Hiking after broken leg repair...

[arch_incubus]

Just getting back on-line after a fair amount of down-time (Too much work followed by an accident.) and was wondering if anyone had any experience with hiking after having a rod placed in their leg (ankle to knee inside the Tibia, to be specific)? I already know that i'm going to have to be more careful because of some numb areas and am quickly learning to insulate better (as it seems to suck up the cold), but am just curious as to what I might have to look forward to as the healing/re-habilitation process continues.
Please don't jump on the "Just take your time and wait until 2008 bandwagon". I'm not quite insane enough to start a NorthBound this March (though I am wondering if i could manage SouthBound later this year...). BTW, my last appt was on Nov 20th (accident happened on Nov 9) which was say too early for the Doc to give me anything useful, but I should know more after this Friday. Since the Doc is not a backpacker, however, her usefulness in certain regards is limited. Thanks In Advance for any advice that anyone can offer.

[rafe]

I suppose every case is different. I broke my femur skiing at Sunday River early in 1989. By mid-summer '89 I was hiking again, and I started my (attempted) thru in April '90 -- with the stainless hardware still in my leg. I got as far as mid-Virginia. The hardware in my leg was not an issue at all.

[c.coyle]

So you're 60 days out from busting the main weight-bearing bone in your leg. You're thinking of walking 2,100 plus miles carrying at least 30 extra pounds, in all kinds of terrain and weather, 10-15 miles per day. The injury was serious enough that you've got a foot-long nail in it, and you're thinking of discounting your orthopedic surgeon's advice just because he/she isn't a backpacker?

Take it from someone who had a serious leg injury in Spring '04. You're going to have atrophy and weakness in your calf, quad, and hamstring. Tell the doc (and your physical therapist) exactly what you want to do and when you want to start doing it. Then do exactly what he/she says you need to do to rehab your leg, at least at the start.

After following the doctor's orders religiously for a month or two, you'll know whether you can push it or not. Just don't push it at the start.

I personally wouldn't start a serious hike until I'm sure I can do a couple 12-15 mile days, pain free.

[hammock engineer]

Good to see another Cincinnati person on here.

I can't speak for a broken leg, but I did have back surgery and was back doing everything I was before a year later. I think my doctor said it best when he told me that I am as good as I am ever going to get. If I rehurt myself he would try and fix me again. Other than that he said to listen to my body and do what ever I felt comfortable with.

If you need a second opinion I know a good sports medicine doctor. His group is the same one that deals a lot with the Reds, Bengals, and local high schools. They take things from more an athletic approach instead of a normal person approach. Which usually means getting you back up to speed faster.

[Frolicking Dinosaurs]

I have a steel rod from knee to hip in my right femur along with a lot of other hardware. If I didn't also have muscle and nerve damage (http://www.whiteblaze.net/forum/showpost.php?p=202410&postcount=3), I'd be good as new (actually better than new – a steel rod can't break :D). I know a lot about rehabbing such injuries.

Are you able to bear weight on the leg or still on crutches or a walker? If you are already weight bearing, you might be able to get a late start for a NOBO or join the NOBO’ers in early May and flip to finish up the missed southern portion.

Are you already in physical therapy? If so, take it seriously. If not, push the doc to get you in now. If you have a choice of physical therapist, get someone familiar with sports medicine (the people who rehab athletes after injuries). Those therapists know how to get you back into the sort of shape you need to be in to do a thru-hike. Do the exercises flexibility exercises at least as much as prescribed, every day. Push yourself up to the point that it starts hurting and then back off. Do the strength training exercises (they will come later in your PT) every other day. Be sure to eat a diet rich in protein and calcium and get enough rest.

Assuming you do not have any permanent nerve or muscle damage, (numbness 3 wks out is normal) you could hike this year. Don’t lose your hope.

As for managing the injured leg while hiking, plan to have ways to keep it warm. The metal rod does get cold if the leg is exposed and it will hurt and cramp if the rod gets cold. In your situation, an insulated gaiter or lower leg warmer will probably do the trick. Also plan to give the leg extra insulation and padding at night.

