The Great Adventure

A Frank Assessment of My Busted Ankle

It has been over two years since I broke my ankle, and 18 months since surgery.

I broke it doing incorrect parkour, without proper training or supervision. Parkour is wonderful; training too aggressively is not.

So how is this ankle doing? And can I walk across two continents on it?

This is not actually my ankle… this may not even be what was wrong with my ankle.

Quite a Doctor

I knew from the beginning I’d go on the Great Adventure whether I broke my ankle or not. But other people have mixed reactions. Most don’t realize I injured my ankle at all: after all, I walk normally. When I remind someone I am still fighting an ankle injury they look horrified and tell me not to go.

My surgeon has a different opinion.

“You’re going to have arthritis for life,” he told me. “It will get worse. Eventually, if the pain is too great, we can fuse the joint. I recommend you beat the hell out of it until then.

He knew about Plan Walk-to-South-America when he gave this advice. His reasoning is that the joint will get worn out anyway, so enjoy physical activities while I can. Avoiding my favorite things for decades isn’t worth it. I like that reasoning and I agree with it.

Plus walking can actually improve my ankle. It’s a low-impact way to keep it in constant use, strengthen it, and get that joint flexing again.

So I have the full approval of the orthopedic surgeon who knows my ankle best. But that doesn’t make it easy.

Learning to Walk

After my surgery there were three main long-term factors I had to deal with. They are:

  • Recovery from the injury itself and the surgery
  • Atrophied, stiffened joint from over a year in a “boot”
  • Immense scar tissue limiting flexibility in the joint

Additionally there is the arthritis, but there isn’t much I can do about that.

The immediate effects of the surgery included swelling, soreness, and months of staying off my feet. 18 months later the swelling still  isn’t completely gone—I found out recently it might be swollen forever.

Atrophied, stiffened muscles are nothing to play with. My Achilles tendon literally got shorter during a year of immobility. It became impossible to stretch my injured foot as far as the good one. All the other muscles were weaker, too.

Are weak foot muscles a big deal? Well, aside from holding you up, the muscles around the ankle play a crucial role in balance. Post-surgery I could balance on my good foot for 60 seconds easily. With my recovering foot, it capped at 1.5 seconds.

I started daily stretching, as well as ankle lifts to strengthen the muscles. I did a balance routine and when that got easy, I started doing it on a bosu. Because of muscle stiffness, it was hard to absorb impact when landing from even a small jump, so I worked my way up to dismounting from the bosu aerially.

I can now balance on one leg on a bosu, then spring up in the air and land on the ground.

…Carefully.

Scar tissue remains pretty serious. Recently I began to have a new kind of pain near my heel. As I break up scar tissue and regain flexibility, it turns out I’m starting to use muscles I still wasn’t using before. Which means… they’re still atrophied. Those muscles weren’t needed for my limited range of motion, so they never got worked out at the gym. Till now.

For My Next Trick

This is an ongoing process, and one of the most difficult things in my life. A month ago, walking for a few hours left me with an inflamed, aching ankle and I could barely limp the next morning. Now I can hike 5+ hours up a mountain and still get up tomorrow.

I’ve learned to manage the arthritis and swelling through stretching, regular activity, and continual conditioning to handle longer and longer walks.

The Great Adventure will be the ultimate test of this conditioning. I have 6 months left till I start, and I need to train daily. The uneven streets of Chiang Mai have proven a good setting for that.

 

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27 thoughts on “A Frank Assessment of My Busted Ankle

  1. Rebekah says:

    When I was a senior in High School I was in a major car accident. In the accident I busted up my right knee. So I currently have no cartilage in that knee. I was told by the orthopedic surgeon that I would have arthritis and get to the point where I would have to have weekly shoots to just stand and walk. He estimated that this would all happen by the time I was 21. I decided that I couldn’t live life like that and I refused to let my knee dictate how I live my life.

