Welcome to The STEM Sessions Podcast. I am your host, Cody Colborn
Recently spent a week on the family property in Montana
- Did a lot of sciencey stuff like identify and log wildflowers in the fields, insects near the house
- Watched for bats in the evening
- Looked at the night sky
Main purpose was cleaning up generations of stuff with my siblings
- Hauled several trailers of junk, totalling well over a ton, to the dump
- Started organizing the basement, garage, and shops
- A bit of landscaping too
A homemade flagpole has stood in the yard for as long as I can remember
- We tried many times to brute force this thing out of the ground with no success
- Afternoon before heading home, I decided some acrobats on the flagpole would be a good idea
- It was solidly in the ground, after all
- I took a short run up, jumped, and grabbed the pole
In my mind, there were two outcomes
- One, the pole would remain rigidly upright, and my momentum would swing me around the pole
- Two, the pole would bend a bit and I would be lowered gently to the ground
However, what actually happened is the pole snapped and I hit the ground hard
- So hard, I rolled my left ankle
- Eventually, I was able to stand and walk around
- It was sore, but didn’t seem like a big deal
We went to dinner and upon leaving the restaurant, I couldn’t put full weight on my ankle
- It had swelled to double its normal size
- Fortunately, the friend we were dining with had some crutches I was able to borrow
After sleeping with it elevated and heavily iced, it felt better
- I could even walk on it, albeit with a limp, so I left the crutches behind
- Had I known I would be stuck in Crowdstrike airport Armageddon, I probably would have taken them, but that’s a story for another time
This episode is about the time I broke my other ankle playing hockey in Feb 2020
- Pulverized might be a better description
I figure it’s about time to share my experience, primarily about the recovery
- In the days immediately after my surgery, scoured YouTube to get an idea about what was ahead of me
- Video after video of people complaining about still having pain and limited motion
- It scared me, and promised myself I would do whatever needed to fully recover
- As it turns out, everyone should fully recover if you follow doctors orders and fully commit to physical therapy
Hopefully, this can be a positive story for people to find
This is The STEM Sessions Podcast Episode 29 – Your Ankle Shouldn’t Bend That Way
Part 1 – The Injury
Late game that all beer league hockey players are familiar with
- You’re already tired
- Just want to play and not get hurt so you can get to bed and wake up for work the next morning
My second shift, I was backchecking hard to get the puck that had been dumped into our zone
- Puck sat against the boards, behind the net to our goalie’s right
- Going about 80% my top speed, to out-skate an opponent
- Lost an edge near the face off dot and slid on my right side, feet first into the boards
- Tried to crumple my leg to absorb the impact, but right foot hit square to the boards, my leg nearly perpendicular to the boards
This is why they teach kids to never skate directly to the boards
- If you come in at an angle and lose an edge, your energy is deflected
- Straight on and your energy goes right into you
Intense pain
- rolled around yelling profanity
- But I think the screaming was more from the shock of what happened
- I remember the ref immediately blew the whistle, so it must have looked bad
After initial shock, I sat up, and saw my right foot was bent outwards
- direction ankles don’t bend.
- First instinct was to try to straighten it.
Teammates helped me stand;
- tried to put weight on my right foot,
- sharp pain immediately shot up my leg
- Helped me skate to the lockerroom
With the game continuing, slowly taking off my gear
- skates are carbon fiber so very stiff.
- purposely wear extra long laces to give me feet enough room to get in and out without unlacing any eyelets.
- Had to remove my lace completely.
Ankle was swollen but not bruised.
- Almost the size of a softball
- No bones protruding, and no longer painful
- Thought it was maybe just dislocated.
Rink officials asked if I wanted an ambulance, but I decided not to go the emergency room
- It was nearly midnight, and I figured I could go in the morning
- Called my wife and asked her to take an Uber to the rink so she could drive me home
- Teammates helped me to the car
- One took my gear home with him, no way I could carry it
Got home and quickly realized pushing myself out of the car was difficult
- And the front porch has two stairs
- Luckily we had crutches from a previous bad sprain, so we dug those out of the garage
- Hobbled into the house a bit after midnight.
- Didn’t shower, just changed clothes and got in bed
- Slept with my ankle elevated and covered in ice.
Urgent care in the morning (Friday) instead of ER
- X rays confirmed broken ankle and lower tib-fib break.
Made appointment with orthopedic surgeon for that afternoon
Surgeon took new x-rays,
- scheduled surgery for the next morning.
- Before sending me home, he set my ankle and placed me in a lower leg splint.
- Before setting, he injected lidocaine in my ankle to numb it
- Needle piercing deep into my joint was the worst pain I’ve ever experienced
- At least I think it was, I was so mentally taxed and exhausted, I’m sure my brain was exaggerating it
Let’s talk about the anatomy of human leg
- Above the knee, you have the thigh bone or femur – typically the longest and strongest bone in your body
- Lower end of the femur forms the top of the knee joint
- Below the knee, you have two bones
- Larger of the two bones is the Tibia, sometimes called the shin bone
- Smaller of the two is the Fibula, sometimes called the calf-bone.
