# Broken ankle rehab



## wordfarmer (Oct 14, 2005)

Just wondering if anyone out there had returned to the bike after breaking an ankle. I just got my cast off and my doctor doesn't understand how much biking means to me. He said just walk for six weeks and then we'll talk about therapy. Does that sound right? At what point should I hit the trail? Clipless or not? Any tips would be appreciated.


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## dir-T (Jan 20, 2004)

Having been in your shoes a few times (1 truely broken ankle, 1 avulsion fracture, and about 6 sprained ankles) I can tell you that pedalling is probably going to be more comfortable than walking and will get your blood flowing better which should aid in your recovery.

The problem is that you don't want to fall and land on your bad foot/ankle and re-injure it. I would suggest (although I'm not a doctor) riding on smooth paths and gentle trails where there are no chances of you falling unexpectedly. Lots of big bumps might still hurt too.

I wouldn't go clipless yet because the twisting motion needed to clip out might also hurt but that may be a bigger issue with a sprain than with a break. Maybe experiment a bit with that first.


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## wordfarmer (Oct 14, 2005)

thanks dir-T. I think twisting is not an option right now, but what you said about pedaling makes sense.


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## Lutarious (Feb 8, 2005)

*Yea,*

I have had a few serious ankle injuries too. The last one seems to have killed any hope of marathon running in the future, which I truly did love. Biking is much better, but not without issues.

As soon as I could, I started excercises to regain some range of motion without putting loads on the ankle. After a few days I could ride an excercise bike with flats, or by opening my shoe to get in and out, but leaving it in the pedals all the time. I eventually settled on Power Straps when I did get back on the bike since I can get in and out of them without twisting against a spring.

I had custom running orthotics from my podiatrist, and I used super feet or simalr insoles in my bike and Ski boots. Now I am back to riding longer distances on the MTB and the road bike, and I still have considerable pain, especially after a longer ride. I think a set of orthotics made specifically for bike shoes might solve the problem, but I am not sure if my podiatrist will understand how to make them....

Good luck with your rehab. Go slowly and get motion back first.


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## Bodhinaz (Sep 30, 2005)

*Well, 6 weeks seems long to wait for therapy,*

It would help to know a few things before launching into a web tutorial on ankle rehab. How long ago did you fracture it? Any surgery to fix it, or just a closed set of the bone? Is it fairly stable, or is your doctor worried about it not healing well? It is very hard to make firm suggestions without more info, and I would hate to steer you in the wrong direction and really mess you up.

In our clinic, we sometimes start aggressive PT once the cast is gone, but only if the MD is sure the fracture is well on it's way to a good union. I would not do this without their "okay" though. If you can give some more info, I might be able to give you some suggestions.


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## wordfarmer (Oct 14, 2005)

Lutarious: thanks. I think I'll go with Power Straps. Sounds like your injuries never really healed. this is my first ankle break, and hopefully the last, so I am still hoping for a full recovery. Maybe I'm hoping for too much?


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## wordfarmer (Oct 14, 2005)

Bodhinaz: I had two breaks in the media-something or other, the round bone on the inside of the ankle. The bones are in place and healing well. No surgery. Doc said it will be another three months for full recovery. It's been three months since the accident.


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## KDS (Apr 29, 2004)

*Riding is the best P.T.*

Riding is definitely the best therapy. I broke (more like destroyed) my left ankle almost 3 years ago, I have very little motion left in it. The Dr. recommended a total fusion, but I decided not to do it. Riding is about the only thing that doesn't cause pain, so I ride nearly every day (flat pedals) to keep what little motion I have. I started riding while I still had 4 pins in the bones(removed about 2 mo. later), it helped a great deal. I wish you the best for a quick recovery.
Kevin


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## kristian (Jan 20, 2004)

I think 6 weeks is a long time too! That's way too long to wait to do rehab UNLESS you are having serious issues with the bone healing (which it doesn't sound like you are having). 

I did a spiral fracture to my tibia, broke my fibula twice and had a pretty serious dislocation of my ankle in a crash a few years ago. I was wearing a cast for 6 weeks and then I went into pretty aggressive physical therapy the day the cast went off. Now I don't have any negative effects of either the surgery of the dislocation. 