    So I started an advanced regimen of physical therapy with a therapist and get regular Chiropractic Care. I am 30 years old now and I still don’t take pain relievers daily. I’ve worked very hard to be able to continue a some what active life. Keep up your walking and make sure you walk normally if you can. That makes all the difference. People can’t tell that I have a knee injury until I tell them because I don’t limp or even favor the leg. Keep up the good work and I can bet that your ankle will keep up with you.

    • Hi Rebekah,

      This was an incredibly encouraging response – thank you. I think I am on the way to proper care & maintenance of this ankle then. I’m so glad you have done well with your own injury!

    • I second this, as I have had similar experience.

      Anecdote 1: When I was 14 I was playing basketball and knocked knees with another, fracturing my patella. The surgeon removed the broken fragments, and told me I would get arthritis in my mid-20s and need a knee replacement eventually. I worried about this for years.

      I am 28 now and don’t worry about it now. My knees aren’t in great shape; I have to wear braces if I play a sport that involves quick change in directions (softball, soccer, etc.) but not for sports like running. I don’t think I have arthritis yet.

      Anecdote 2: Last April I had a high ankle sprain twice within a week. I was training for a half marathon in May (although both sprains happened when I was simply walking.) I remember the doctor saying 6 weeks – 6 months recovery. I took April off and resumed training a couple weeks before the run. I ran the entire half marathon (13.1 mi), even though I lost a month of training so my longest training session was only 7 miles.

      My conclusion is to just listen to your body. Take care of it. But when training, push yourself a little more each time. You will improve, and may or may not discover your limits. Medical advice is a guide, but not an absolute.

      • Thanks Mitch. Of course, you know what this means right? With my knees, your ankles and a sharp saw we could assemble a flawless, fully functioning adventurer.

        This is a promising plan for when we travel together.

  2. Beth says:

    I don’t have any injury-based issues, but I’ve had chronic back pain for about the last 8 years. No one has ever really been able to tell me why. But honestly, the only reason it doesn’t hurt less than it does is that I’m not as good as I should be about doing the exercises that I know I should do. I have never met anyone as self-disciplined as you. Just keep being appropriately careful, doing the things that will help your ankle, and paying attention to your body; it will tell you when it needs you to slow down versus when you are challenging it in a productive way. As long as you don’t go barreling past a limit without training up to it, you’ll be fine.

    My best advice would be: don’t be afraid or ashamed to take it easy when you need to. I find that to be the most frustrating thing, when I have an injury and the reality is that I just need to rest it. Sometimes you just have to find something else productive to do with that time, whether it’s a different exercise or a non-physical activity that at least makes you feel like you’re doing something worthwhile.

    • Mike says:

      I used to have chronic back pain too. I also have joint pain in my wrists and elbows that needed pain killers daily and spent a ton of money at a doctor trying to find out what was wrong. They could not find the cause. I changed a lot of lifestyle factors. When I stopped doing traditional western style workouts the wrist and elbow pain went away. The back pain was always there. Eventually, I found a yoga routine on the internet speciffically designed to rehab back problems. I no longer have back pain. To Drew, try looking for a stretching/strengthing routine like yoga for your ankle on the internet. There is a lot of useless new age crap out there, but working the muscles and stretching the muscles and joints is the only way to get any better.

    • Hi Beth, thank you. Yes, with that injury came a lot of humility. I have made a promise to my teacher and myself not to overdo it. Every day I learn to listen to it a little bit more.

