Subtalar fusing

[dubsho3000]

I'm curious if anyone here has a fused subtalar joint. What impacts have you noticed? I would expect rock climbing to be difficult or impossible. Hoping that skiing and hiking would still be possible. Ideally I'd like to be able to hike up to 20 miles on a given outing, and do multiple shorter days back to back (backpacking, multi-days outings on high peaks, etc).

I'm hoping to avoid fusing anything, but it sounds like fusing the subtalar joint would eliminate a lot of arthritis pain for me. I fractured my talus about 10 years ago and currently have quite a bit of pain and swelling almost daily. Bone spurs have developed as a result, which limits my range of motion and causes me more pain. I'm hoping to have the spurs removed, but it sounds like they might just come right back if I don't change anything else.

[Dave B]

Have you heard of people having success with this surgery? Also, I'm presuming it's a surgeon who's suggesting this surgery would solve the problem. Brings to mind the old saying "when the only tool you have is a hammer, every problem is a nail."

I know three people who've had fusion surgeries as recommended by a surgeon. One in their hand, the two others in their feet. End result in all three was a loss of range of motion, but not pain.

Anecdotal and second hand information isn't helpful, but here it is anyways.

[gb]

I have no experience with this, but my advice would be to talk to several doctors before committing to a fusion. They're just people and they all have their own thoughts and biases. Maybe you already have.

[dubsho3000]

Dave B - I have not met anyone personally who has had this surgery. I have read on a different forum of a few folks and some seemed positive, some negative.

I understand your pessimism with the hammer/nail analogy but I have a lot of respect for this particular surgeon. I was given a 90% chance of having my talus collapse when I broke it due to avascular necrosis in the upper part of the talus (by the emergency surgeon in Montrose, not the guy I'm seeing now), and he helped me avoid that with a custom-made brace, a bone stimulator, vitamins, 18 months of non-weight bearing restrictions and minimal surgery to date. He has a very cautious approach to surgery. I'm talking with him and with the Steadman Clinic to hopefully get a range of options. Coming here to find first-hand knowledge. I know you are a fan of foam rollers, strength-training and stretching and I can tell you that ain't gonna cut it with this injury. I've been pursuing that option for 5 years and things are deteriorating. While we're at it, barefoot running is out too...

[John Landers]

Dave B - I have not met anyone personally who has had this surgery. I have read on a different forum of a few folks and some seemed positive, some negative.

I understand your pessimism with the hammer/nail analogy but I have a lot of respect for this particular surgeon. I was given a 90% chance of having my talus collapse when I broke it due to avascular necrosis in the upper part of the talus (by the emergency surgeon in Montrose, not the guy I'm seeing now), and he helped me avoid that with a custom-made brace, a bone stimulator, vitamins, 18 months of non-weight bearing restrictions and minimal surgery to date. He has a very cautious approach to surgery. I'm talking with him and with the Steadman Clinic to hopefully get a range of options. Coming here to find first-hand knowledge. I know you are a fan of foam rollers, strength-training and stretching and I can tell you that ain't gonna cut it with this injury. I've been pursuing that option for 5 years and things are deteriorating. While we're at it, barefoot running is out too...

I dislocated my ankle and fractured the talus bone in my right ankle due to taking a leader rock climbing fall 17 years ago. I was lucky the blood flow to the talus bone was not impaired, the orthopedic surgeon at Denver General reset the dislocation as soon as he walked into the room as he was concerned about that. I have had issues with some loss of range of motion and pain, but a 2017 surgery to clean up a joint of debris and smoothing the bone has resolved things and it is now reasonably good. One option my ankle and foot surgeon at Panorama Orthopedics mentioned to me was ankle replacement surgery if pain and arthritis become too much of a problem.

[pw]

I don't know if this will help, but it's an extensive thread on sublatar fusion because Tiger Woods just had that surgery.

[derekpetrie]

You may have already done this, but I’d ask the surgeon what range of motion (ROM) outcomes they have seen in their prior patients, and if they have had patients with similar goals as you. Each surgeon will have their own technique and approach, it can affect how you recover. Get a couple opinions if you can, and find a doc who has done the procedure for multiple people similar to you in age and post surgery aspiration.

I split my humeral head in two in a Dec 2021 skiing accident. Lucked out that the on call at Summit County Hospital was a shoulder specialist and avid skier himself. Even in an emergency surgery scenario, he shared typical outcomes he sees from the procedure, and we talked about my desire to continue all the hobbies I love. so I knew 70% range of motion was highly likely, and 90% plus likely especially if I focused on PT. 9 weeks later I was back skiing with 95% ROM. Fully convinced that if I had a different surgeon focused on repairing similar breaks but dealing mostly with the elderly, my outcome would have not been as good.

[Dave B]

Coming here to find first-hand knowledge. I know you are a fan of foam rollers, strength-training and stretching and I can tell you that ain't gonna cut it with this injury. I've been pursuing that option for 5 years and things are deteriorating. While we're at it, barefoot running is out too...

Definitely didn't mean to imply this was an issue that could be solved with lifting. More just a critique on certain surgeon's willingness to completely tank their patient's mobility just so they can apply the standard treatment without considering alternatives. But, it sounds like you've got a good doc. I also think Derek's story above is pertinent, having a surgeon who's familiar with treating athletes rather than older or low mobility patients is important.

[dpage]

Are you a candidate for an osteochondral talus transplsnt/allograft? I've work with lots of people over the years who have been unhappy with the fusion. I've been told I'll need an ankle replacement at some point but to wait since the replacements don't ladt long in active individuals but am not a candidate for the allograft because of the changes at the distal tibia.

[dubsho3000]

Are you a candidate for an osteochondral talus transplsnt/allograft? I've work with lots of people over the years who have been unhappy with the fusion. I've been told I'll need an ankle replacement at some point but to wait since the replacements don't ladt long in active individuals but am not a candidate for the allograft because of the changes at the distal tibia.

No I don't think I'm a good candidate for that due to some minor collapsing of the talus that we observed 5 years ago in an MRI. It's something we are going to look at again with the fresh MRI I took a week ago.

From the comments above, and since no one has chimed in with "hey I've got my subtalar joint fused and I hike ALL THE TIME", I'm thinking fusing is going to be off the table for now. If someone was hiking with a fused ankle, they'd surely be frequently the .com ready to share their story... In what capacity do you work with people with fused subtalar joints?