Heel injury

[cliveous]

hello all, had a really nasty fall over the weekend, apperently out the front (I cannot remember), the single hard sheel released as it should have done but it felt really violent. had terrific pain in the heel and after x-ray, I have got achilles avulsion fracture, which is were a fragment of bone is broken off the heel with the achilles tendon attached. It has been pinned and I am looking at up to 8 weeks in plaster, the only saving grace is winter is about to start in UK.

There must be other skiers out there who have had the same injury, how long was the recovery time, what treatment you had once the plaster was off, how long before you were skiing again andwas there any long term complications.

looking forward to your replies as I now have loads of time on my hands.

Clive

[ForrestGump]

Clive, I'm just glad to hear it wasn't a complete rupture or fracture from the heel.  The last person I know who had this same injury was off the water for 6 months. 8 weeks in a cast, though seems long. One of my ski partners had a complete rupture of her achiles 3 weeks ago with surgery to repair two weeks ago. She's only in a hard cast for 4 weeks, then a boot for 4-6 weeks they are telling her, then a LOT of PT. We expect her to be off the water for between 6 and 9 months.

One thing to keep in mind is that an achiles injury like you have is followed by the opposite leg having the same/similar injury within a year in a lot of cases. Think about it, you're on crutches for months and your other leg is bearing the brunt of your body weight. Scot Jones on here is a physical therapist. He'd be a good one to ping for ideas on the rehab and convalescent time.

[MrJones]

Clive,

Just saw your post. You are actually probably lucky that you avulsed the bone. It should heal more quickly and with a better repair than if you had torn the achilles.

The problem with an achilles tear is that the tendon in that area is not well vascularized. Low blood flow means slower/poorer healing with an increased risk of re-tearing. Bone typically has better healing properties. 8 weeks in the cast stinks, but the rehab should be relatively smooth and not extremely long.

Good luck,

sj

[cliveous]

Hi Scott/Shane,

Thanks for your input guys. Scott apart from keeping my leg elavated is there anything else I should be doing to help the healing process?

Regards Clive

[MrJones]

Clive,

Without knowing exactly what you had done I hate to say anthing specific. The likely answer for now is no. It is just going to have to heal for a bit. You can do a few sets of straight leg raises to the front and side lying down to keep you quad firing and help retard muscle atrophy. No direct work for your ankle/foot until your physician releases you. Hurry up and wait...

sj

[chris carter]

Scot,

Do you have a binding philosophy to mitigate this type of injury?...I recently had a violent crash and had a slight break on the ankle bone, should be only a few week heal?

 

I have two thoughts but am pondering:

 

I am currently RTP, and have asked Wileys to make me a soft rubber boot, loose overlays, and use my custom orthotics to help edge control and knee alignment. almost guaranteed to come out, yet there is still some pull on a previously injured ankle in a release.

 

My second thought is go to a double hard shell where both feet stay on one plate, yet this is daunting wondering about pre-releases, too much mechanical tension, and situations where they just won't release, yet maybe 2 feet on one plate may have some meritt?

 I know, here we go again, but anybody thinking?

 

[MrJones]

Chris,

Actually the "two feet in" bindings are more dangerous for a front heel injury. In a straight OTF fall most of the pull comes from your front heel. Unfortunately the bindings need to release from the very back of the plate. I did this to my left (front) ankle about 5 years ago on a Goode powershell set up. I still use dual lock, but much less.

I actually like the Radar system the best from a conceptual standpoint. Lynda is now using them and skiing well. If you don't pull the laces tight your heel can lift very easily. I would actually like to try them, but think this feel will make it hard for me to switch after years of double hardshells.

As always, there is no completely safe binding. "You pays your money, you takes your chances."

[Marco]

Cliveous-

I did a complete tear on my achilles 3 weeks ago today, and 2 weeks post op.  I have been told to expect no weight bearing for another week or so, then partial weight bearing until the 8 week mark, when I can hopefully lose the crutches.  After that, lots of PT and strength training, with a goal of being back to "normal" in 6 to 8 months post op...that is if the blood clot they discovered in my calf yesterdy doesn't set me back any further.  My surgeon told me I would be better off if I had the fracture instead of the full rupture.

I feel your pain.  Hang in there, and hopefully we'll both be back on the water by May.

 

 

[cliveous]

Hi Marco thanks for you comments sounds like you are in for the long haul like myself, how did the blood clot occur? I have also pencilled in May for a return to getting on the water.

I have some more questions Scot sorry to be a pain but I have so much free time now. Once this injury is healed pardon the punn, will foot be able to perform to the same standard as before?