Upper end of the tibia forms the bottom of the knee joint and the lower forms part of the ankle joint
Fibula runs alongside the tibia, on the lateral part (or outside) of your leg
- Top end located below the knee joint but is not part of the joint itself.
- Lower end of the fibula forms the outer part of the ankle joint.
Tibia carries the majority of your body weight and fibula stabilizes it.
Bones we consider to be our ankle joint are actually the ends of the tibia and fibula.
- Medial malleolus is the bone on inner side of the ankle, formed by the lower end of the tibia.
- Lateral malleolus is the bone on the outer side of the ankle, formed by the lower end of the fibula.
- Posterior malleolus is the posterior section of the tibia.
Ankle experienced a trimalleolar fracture meaning I fractured everything;
- Lateral malleolus, the medial malleolus, and the posterior malleolus.
- Accompanied by joint dislocation and damage to the ligaments and tendons.
Also shattered my lower fibula
- Think of the impact this way
- hold a stick between yourself and a wall, so perpendicular to the wall
- Apply compression (force towards the wall)
- Stick can’t actually compress, so it bows.
- Apply enough force, the stick bows to the point it breaks
- That was my fibula.
- Stiffness of my skate protected the bones in my foot.
- Compressive force converted into a torque at my ankle, folding my foot under my leg, shattering the joint.
Part 2 – Surgery
Night before surgery, again slept with my leg elevated and iced
- Also took a lot of advil
Arrived at hospital at 6A
Additional x-rays were taken
- The hope being since the surgeon set my ankle the day before, the swelling would have reduced enough to get a clearer image
Also had a chest x-ray, blood work, and other tests
Lucky to have a single bed room so I was at least not bothered by other people
Once in the pre-op room, anesthesiologist injected a nerve blocker above my knee
- Not sure of the exact drug, but it prevents pain signals from traveling to the brain
- Several types of nerve blocks, mine would be a peripheral nerve block as opposed to the more well known epidural which is injected specifically just outside the spinal cord
- Chemical is an anesthetic, the family that includes lidocaine that you receive during dental procedures
- Anesthetics block pain signals at the nerve endings
- After getting injection, the weirdest impulses traveled up and down my leg
- Anesthesiologist warned me ahead and said just to ride them out
Then came general anesthesia, and I remember nothing after that until waking up in recovery
Surgery is commonly referred to as ORIF, or Open Reduction & Internal Fixation
- Most common procedure for repairing ankles
- Open Reduction refers to surgical realignment of the bones
- When a doctor or medic sets a break without surgery, that would be considered a Closed Reduction
- Internal Fixation part refers to the use of screws and plates to keep the bones in the correct position while they mend
Surgery estimated to take an hour and a half
- But because my ankle was so messed up with bone fragments everywhere and tendons and ligaments twisted out of position, it took four and a half hours.
- Woke up in recovery, very confused because the clock on the wall was three hours later than I was expecting
- Couldn’t figure out if I was actually awake or dreaming because of that
Surgeon installed three plates and a dozen or so screws.
- Three incisions to do it.
Soft splint to allow everything to drain if needed.
And drain it did that evening and night
Leaked all over the pillows which were propping up my foot
Obviously kept overnight to make sure there were no complications
- Given lots of antibiotics and decent enough food
- Very uncomfortable with my foot elevated as much as it was.
- Couldn’t adjust the bed in a way that worked for me.
- I’m a side sleeper, so being forced to remain on my back was rough
Nerve blocker wore off around 2A
- I could feel the pain creep in
- Called nurse for a Percocet.
Went home middle of the next day after getting clean bandages and splint
Part 3 – Recovery
More or less bedridden for the first week.
- Very uncomfortable and painful and immediate throbbing if my foot dropped below my heart
- Peed in a bottle just for convenience
- Don’t recall if I took a bath, probably just washed up
- Percocet regularly for most of the week, especially at night to sleep – Loved those dreams, incidentally
After one week, follow-up with surgeon.
- New x-rays.
- Staples removed.
- Split replaced with cast.
Took it easy for another week
- moved around the house on crutches.
- Sat on stool in shower to bathe, using those waterproof sleeves for my cast
- Foot was still swollen and painful, but started cutting back on the percocet
- Advil during the day, percocet mostly at night if I had trouble sleeping
Week three, restlessness began setting in.
- Used to being very active, so two fully weeks of doing nothing was getting to me
- Only using Advil for pain.
- Pain dissipated but was replaced by muscle spasms and nerve tingling, which were maddening
- Prescribed a muscle relaxer to help
- Got so bad I went for a massage to try to distract me.
Itching to do something, so I test drove a knee scooter around the back yard
- Absolutely hated it
- Its turning radius was horrible
- Made me feel big and clunky
- Also My house has front steps and back steps, so how was a scooter going to work?
- Scooter needs to be lifted in and out of a car, which is also dumb when I can’t put any loading on my healing ankle
Tested the a knee crutch.