I would STRONGLY suggest you get a second opinion on the PT--I would think you should be starting it right away after the cast comes off.


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## daveM (Jan 15, 2004)

*If your doc said that you have full weight bearing...*

Do as much as you can, with as much pain as you can stand. My ankle joint was shattered about a year and a half ago in a construction accident. Two surgeries put most of the pieces back in 'roughly' the right place, I still have eight screws in the joint. I walk with a limp, am in alot of pain most of the time, and wish that I had done more agressive PT. Time is precious, the longer you wait, the harder it is. I used a trainer at first, with clipless pedals, and a right shoe cut apart, so that it was like a sandal with one strap that I would secure after I got on the bike.

The good thing is that I'm riding a fair amount now, better than I can walk! But GET THAT ANKLE MOVING NOW!!!!!!

Good luck!!!


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## BoiseBoy (Mar 1, 2006)

*Pt*

As a PT, I find it very funny as to how many non-PT "experts" there are on this thread!
I do believe that we get the best results if we can get to the pt as early as possible to begin treatment. That being said, your Doc likely has a reason for not beginning treatment yet. Genarally you may begin stationary cycling well before you are weight bearing and often as soon as you are out of your cast. One thing you didn't mention is your weight bearing status and if you are walking in a Cam Boot or not. It would probably not hurt to give your Doc or his MA a call and ask to clarify on his precautions as well.


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## daveM (Jan 15, 2004)

*Funny? Hmm...*

Of course , as a PT, your opinion would probably be the most useful, but I wouldn't discount the painfully earned real life experience of those that have actually been through a traumatic injury.

I don't think that anyone giving advice claimed to be an expert, but I know that I've conversed alot with the two PT's that I worked with, as well as a couple of Orthopedic docs, and have done some research. That said, I think very highly of the PT profession, the first one that worked with me (she mountainbikes quite a bit), did as much to improve my 'spirits' as my range of motion.


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## Radney (Mar 30, 2006)

I've never had a broken ankle, but I have had a REALLY bad sprain. My advice is to just be careful. I sprained my ankle over 3 months ago and it still gives me problems while moving my right foot from the gas to the brake petal in my automatic car. I'm no expert, but if you feel pain that's your limit. I play basketball basically everyday and getting hurt tore my world apart. Just try to be patient and not overdue yourself. Someone mentioned that waiting 6 weeks is a long time for a break. I waited that long before I played basketball again and I wasn't near 100%.


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## Wherebob (Mar 29, 2006)

Dave, 

Is that what your ankle looks like now? Pretty swollen for a 1 1/2 ago injury. Makes me hurt just lookin at it. Hope things improve for ya in time!

wordfarmer, hope your goin in no time too


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## SHIVER ME TIMBERS (Jan 12, 2004)

therapy. spell the alphabet with big letters with your ankle in the air 


and get yourself a ankle brace that laces up with shoe strings


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## fat paddy (Feb 9, 2005)

Note fungal infection under right big toe nail. See a doctor about that if you want it sorted. It'll only get worse (take a look at your old man's toes).....Pharmacist point of view.
Good luck with the ankle.
Cheers FP


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## kristian (Jan 20, 2004)

*Not a doctor but I play one on the Internet...*



BoiseBoy said:


> As a PT, I find it very funny as to how many non-PT "experts" there are on this thread!


Not all of us who posted have had medical PT training, but experiences "on the other side of the knife" can be good teachers also. No one has said: "ignore your doctor's advice" in this thread. Just people posting their own experiences and suggesting a second opinion on the PT.

K (big fan of PT but hopes to NEVER need the service again )

BTW, Word Farmer: I broke my ankle end of June and was riding trails again by September. I used clipless with the tension set really lightly at first. Since then, I have weened myself off of clipless and I'll never go back to them. If you can ride flats, they are certainly easier to deal with if your range of motion is limited.