If it happenend again could the the same op be carried out or would that be it?

Marco I look forward to exchanging progress reports with you in May, good luck buddy.

All you Skiers still lucky enough to be skiing, enjoy.

[MrJones]

Clive,

No problem. From a rehab stand point I would expect you to return to fully normal function. As I said you are actually better off than Marco in that bone normally heals more quickly and more solidly than soft tissue. (Don't mean to bum you out Marco. You will just have to be a bit slower and more cautious with your rehab) 

As for a redo surgery in the future? You would need to ask your surgeon about that one. Best thing is to get into bindings you feel good about and don't let it happen again.

sj

ps. I think May is a very reasonable time frame. Clive could likely go a lot sooner, but again that will be determined by your surgeon via x-ray and functional progress.

[Marco]

Clive-Regarding the blood clot, I have a clotting disorder that requires me to be on blood thinners, but I had to stop taking them in order to undergo surgery.  I had a glitch in my meds before I got theraputic again, hence the clot.  Also, clots are always a risk after surgery. 

Scot- No worries about bumming me out.  I am past the denial stage and into acceptance.  Just got back from my PT session and he told me that I will be able to start strengthing excercise and partial weight bearing later this week, so things are progressing better than I expected.

[Brad Conger]

Hi cliveous and all who have had this heel injury.

I ruptured my achilles tendon on Aug. 22 on an out the front fall at 6 buoy in Northern California tournament. Didn't hurt that much but couldn't walk on it and had lots of swelling. I believed it was not that sever so self treated for two week and when it didn't get better and still could not walk went for help. Saw doctors who found blood clot in ankle from swelling and damage. I had a previous PE from a clot from a surgery so this surgery was more touch and go.

This Tues. they reattached the tendon to the muscle which I heard was the worst way to have it happen. Now the same things you face for me, 6 to 8 weeks with a hard cast and on my back with no weight on my left foot. Then weeks in a walking cast and rehab. Hope I'm able to make it back as you do. Let me know how you progress and what is working.

As you, I'm out of the denial stage and hoping to get back to competition form for 2010. Will be looking for a new binding for the future and interested in all information and knowledge you find out. Have fun in rehab.

[chris carter]

Brad, so sorry to hear of such an ordeal.....what kind of boot did you have and type of crash....I had slick gloves let go into the first wake and did 3 back flips, got ribs and small ankle crack, nothing like yours. ..I am going to a loose fitting wileys, had them build in soft rubber and glue in a custom orthotic to help the edge control, but know I will realease.

 

your thoughts?

[Marco]

Brad- Sorry to hear that you are in the same boat.  What are the specifics of the crash that led to your injury?  Which foot is injured, binding system, etc?  For me I am LFF with a Reflex that I obviously had cranked too hard.  I center punched 2 ball at 38 55K, and my left (front) achilles just exploded.  The pain was overwhelming at the time, although I have heard of others like you where the pain was not that bad.

Be careful wih the clots.  Having had a PE, I am sure you are well aware of the dangers.  Be sure to have any calf pain not immediately at the repair location checked out.  Luckily for me, mine was not in the deep vain, so there was no chance of it traveling.  A DVT hower, can have fatal consequences.

There is a good website that a forum member turned me onto.  Check out achillesblog.com. It has a lot of good information.  Good luck with your recovery, and let us know how things are progressing.

[cliveous]

Brad and Marco, here I am thinking my injury is really bad and needing a long period off the water, but your injuries sound so much more severe. I wish you luck guys. Iam a RFF I also ski with single reflex on a carbon plate on radar, I changed to carbon plate this year but experienced a lot of premature releases, so I also clamped it to hard and I think that is what caused my injury. I will be going back to the metal plate as that work fine.

Scot, thanks for the positive feedback you know your stuff.

[Brad Conger]

Hi There,I'm still flat on my back watching college football since there is no waterskiing on tv.

I had Approach bindings front and rear cranked down very hard to not release thinking that if neither foot came out I would be ok. Worked ok for three years and many falls, but mainly to the side.

This was a wrong thing reaching forward going into 6 ball and a snapping out the front fall that I felt in my back and ankle, you read the rest in the post above.

Hopefully this Monday I will get good news about no blood clots in my leg from the doctors and then into hard cast and then we are a third of the way back to skiing. Next the walking boot and then rehab with the start of slalom sometime after that???? We hope.

Anyone heard of other injuries ones like mine with tendon muscle reattachment and how they went?