  3. OK, back in 1992 I had a bike accident, went over the bars and hit the pavement with my left wrist which had been twice broken before, so it was pretty well reinforced with bone. The shock traveled up my arm instead, and broke my shoulder ball joint into 5 pieces, three big ones and two small ones. The surgeon came into the ER after looking at the X-rays, showed them to me, said there was nothing he could do (it also helped that I had a notorious deadbeat insurance company), and sent me home in a sling, not even a cast, saying the cartilage (rotator cuff) would form a natural cast. Apparently this was true, seemed to work OK, bruising and pain stopped. The doc said I’d be a cripple, the arm would just wither up and be useless and so on. The doc gave me a referral to a orthopedic surgeon where I lived and we set up a series of appointments – six that I went to, costing some ridiculous amount of money not covered by insurance – for “physical therapy” for my arm to try to recover some degree of mobility. The exercises were ridiculous, and it was obvious that if I’d continued like that, I’d be a cripple. So I dumped the doc – and they were jerks about that, too, they wanted more visits and more money and I simply told them to fuck off. I started pushing myself until I’d see black spots before my eyes, be about to faint from the pain, take a day off, do it again … then after a couple of months of that, I started to lift weights. Long story short, I got my arm back with about 95% of mobility. The weights and exercises cost me abot 1/3 the amount of a single office visit – which were never on time, usually I’d be sitting in that stupid office for an hour wasting time, then be seen for 5 minutes, then out… then they’d want to collect $250 in cash right there…

    By the way, if you’re still in Thailand, go see a homeopathic doctor, heor she might be able to prescribe you something cheap and effective to take care of the pain (I don’t know these guys, just did a google search, but: http://www.balavinaturalmedicine.com/services.html)

    • Oh, that’s terrible. I’m so sorry to hear about your injury and the bad care you were given. I’m glad you were able to find a way to spring back though!

      I should say, I am very open to natural and alternative medicine, but please be warned about “homeopathy.” Some people use that word to mean holistic remedies in general, which is great, but homeopathy is also the name of one of the worst fraudulent systems of fake treatment out there. Basically, you pay money to be given water and told it’s medicine. Many people don’t know about this, so I always try to mention it when it comes up.

      I think this comic explains it pretty well.

      I also love this quote from the comic’s author:

      I just noticed CVS has started stocking homeopathic pills on the same shelves with—and labeled similarly to—their actual medicine. Telling someone who trusts you that you’re giving them medicine, when you know you’re not, because you want their money, isn’t just lying — it’s like an example you’d make up if you had to illustrate for a child why lying is wrong.

      Again, this isn’t meant as an attack on you, as I’m sure you didn’t know (or just meant holistic care in general, which is awesome) – I just gotta make the PSA from time to time so people are informed.

      • It’s what I take for sinus headaches, bruises, and colds and flus; sinus headaches are over with in about 15 minutes after taking the tablets, bruises, colds and flu resolve overnight. I’ve taken Hypericum Perforatum and Ruta Graveolens for the pain resulting from having two wisdom teeth extracted, and 24 hours post op there was neither bleeding nor swelling – I never filled the scrip for hydrocodone as there was never any need to. And I did wait until the anesthesia had worn off and I was beginning to get a bit shock-y before taking the first dose. The pain resolved in about 8 minutes, I timed it by my watch…

        • H. Perforatum is St. John’s Wort and R. Graveolens is Rue; both are wonderful medicinal herbs with real properties. If you are taking a tincture or pill that has a real dosage of them then yes, I can see how they would help.

          If you are taking a “homeopathic” preparation of them then check the label – it will have a number like 30X. In homeopathy that means the herb is diluted by 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 parts water.

          That means there is not even a single molecule of the herb you paid for in the product you are given.

          In other words, if these homeopathic products are helping your headaches, bruises, colds, or other conditions, it is placebo effect. You would get the same relief if I gave you a cup of sugar water and told you it is ancient Chinese medicine.

  4. D says:

    I’m fifteen years past a pretty major break in my left ankle. The souvenirs?
    Steel pins, scar tissue and some enduring mobility restrictions (but it’s a fabulous excuse to reject high heels for the rest of my life). The swelling was really obvious for the first five years. Daily stretch-and-strengthening exercises as recommended by my doctor (tiny little things that can even be done waiting in line) have done a lot, as has continuing to walk in well-cushioned shoes for good shock absorption. I’ve been warned that the exercises need to be kept up or things will atrophy and tighten again.

    You’re doing pretty much exactly what you should — keep it up and don’t push too hard. The objective is to strengthen, not damage. So far, so good.