[Mother's Finest]

I concur with both CCOYLE and FD.....take the rehab seriously. Take it slow. Only you will be able to tell what your body can and can't take.

peace
mf

[arch_incubus]

First of all, Thank You to everyone who has replied. To address a few points made by everyone- Am taking it seriously, but already know i'm in for some trouble. Just the flabbergasted look recieved when the MD asked how i got hit ("Walking to work. It's only 2 miles.") said i'm already on the crazy list (Dangit, what was that old SF story about the kid whose Mom called the therapist on him because he walked to school??? Think it might have been by Asimov.). Not sure she could conceive of walking to the corner mart, much a couple miles to work, so not an off-hand judgement to want another opinion. The numb areas have persisted for almost 2 months now, so pretty sure they're here to stay. They seem to be pretty much confined to the outside of the knee and the top of my foot though (maybe 1/4 inch deep), so not too worried. Still on crutches for the moment and will feel better when i can get off the blasted things. (Not on them this long because of complications, just been taking forever to get an appointment that the Doc was actually there for. Heck, only needed one pain-killer (other than the occasional ibuprofen) since the beginning of Dec.) The flexibility and strength excercises shouldn't be a problem since learned a long time ago when to slow down. I'm figuring on 1.5 time the amount of time that the leg has been down just to get close to normal, which is why not pushing for the early start this year. Once can make it through a regular day of work without having use a chair, will be at about the equivalent of 8 mpd, 1/2 with a 45 lb pack (packaging plant- lots of carrying cases of metal parts around, and the 2 m walk to work and back). At that point, will see how much time there is to get a SouthBound start (The idea of which is taking a bit of getting used to. Is it possible to follow the leaf changes southward for a bit or does the cold catch up too fast? Duh, brain-fart, there's a SB forum isn't there?) Much Thanks for mentioning the extra insulation at night. Had missed that completely. Will have to check & see what kind of foam this boot/brace is lined with. Except for not being waterproof, it's been pretty warm & comfy. Enough of my babbling for the time being.Thanks Again for all of your concerns, advice, and encouragement.

[Frolicking Dinosaurs]

The numbness on the top 1/4 to 1/2 inch took about 6 months to 2 years to go away. It wouldn't interfere with your hiking.

Once you get off the crutches, the rehab on the leg will go faster.

Don't worry if your doc doesn't understand what you do. Mine looked at me like I was nuts when I told him I had been planning to hike the AT.... and still planned to do it. Just make sure the PT's don't have that attitude. They are the ones who are going to rehab the leg - the doc just fixes it and monitors for complications.

[Mother's Finest]

one more thought arch---
after traumatic surgery or an accident like yours, you may end up with a leg-length discrepancy. If this is the case, you can damage your knees or hips by compensating for it.

If you do have a LL discrepancy now, you should take care of it by adding a heel lift, or if it is more than 3/8 of an inch, an addition to the sole of your shoe.

Your physical therapist or orthopedist should be able to help determine this.

peace
mf

[arch_incubus]

Update- The MD has me doing some basic stretches for range of motion and slowly over the next few weeks putting more weight on the leg. Couldn't get an answer on any LL discrepancy (yet). Asked about a Physical Therapist and they said just work with the limits they gave me for now and if i need one they'll set me up at the next appointment. Tibia's fine, but the Fibula still has a bit to go. Should be back up to taking full weight by the next appt, however. What they hadn't said before (and didn't say much about today/ only found out because heard the x-ray tech & Doc talking about it!) was that there was also a slight ankle fracture. No offense to any MD's out there in WhiteBlaze, but is it standard procedure to just blow off questions and not tell the patient just what the heck is going on? If only Pie-Kill Unlimited were still around... Again, Thank You All for the advice and encouragement.

[rafe]

If you do have a LL discrepancy now, you should take care of it by adding a heel lift, or if it is more than 3/8 of an inch, an addition to the sole of your shoe.


I got a short lecture about this from my orthopod. After the break & pinning & repair, my left leg is 6 mm shorter than my right. Orthopod said it would be no problem on the AT, since the ground is so uneven I'd never notice it. He was right. I've never bothered trying to compensate for it. YMMV and all that.

[Frolicking Dinosaurs]

FWIW - 6 mm is far short of the 3/8th inch (9.5 mm) or more that requires compensation per Mother's Finest (a pro in this field). My ortho said he did not treat this unless it was .5 inch or greater. Mine is nearly perfect - less than 1/8th inch off.