At least we are here, able to communicate and plan for the future,getting better, and skiing right. Unfortunately our sport slalom, trick and jump is challenging but has hazards we have to accept to have fun. I'm with you about good releasing binding binding for my start back into skiing. Thinking of the Wileys' also. Others are saying hard shells???? I believe they are ok for snow skiing but water skis are different.

Where do you guys ski at for training and how is your weather. Since my surgery we have had four of the greatest ski day of the year, oh well next year.

I will check out achillesblog.com, thanks

[Marco]

Brad- I have not heard of anyone who has suffered the tendon/muscle tear, so I can't give you feedback there.  I would imagine Scot J has dealt with it before, so maybe he could give you some good information.  You might find some info, or at least can ask the question, on the achilles blog. With the better blood flow in muscle/tendon interfaces vs. tendon/bone interfaces, i would think that healing would be accellerated, but what do I know.  To answer your other question, I ski in Western Colorado, and have also seen many perfect ski days go by since I had my accident on Sept 10th, but our season is quickly coming to an end..  I also have to watch the snow ski season go by, which will be tough since my office is about 5 minutes from the slopes.  I'd rather miss snow skiing than water skiing, so I am ahead of the game there.

Clive- Why do you think the carbon plate contributed to pre-releases?  I assume you have it screwed to the ski as opposed to inter-loc.  What failed to release...the Silveretta release on your front foot?  Is it your front foot that was damaged?

I had been having problems pre-releasing in tip stall situations at shortline, and after further inspection of the reflex, I noticed slop in the boot heel/Silveretta.  It turns out that the top of the front of my boot and the bottom of the horseshoe that holds it had worn, allowing my boot to slide foreward slightly.  In response, I moved the horseshoe back to snug up the boot, and at the same time, increased the tension on the Silveretta, thinking that the "stay with the ski at all costs" was the safest protocol.  WRONG!!!

My question is; Is there a binding system that protects Achilles tendons and related tissue better than others?  I know that bindings are a "pick your poision" decision, but I need to find the best system to protect the injury I have incurred.  I love the performance aspects of the Reflex, and don't want to sacrifice that, but at the same time, I want to minimize the chances for re-injury.

 

 

[Deke]

Marco, I can't imagine an achilles injury in RS-1's unless you really cinch them down and your achilles is about to go anyway. You might give them a try.

[chris carter]

Marco, as i posted above, i am had wileys build me a special soft boot with an orthotic. after ankle surgery, and a recent break, i used to ski about the same many years ago with soft rubber, and i am too old for more injuries especially what you guys are going through.

[cliveous]

Marco, I was boasting just the other week that I had used reflex bindings for around 11 years and never suffered an injury. The original set up I attached to a KD plate and I used this up until around July time this year with no problems except for the occasional premeture release normally at the bouy.

When I fitted the carbon plate on it felt I could go to the next level, incidently I ski on a RS1, then one day it released on the wake. After inspection the boot was loose in the silveretta clip, so a clamped it down some more and had another set and second pass you guess it the clip releases again on the wake.

Closer inspection reveled that due to screwing the plate onto the ski the plate rises between the screws causing a slight hump, as you said it slopes, but due to slight slope on the plate the silveretta clip is not square with the ski but sits at a very slight angle which I felt caused the clip to release prematurely.

Itried to correct this by putting a thin plastic washer between ski and rear of the plate and to clamp the boot down more, it seemed to be working for a while but while skiing I would feel it click so I knew it was getting loose again, so I put some gaffer tape around the horse shoe and clamped it down some more, and the rest is history.

I changed to hards sheels due to repeatedly having sprained ankle ligiments and have no intention to going back to rubber as I believe there are no completely safe bindings, we just run out of luck. I will definetly be putting the KD plate back on even if it is just for confidence.

Read some of achilles blog, gives me a healing time scale.

[cliveous]

Brad, I ski in the UK at a club called south lake ski school about 60 miles north of London, the weather at the moment is sunny, air temp around 68 water temp around the 62 mark, calm wind and I just know the lake will be busy today. Gutted.

[Marco]

I think I would have a hard time going back to rubber bindings as well.  The performance increase I felt with the Reflex was pretty dramatic.  The RS-1's do sound like they would be a happy medium between rubber and hardshells, and safer for an OTF fall.  I have not seen a pair in person, but I understand that they are a medium stiff lace up boot with the release being the elastic laces???  Deke- do you ski on the RS-1's?  If so, I might have to track you down to have a look at them.

 

[ForrestGump]

Just so you know, I stuffed the ski yesterday at the apex and went right out the front in my RS1's.