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## wordfarmer (Oct 14, 2005)

Thanks everyone. It's nice to hear the way others dealt with this injury. Seems everyone can agree riding is good for the ankle, and that is good news. 
Krisitan: You were back on the trails in three months?! What kind of break was it? I have a compression fracture of the media-something or other, which is the round bone on the inside of the ankle. It suffered two breaks. It's been three months and I just started walking, if you can call it that. Am I healing slow, or do you just heal fast?


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## moff_quigley (Jan 1, 2004)

*My experience...*

Broke my tib/fib 4/5/2005. I had to have surgery to put everything back together. I was in post op bandages/splint for 2 weeks, fiberglass cast for 3, and then a Cam walker (removable walking "cast").

I was non-weight bearing until 6/2/2005, which was very frustrating. I then had another surgery to remove a screw that held my ankle joint in alignment mid July. This allowed my ankle to start moving again and I was able to ditch the Cam walker. Followed that up with 6 weeks of PT.

I got an old road bike that I rode once I was out of the boot. I could barely put any power down with my left leg. I used flat pedals and no straps. On 8/8/2005 my Dr. released me to resume my normal activities. Ran flat pedals on both the MTB and Roadie for a bit as my ankle was still fairly swollen and didn't fit in my shoe too well. I wasn't comfortable with the clipless anyway as it hurt quite a bit trying clip out.

Left ankle still not down to normal size and it gets stiff after a day of being on my feet all day, karate class, or a big bike ride. All told I'm just about normal and for that I'm very thankful.


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## dadat40 (Jan 3, 2005)

As I sit here with my rocker boot on right foot reading these post I am wondering what my cycling life will be like when my fused ankle is all healed and I can walk with out cruches.
I have a good riding friend who is also my PT and he told me to wait as long as I can for the bone to heal and go easy , my Doc has me putting partial walking weight on my foot now my next appointment is 4/12 so am hopeing that the boot will come off and at least be in my shoe and more weight bearing( my surgery was end of jan.) I would like to be back on bike by june .


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## kristian (Jan 20, 2004)

wordfarmer said:


> Krisitan: You were back on the trails in three months?! What kind of break was it? I have a compression fracture of the media-something or other, which is the round bone on the inside of the ankle. It suffered two breaks. It's been three months and I just started walking, if you can call it that. Am I healing slow, or do you just heal fast?


My break was very similar to Moff's based on his x-rays. I had a spiral fracture of the tibia which they put back together with a plate and screws like Moff's. I also had a long screw between the tib and fib like Moff.

The fibula part of my break sounds similar to what you are describing from your injury. I broke off the bump off on the inside (the left side of Moff's x-ray where the little screws are). For me, that bump was actually broken off and there was a long screw going from the bottom of the bump diagonaly up through the fibula. I don't know what they did to fix the second break on the fibula or even where it was.

I had a standard cast for 6 weeks (non weight bearing) and then a boot cast for 3-ish weeks. I started PT once the standard cast came off. Most of the early PT was just to get my range of motion back using those rubber band thingies. Since I did so much tissue damage to my anlke, they wanted me to work it as soon as I was able to with the cast off.

I never heard the doctor use the word "compression" fracture so that might be the main difference in our injuries. Everything that happened to me was the result of twisting action that the bones were not designed to deal with, not because of compressing them.

If you had surgery, make sure they take the hardware out of your leg at some point--it makes a great mojo to hang off your stem! Good luck with your healing!


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## wordfarmer (Oct 14, 2005)

good luck to you dadat40. I can say walking, even though painful and rickety, is an absolute joy. my bike is also nearing the end of its rehab and will be out of the shop monday or tuesday. sometimes it seems like it's never going to end, but hang in there.


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## athalliah (Dec 9, 2005)

Sorry to hear about your ankle, wordfarmer. I haven't broken my ankle but I did have a bone removed (os trigonium) removed from the joint in October. While recovery is quick with this type of surgery, I was in a cast for a week and then went on to the big black boot for six weeks. My ankle guy (who primarly works on athletes) understood my rush to get back on the bike. He cleared me to ride on a stationary bike with the boot on in the sixth week of recovery. After a week of this very akward way of riding I would just ride slowly around my street on flat pedals. Clipless pedals hurt like crazy. 