  5. Remember it’s not just the scar tissue but the cartilage that you have to break up. Cartilage doesn’t stop growing just because you are wearing it down slower. After shattering my leg, that was some of the worst bits of PT, breaking the cartilage in my knee and ankle until it all (mostly) worked again.

    And I needed Kira’s help to do it. In your case, and since it’s just your ankle, sitting in the seiza position* (to use the Japanese term) might help to break that up.

    *Unassisted, of course. I’ve been studying martial arts and using the seiza position for meditation and stretching since… 1987 and I’ve never seen nor heard of all these pillows and benches I found when googling the term just now to make sure I spelled it right. Daft shit sold to gullible newage yuppies, you don’t need a bench for “proper sitting.”

    • Wow. I no idea about the cartilage Tony. As far as I know that is not a factor in my injury, but now I want to check with my doctor.

      Seiza has been super helpful. Honestly that and Daijodan no Kamae have probably done more for my ankle than anything since the bosu balancing regimen. Thanks for the confirmation, I’ll keep working on it.

  6. If you need to build up cartilage, eat jello, it’s made from cartilage. Or drink it. Gummy bears are the same, Tony used to scarf them down when he was rebuilding his knee. (And btw, helping him break that overgrown cartilage in his knee so it would bend again is one of the worst things I’ve ever had to do.)

    I have tendonitis issues in my wrists, lots of swelling now and then. Mostly I keep in under control with a combination of (depending what’s on hand): ibuprofen, topical ibuprofen cream, a gel called “Deep Relief”, and sometimes this electrical gadget called a tens unit that runs a current between two pads. It simulates acupuncture, which was actually the absolute best thing for my wrists but I’m a little nervous about going for here in Russia. You should try it while you’re in Asia though! Acupuncture basically gave me back my hands.

    • As it so happens, I’ll be staying with an accupuncture/TCM specialist in Mexico…

      I’m a little dubious about the gelatin thing. I mean, it IS the same stuff, but it’s not like your stomach send little construction guys with it over to the injury site… it gets broken down in digestion. That said, eating a lot of gummy treats is cheap and easy so it doesn’t hurt to try. I like this plan :)

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  8. When we train for horseback riding, we stand on the stairs, similar to a back dive position (on the balls of your feet, heals hanging in the air) and slowly let gravity stretch the hamstrings. You can let yourself lower until you can’t take it. I suggest the bottom step so when you step/fall off, there’s just a small way to go.

    For riding, immediately as an American my hamstrings are too short. I need to stretch them from time to time and this is a good exercise. You need to keep heels down in the stirrups.

    Hope it helps.

    For what it’s worth, when I broke my finger in High School, the doctor told me I’d have arthritis in it someday. My response, I guess I should have gone to a better doctor. Don’t give up, western medicine only goes so far.

  9. I had a traffic collision that left me limping for a month and a half. I walked everywhere even then, I just made sure I had more time to get to where I was going. Having a 3 yr old wanting to hop on your lap all the time was the most difficult part. We trained her to avoid the injured leg and after a week she knew how to not make mommy hurt. Over a year & three months later, I still have a bruise at the impact location below the knee on my left leg, and it sends shooting pain if directly hit in a way that is more than a tap. Making coffee tables my enemy when bumped into >.<

    Other than that, everything works great and I don't notice it and will likely not get any long term consequences. Which is surprising considering my car was written off at a glance, having the entire front crumpled and fumes spewing everywhere. Thank goodness for air bags!

    I think your trip will do your ankle some real good. Folks I've met who are very active out of doors tend to look 20 or more years younger because everything gets a work out all the time. Some swear that before such activity they looked older than they currently do, and that was 10+ year ago! Who knows, maybe you'll end this adventure looking more like your younger self :D

    • Oh, I hope so Rua. I can feel the fake age on me from my years in an office. I feel joy when using my whole body. Thanks for sharing your story & your optimism. I’m glad you’re able to get around no problem.

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