[Deke]

Marco,

Yes I have been on RS-1's 2 seasons now. If your up in town, I have them at home right now.

Deke

[Marco]

Deke- I'd like to check them out.  I'm not very mobile right now, but maybe we can hook up later on when I can get around better.  Thx!

[ForrestGump]

Marco, Marc Austin(MAD11) seems to have encouraging things to say about the FM E series too. Although he didn't rupture his achiles, he probably had worse damage done to his ankle when his WR split in two and folded back in his face. 

[Marco]

Wow!  How long ago did he have that crash?  Sounds nasty.

How is your friend coming along who recently had achilles surgery?  As I recall, she had it around the same day I did (sept 16th).  I am already partial weight bearing, which is weeks ahead of what I was told to expect! /vanillaforum/js/tinymce/jscripts/tiny_mce/plugins/emotions/images/smiley-laughing.gif Hopefully your friend is doing just as well.

Thanks for the info on the FM E series.  I'll look at those also.

[cliveous]

Hi Scot, Brad and Marco, it has been a long time since I last corresponded with you guys. it has been seven months since my achilles avulsion fracture, I had 10 weeks in plaster, 3 months off work. Had a few scares along the way, the bone fragment that was re-attached split into 3 pieces due to bolting such a small fragment of bone, possiblity of another op to lengthen the achilles due to lack of movement of the foot. got through all that but the the doctors were a bit reluctant to remove the bolts. Any way now have full movement of the foot but it is fairly still fairl weak, can do a small single foot calf raise only. the bolts are to come out on the 12 May so the light is at the end of the tunnel.

how about you guys how is your recovery going? are you all fit again? are you on the water yet?

have been asked many times about which binding I shall be using on my return. I think I will still use the reflex but with a metal plate a I still think the carbon plate contributed to the injury.

 

[Marco]

Cliveous- Good to hear from you.  I hope yours and everyones recovery went/is going well.  I am almost 7 months post op, and although I can walk fairly normally again, I have very limited strength in my calf and ankle muscles, and my tendon is about three times the width of my healthy one.  I haven't been to PT since the 3 month mark because my insurance ran out, and life and other things got in the way, so I haven't been as diligent with my rehab as I should have been, but I have been able to start working out more vigorously lately.

I have not yet been back on the water, but our lake should be full again by the end of the month, and I plan on getting out then.  I have been asking about bindings and achilles injury (see the thread on the lower part of the 1st page), and will be trying out some RS-1's that Richard is generously loaning me.  Scot says that they will be one of the better systems to use given the injury, but also said the Reflex system releases in a way (when set up properly) that does not overly stress the heel.

What is your recovery time from the surgery to remove the bolts?  I hope it is very minor in nature and you are back on the water soon.  Keep me posted.

[Mbskier]

Ski buddy

I had a complete tear of the achilles after regionals in 08.  Back foot.  Had surgery the whole 9 yards.  I was out of my cast and putting weight on it in 5 weeks.  The doctor said he never saw anything like it before.  I was skiing the following spring (April).  I skied all year at a level 8, nothing super aggressive, just alot of consistant 28 and 32 passes.  34 mph skier

My theropy was as follows.  I started walking with the best possible stride I could.  Heal, toe, heal, toe.  Concentrated on equal stride leingth.  I rode my road bike 50 miles a week.  I didn't go to the gym because with the walking, biking, skiing I didn't want to over do it.  This fall I started working out in the gym.  It has been amazing.  I am now 18 months post surgery and feeling stronger than ever.  My calf muscle is starting to show some deffinition and greatly improved streingth.

I also used a Wei patch.  It is some herbal patch.  I think it worked.  I had a removable cast so after the surger I applied the patch.  Used it for 10 days.  I highly recoment it...  Here is the link if you are interested.  http://www.weilab.com/

 

Good luck

[aguylikeshark]

Had some comments to add - this goes for the orig thread and Peter's nasty gash. Using a Silvretta is safe but the boot floor has to be stable so that it does not roll out & pre-release (in the cut or leaning hard over). If the boot is not stable or deforms, the rolling action will pop the release. This is because the attachment point is 2" above the floor of the boot or contact on the plate.

 

We have two Silvretta based systems that firstly use a full plate to make sure the boot stays contacted(REVO SB). The REVO ST clamps the toe very well and also has a dual lock pad under the heel. Also the heel of our boots are very stout so they resist roll out. So these are some of the things we have done to make the Silvretta binding reliable and safe. For example Chet has been riding the REVO SB design for years. For me the release tension needs to stay in the 4-5 range. Just did a test the other day a 4 1/2 felt good to me.