Well, for what it is worth that's my story. If you do have the boot you could check out the stationary thing. Heal fast and try not to go crazy while waiting to ride again!


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## daveM (Jan 15, 2004)

*Thanks for the tip...*

That toe got smashed pretty good, after cutting off my boot, the ER doc lifted the nail off and said,"well, you don't need this any more..."

Doesn't seem to be growing in very fast.


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## daveM (Jan 15, 2004)

*Not swollen, just not OEM...*

The entire front of my ankle joint was shattered, and it kinda went back together alittle bigger. Left foot-size 11, right foot-size 13.

Very glad that I still have a foot and can ride!


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## Wherebob (Mar 29, 2006)

daveM said:


> That toe got smashed pretty good, after cutting off my boot, the ER doc lifted the nail off and said,"well, you don't need this any more..."
> 
> Doesn't seem to growing in very fast.


I've busted off my toe nail and it took about 8 months to a year to grow back and then I broke it off again and now it's just not right and probably never will be. Its not sticking to my toe very well. It looks good just won't stick.


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## Duncan (Jan 2, 2004)

I found this thread while searching for ideas about how long a sprained ankle is going to cause trouble for. Now I feel like my injury is nothing compared to what somne of you guys are having to deal with. I hope your recovery goes well and that you can get out riding again with no concerns about further injuries or damage.

One 50 year old Korean mountain biker I know has an interesting pair of what would could only be very loosely described as ankles. An outdoors freak and former professional mountain climber (and incidentally, now the Korean importer and distributor for SRAM, Santa Cruz and Kona), Paul Choi certainly has a story or two to tell.

About twenty years ago he was ice climbing up a frozen waterfall in the middle of the brutal Korean winter when he slipped and fell several meters onto an ice ledge, crushing both ankles in the process.

This was in the days before rescue helicopters. So he then had to spend the next 24 hours hunched down, kneeling on his two broken ankles while the rescue team came for him. The final result; several toes lost to frostbite and a couple of mangled lumps for ankles. He still climbs and rides quite well even these days, but you won't see is svelte legs gracing the cover of the Sports Illustrated Swimsuit Edition any time soon.

Oh yes, by the way, what's the Doctor's opinion about my poor buggered ankle? Nasty twist 4 weeks ago, seemed to recover quickly at first but now the remainly pain and tenderness is lingering. I finally went to the hospital last week, where the Doctor put me in a brace and told me not to ride for a few more weeks. Is it normal for the injury to linger for several weeks? I really want to ride.

Cheers,

Duncan


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## jae (Apr 19, 2004)

wordfarmer said:


> Just wondering if anyone out there had returned to the bike after breaking an ankle. I just got my cast off and my doctor doesn't understand how much biking means to me. He said just walk for six weeks and then we'll talk about therapy. Does that sound right? At what point should I hit the trail? Clipless or not? Any tips would be appreciated.


I broke my left ankle (on the bike, unfortunately) and am in the process of recovery. Just last week, I got the go ahead to start putting weight on it, after about 14 weeks on crutches. I wasn't in a cast, since the bone was screwed back together, but the ankle has lost a fair amount of range of motion due to non use. I'm hoping to start some easy rides in another couple of weeks, but I'll have to see how it's feeling then. Right now, it still hurts more than I'd like.


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## TahoeBC (Apr 11, 2006)

Had a spiral fracture of my Fibula right above the ankle March 3rd of this year, on my 6th week in this cast and am going crazy, 2 more weeks to go.

A few days ago I put a platform pedal on the cast side of my road bike and wrapped a few old socks around it to keep from damaging the cast. Put it on my trainer and have been doing about an hour a day of light to medium spinning, but using the clipped in leg to do most of the work putting hardly any pressure on the casted leg at all. Yesterday I could not stand it any longer and went for a 30 minute ride on the streets around the house, I'm sure my OS and wife would not have been impressed, but it sure felt good!