- I loved it
- Immediately mobile again.
- I could take out the trash and get exercise.
- I could walk up and down stairs
- Walk around with my hands free to carry things like food and drinks
- Plus it made me look like a pirate with a peg leg
- Highly, highly recommend it
Week four new cast, new x-rays.
- Swelling a had reduced so much the old cast didn’t fit and had become uncomfortable
- Trip to Seattle, which we had planned.
- Took train up, walked around Seattle, and took plane back, all in my knee crutch.
Week five and six, much more mobile.
- walked to grocery store, and carried groceries home
- Mowed lawn
- Cast got very uncomfortable again because swelling had reduced so much.
Week seven, x-rays confirmed bones were fully healed
- Cast removed.
- Shocked by the incredible atrophy of my calf muscle – it looked like I had no muscle at all
- Fit with walking boot.
- Still used crutches to walk back to my car
That evening the shower, washing and massaging my leg is the most pleasure have ever given myself.
- Every nerve, every muscle fiber was hyper sensitive.
- They hadn’t been used in seven weeks.
- I cried and shivered in pleasure.
- Dead skín everywhere.
- Made a point to stay hydrated the entire recovery so the scaling wasn’t too bad;
Immediately started relearning to walk.
- I knew the bones were better than ever.
- I never doubted the integrity of my joint.
- It was the muscle and connective tissue that were weak.
Connection between my brain and leg felt like it needed to be established.
- felt like my brain didn’t know what to do with the signals it was receiving or it was misinterpreting them.
Walk back and forth in my living room, using crutches, but putting more and more weight on my leg with each lap.
- After a few minutes I’d take a break. Then start the process over.
- After a day, I could walk around with a single crutch.
- After two, no crutches.
It was sore, and felt weak.
- I pushed to the point of hurting
- I took slow but complete strides until I regained confidence.
- Always applying ice when I stopped.
Surgeon says wear boot for three weeks.
- After three days, I felt I didn’t need it
- Surgeon said he trusted my instincts, and gave me the approval to proceed without it
- After that, ace bandage to help with swelling, not for stability.
- Ankle would swell throughout the day, but typically dissipate over night
Part 4 – Physical Therapy
Ten days after my cast was removed, I started physical therapy.
- waited until I was able to walk for extended periods of time without using a crutch
Two times a week in the office, plus daily exercises at home.
The first few weeks was about joint mobility.
- Lengthening all of the ligaments and tendons that had atrophied.
- Twisting exercises. Stride exercises. Stepping down stairs.
- Three sets of every exercise with 30-50 reps in them.
It was boring. It was repetitious.
- But each day my ankle loosened a bit more.
- Very obviously progress
A few weeks into physical therapy, we added exercises to rebuild the muscles.
- Involved hopping forwards and backwards and side to side.
- Squatting… lots of squatting. One leg, two leg, crab walking, monster walking
A few weeks after that, we incorporated agility exercises using one of those agility ladder.
- Advanced hop-scotch.
- reached a point where it was clear my ankle was no longer the limiting factor.
- At the limit of my normal athletic ability
Physical therapy sucked.
- It was boring. It was repetitious. It was exhausting.
- Sometimes it hurt.
- But it worked.
- In two months I had 95% of my pre-break range of motion and strength.
Had the ice rinks not all have been shuttered for COVID, I would tried playing right then.
- But it took until September to step on the ice by myself.
- And then my team had a scrimmage in October.
There was definitely some flexibility and strength I didn’t regain during physical therapy,
- But after being very active for the last several years, I’m as close to 100% as you can get
PART 5 – CONCLUSION
Primary reason for discussion this is to show you can completely recover from this injury as a normal person
YouTube and blogs full of whining like “my ankle still hurts”
- It’s daunting watching and reading them
- Even our uber driver in Seattle broke ankle snowboarding and he said it still bothers him
- But they didn’t put in the work to fully recover
You need a great surgeon, and I had one (undergrad in engineering, not that I’m biased), but the rehab and physical therapy is all on your shoulders.
- If you don’t put forth the effort, you are wasting everything the surgical team did for you
- wasting your money.
- Felt I owed it to them to do everything I could to regain full function after I put them thru nearly five hours of surgery.
My ankle gives me zero problems day to day
- Very minor swelling every so often, which is to be expected, because the lymphatic system can take a really long time to full heal
- I can skate, run, jump, hike… everything I did before
So don’t buy in to all of the YouTube whining.
- Listen to your doctors
- Put in the effort at physical therapy
- Eat your cheeseburgers (protein and fat are important to your bones healing)
Thank you for listening to this episode of The STEM Sessions Podcast; researched, written, and produced by Cody Colborn. Shownotes can be found at thestemsessions.com. Feedback and corrections are always welcome.
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Please remember, STEM belongs to everyone. We should not allow it to be siloed or gate-kept by experts, policy makers, or talking heads. Bias is found in every message, so always verify what you read and what you’re told.
Until the next episode, stay curious.