 

http://twitpic.com/1dinmf

[Marco]

Mbskier- I was put on the early weight bearing protocol as well.  Light weight bearing starting at 4-5 weeks.  I think its a a fairly new protocol, as I believe previously the conventional wisdom was full cast for 3 months with no weight bearing.  After about 12 days I was in a removable walking cast, so I could start doing range of motion excercises.  Still, my dorsiflexion is limited, mostly due to constriction in front part of my ankle joint.  Hopefully that is just due to scar tissue that will break up over time.

I couldn't imagine being immobilized for 3 months.  That must extend the rehab duration drastically.

3 weeks till I'm back on the water.  Can't wait...

[Deanoski]

My findings are if the reflex boot is releasing in the turn the heel piece is one hole to far back not enough forward pressure, (Snow ski binding term.) meaning you need  the boot to push into the toe loop.

 

I have set up 4-5 reflex systems if you set the heel then test it by how hard it releases pulling up and forward on the dock with back foot out  ( standing feet side by side)   you should be in the Din Range of 4-5 choose 6 and you will come out. I ski 5 and my buds ski 4 and 4  1/2  

like any system to tight or wrong setup and you are in for trouble.

 

I hope you heal fast!   like  Mb did he is stronger than ever and he will cut it down this yr.

 Deano

[Deanoski]

Bruce, the last one I help set up was for Terry Goodman, when we took the boot and plate out of the box mounted it on hes ski. the boot was loose so we moved the heel piece forward one hole, the heel piece should be hard to pull up, not just a slight resistents  like reflex says. Terry is 195-200 6'3" he is on a 5 din setting.

I have also seen Bondo on the plate put a small amount of bondo in the heel area then put sun screen on the bottom of the boot, put boot into binding let dry.  I think that is a andy maple trick.  

We do not use bondo, And have never had a prerelease, and always released when need. 

 

Deano

[cliveous]

Hi Marco sounds like you are well on the road to recovery and looking forward to the new season. I too can walk half decent now providing I take my time, as mbskier said important you walk correctly. its this old muscle memory thing we go on about when trying to correct bad skiing habits. I cannot believe I have been walking for over 52 years, and after 3 months of being immobile someone has to teach me how to walk properly again, so perhaps couple of months free skiing using correct techniques I could teach my muscles to make me into a ski god. I did say perhaps. the calf muscles are responding well to exercise not as big as before but improving. my achilles was also very swollen but as the calf got stronger the swelling went down and now the tendon area is as it was before, so hopefully yours should go the same way. Wobble board helped to strengthen the foot. walking, cycling and calf raises helped with the calf. the phsio got me walking real slow and got me to balance on the injured foot at the top of each stride.

recovery time after the bolts come out, do not really know. Iam hoping once the op has been carried out it is a case of the scare healing. I have pencilled in first week of June. month after you.

Hi mbskier sounds like you are a quick healer whats your secret? I agree what you say regarding the walking issue, it is easy to get comfortable with walking incorrectly and then it can be hard to correct a bit like skiing habits don't you think?

Hi aguylikessharks thanks for the feed back regarding binding plates, interesting concept not seen that one before.

Regards Clive

[Mbskier]

Marco your dorsiflection will improve with time.  One thing that help my flexability is a wobble board.  I used 2 snow ski poles to help my ballance while standing on one foot at a time.  I started with 3 sets of 30 seconds.  Now I am up to 3 sets of 1.5 minutes and only using 1 snow ski pole. 

 Cliveous Yes.  I did lots of single leg calf raises with high reps and low weight this winter.  That has seemed to help out quite a bit.  The other thing I did was change my shoes more often than usual.  That helped with the correct foot allignment for walking...  Bit technicle but important!

 Looking forward to this ski season!

MBskier

[Mbskier]

richard

I might.  Trying to figure out my tournament schedule for the summer.  There are only 2 tournament this year in E.Wa.  Need to ski in a couple of more tournaments to get my scores for regionals.  I will let you know by the end of the month

MBskier

[Marco]

I've been concentrating on walking correctly as well.  If I don't consciously think about it, I don't push off with my toes.  During recovery, I couldn't, and now it is just habit and lack of strength.  I notice weakness around the muscles around my ankles, the ones that play a big part in balance.  i hope that won't affect my early season skiing.  Thanks for the reminder on the wobble board.  I started with it in PT, but stopped when I stopped PT.  I think I'll make one this weekend if I have time.