bone spurs) and could be the reason why I get sore so fast when I do things that require moderate dorsiflexion (like jogging). It was determined that getting the hardware out wouldn't hurt anything and grinding those osteophytes away might help too. So February 15th 2012 comes around and I earn my bottle of narcotics by having some orthos beat up my right lower limb. They gave me a bag of metal that they found in my leg.
Recovered hardware: 13 whole screws and 1 head (two screws unrecoverable and one broken)
Recovery is never fun. I am very familar with tendonitis and general discomfort at this point. After a short hike with some scouts I experienced some real bad tendonitis pain so I got back in to see Dr. Amendola and some fresh x-rays were taken.
Lateral view post hardware and osteophyte removal

Anterior view post hardware and osteophyte removal
After Dr. Amendola looks at the x-ray and talked to me about the pain and when it rears its ugly head (the morning after stretching my heel-cord is particularly "uncomfortable"). He then says that the front part of my ankle joint is the most damaged portion. So dorsiflexion is likely causing the inflammation and great discomfort since the forces go to the front of the ankle when it is put in this position. He sent me off with a pair of 3/8 inch heel lifts and a prescription for high strength ibuprofen. It seems to be feeling better, I also quit worrying about stretching since I can squat pain free with the heel lifts in my lifting shoes. I'll see Dr. Amendola in 3 months and we'll see if there is anything else to be done. He mentioned that if I were 50-60 years old we'd be talking about ankle fusion or total ankle replacement. Due to my youthfulness and relatively high activity those aren't options, thank goodness. There is a procedure called ankle distraction that might be helpful but I don't want to have another surgery soon.

The take home message here is don't mess up a joint, they never really get better and they don't forgive you.


  1. Bri, I ,learned some things that I didn't know previously...Jana's initial skill and help, heal lifts, and possible future surgeries.
    What's ankle distraction? You may also want to add why there are a few screws left in your ankle. We've all got crosses to bear. Keep on keepin' on.

    1. The heel lifts keep me out of dorsiflexion. The ankle distraction procedure is similar to limb lengthening procedures. An external fixator is installed and the joint is spread apart which allows for some secondary cartilage to grow. The highlighted "distraction" at the end of the post is a link to a website that explains the procedure much better than me. I hope I don't need it but I also have good insurance and a good hospital here in Iowa. It is a bit of a decision that won't be made for at least 3 months.