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## xray_ed (Oct 9, 2004)

jae said:


> I broke my left ankle (on the bike, unfortunately) and am in the process of recovery. Just last week, I got the go ahead to start putting weight on it, after about 14 weeks on crutches. I wasn't in a cast, since the bone was screwed back together, but the ankle has lost a fair amount of range of motion due to non use. I'm hoping to start some easy rides in another couple of weeks, but I'll have to see how it's feeling then. Right now, it still hurts more than I'd like.


Hey jae- very nice CT reconstuction image! Where was that done? That must have been a newer scannner.

You guys that are back to riding after being in a cast or otherwise immobilized be careful. When your bones are immobilized for a long time they lose density similar to someone with osteoperosis. You are not only at risk for reinjury, you are also at risk for a new fracture. It will take a while to get the bone density back.


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## jae (Apr 19, 2004)

xray_ed said:


> Hey jae- very nice CT reconstuction image! Where was that done? That must have been a newer scannner.


It was done at Scottsdale Healthcare Osborn in Arizona. Not sure what scanner they used.


xray_ed said:


> You guys that are back to riding after being in a cast or otherwise immobilized be careful. When your bones are immobilized for a long time they lose density similar to someone with osteoperosis. You are not only at risk for reinjury, you are also at risk for a new fracture. It will take a while to get the bone density back.


I plan to take it easy. Honestly, after this injury, I may hang it up as far as any sort of technical riding goes.


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## ingluis (Dec 4, 2004)

I would ditch your doctor and find one that specializes in sports medicine. Some doctors don't understand that you actually want to USE the broken limb after it heals. Good luck!


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## Lucky (Jan 12, 2004)

ingluis said:


> I would ditch your doctor and find one that specializes in sports medicine. Some doctors don't understand that you actually want to USE the broken limb after it heals. Good luck!


Agreed. I'm thinking a 2nd opinion from an ortho doc that specializes in treating athletes would be a good idea. My experience with a shattered wrist is that doctors vary in their aggressivness of treatment, and sometimes a given doctor will recommend more or less aggressive in treatment based on the patient's lifestyle and use of the damaged limb.

My own story, and why I recommend the 2nd opinion:
I shattered my left wrist in a road bike crash. ER doc says it needs surgery to reassemble the puzzle and hold it together, but he's not in my insurance plan. Sets the wrist and I go see my own orthopod the next day. He's a conservative guy, says the ER doc did such a great job of setting it that it may not need surgery. It's not a real stable fracture and could move as the muscles atrophy and shrink. We decide to wait and see. Fast forward 6 weeks. Get a good clean x-ray out of the cast and the shattered end of the radius is now one nice piece, and the articuating surface appears to be in good shape. But, the end of the radius is now attached to the rest of the bone at a 40 deg angle. He says go to PT and see what we can get for range of motion. I'm an engineer. I'm looking at this bent machine and realizing it's just not going to operate a twist shifter again. Not only that, but my arm looks deformed. How am I ever going to get a date looking like that? He senses my speechless dismay and suggests I see his buddy the hand surgeon for a 2nd opinion.
I see the hand surgeon who tells me that if I were the type of person who sat around playing cards, watching TV and going on cruises on vacation, he would agree with doc #1's approach. Surgery comes with its own problems and additional scar tissue. But, given what I do for fun, he would recommend surgery to re-break and straighten the wrist and restore the original anatomy to the extent possible. I had him do the surgery, and it took a 2nd surgery to fix everything, but it works great and bothers me less than the one I didn't break. It looks pretty normal, too, except for 5 light scars.

Good luck!

Kathy :^)


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## dadat40 (Jan 3, 2005)

So since my last post as of to day my doc has me full weight and walking no cruthces and can start spinning on trainer super easy, I feel good just being able to wear a pair of shoes and socks quite a bit of pain from toes and plantar musle since thay have been inactive for quite awhile now and it it very nice to be able to get my own cup of coffe.
on the sprained ankle post it is very important to let a sprain heal and to rehab it to restrengthen joint some of my problem started from working through sprains and over the years tendons would not hold ankle in corraect position.


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