Ankle problem, hiking, cycling

So, on a very rainy and windy day coming down Mt Albert down south, I took a fall. A roll and half twist slamming right foot down hard. Since it was 38F, my primary concern was whether my rain gear was damaged (no). At first, my right ankle was just a little sore. The next day, I was limping a little bit but did a big day from Wind Stair to just before the Shelter short of the NOC. The next day was down then up that long climb and down. It started to hurt and I was definately a bit slow. I took it relatively easy the next two days. I got a hotel room. Two days rest and it was worse. What? I got off trail, regrettably. But probably the right thing?? A walk in place did an x-ray and she said nothing is broken, probably just a contusion inside the bone, whatever that means. It only hurts if I put weight on the heel. I can walk tippy toed without pain. I was thinking of going back onto trail next week but something says to get another opinion cuz it still hurts and besides, I can return even in the Summer.

I have been riding my exercise bike to keep fit and no problems, otherwise, I am on the couch per the original Doc (actually a PA).

I got an appointment with a real foot Doc. I hope he doesn't put a boot on me. I have had many sprained ankles in the past, this is not a sprain. It feels fine, except if I put weight on the heel like a normal walking gate.

Any I being too cautious? Anybody ever get something like this? I really miss the trail

(to answer the question how I fell. My left arm sometimes goes useless. So, I was hiking down a moderate slope only using right pole. The trail was a freakin river. My left foot hit mud and I was skiing downslope. I went with it until I hooked and edge so to speak and did an Endo. I probably should have laid it down right at the beginning but I assumed rocks would hurt the hip and I have arthritis in that one)

A contusion is a hematoma, the medical term for a bruise. Bone contusions are bruises on or inside the bone. The Doc ordered an X-ray to look for and rule out breaks or fractures. Bone contusions and ligament damage don't always show up on x rays. If the Doc thought it was more serious they would, and still might, order an MRI after swelling subsides. Bone contusions, in the incidences I've experienced them, took longer to heal than surface contusions. If it was me I'd use the RICE protocol, get a follow up MRI to check for stretched or partially torn ligaments and cartilage damage, and supplement with Ca, D, Mg, K2, hyaluronic acid, MSM, glucosamine, chondroitin, Arnica(I took it orally and applied it topically when experiencing an inflamed left ankle resulting from ligament tears, ankle bone contusions, and a compound break), Boswellia serrata, turmeric, Alapha Lipoic acid, and Bromelain. Most of those vitamins and supplements were gained in sufficient quantity in my food choices or in multi form rather than all singularly. I had already adopted an anti-inflammatory diet and lifestyle but double downed on their application. A boot was worn for some two months. I did physio rehab 2x weekly but more on my own with rubber bands. The Podiatrist and Orthopedist both said they never saw anyone reduce swelling and heal as fast. They were so enamored with the rate of healing they took notes from me. Everything healed. Two wks after my boot was off. I still sometimes used crutches. I started a completed NOBO AT thru hike one week after I layed down the crutches. My ankle was still sore. I weened off any supplemental NSAIDs on trail. I never fully relied on then anyway. I moderated pace and distance, walking mindfully.

BTW, always ask your Physicians to define or explain that which you are vague in layman's terms. That's part of the goods and services you're paying. ;)

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Originally Posted by Dogwood

A contusion is a hematoma, the medical term for a bruise. Bone contusions are bruises on or inside the bone. The Doc ordered an X-ray to look for and rule out breaks or fractures. Bone contusions and ligament damage don't always show up on x rays. If the Doc thought it was more serious they would, and still might, order an MRI after swelling subsides. Bone contusions, in the incidences I've experienced them, took longer to heal than surface contusions. If it was me I'd use the RICE protocol, get a follow up MRI to check for stretched or partially torn ligaments and cartilage damage, and supplement with Ca, D, Mg, K2, hyaluronic acid, MSM, glucosamine, chondroitin, Arnica(I took it orally and applied it topically when experiencing an inflamed left ankle resulting from ligament tears, ankle bone contusions, and a compound break), Boswellia serrata, turmeric, Alapha Lipoic acid, and Bromelain. Most of those vitamins and supplements were gained in sufficient quantity in my food choices or in multi form rather than all singularly. I had already adopted an anti-inflammatory diet and lifestyle but double downed on their application. A boot was worn for some two months. I did physio rehab 2x weekly but more on my own with rubber bands. The Podiatrist and Orthopedist both said they never saw anyone reduce swelling and heal as fast. They were so enamored with the rate of healing they took notes from me. Everything healed. Two wks after my boot was off. I still sometimes used crutches. I started a completed NOBO AT thru hike one week after I layed down the crutches. My ankle was still sore. I weened off any supplemental NSAIDs on trail. I never fully relied on then anyway. I moderated pace and distance, walking mindfully.

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Thanks, Dogwwod. Gives me some hope.

I hear you on the supplements.

My preventative medicine Doctor is a big believer in that stuff. He loaded me up before rotator cuff surgery. Pretty much all what you wrote. The Shoulder Surgeon could not believe how fast I healed. At 2 weeks post op followup, he dismissed me saying I did everything he would test me for at 6 months and that he had never seen such fast recovery and he had done lots surgeries on "professional athletes" . His eyes were just popped. I am only currently taking K1/2/3 vitamins, Boneup supplement, 10,000 IU of D3, 1000mg C, fish oil, and a multi. Probably make sense to up my game on supplements. I think I have arnica still, ALA,Mg and tumeric for sure. I have been icing a few times per day. Laying on the couch with foot up going crazy. It is funny, everyone got off the mountain because it was going to rain and a few days before that because it was going to 20F at night. I was hiking with someone almost done with the triple crown who fell like 2-3 times per day. I was like, are you ok? Why you fall so much? "don't worry, I fall all the time? I fall once and hose up my ankle.

Very odd that it only hurts with load or if I twist it a certain way.

I did see a Doctor when I broke my elbow 30 years ago and now I suffer for that bad decision. I broke my ankle from a slap shot as a kid and did not see a doctor and no ill affects. I guess I just want to be sure I do not duplicate my stupid elbow decision in case something is actually wrong with my cuboid bone (that is where it hurts). Sucks. Not the end of the world, I had a weird thru plan anyway. Springer towards Roanoke area in like 5 weeks or so. Vermont to Maine in mid Summer after black flies die. Then, the middle section in the Fall down to wherever I dropped off.

You might ask for an ultrasound...much cheaper and less radiation than an MRI. A stress fracture or subtle fracture probably wouldn’t show on an early X-ray, but will show after 2-3 wks. Relative to supplements, if you are not deficient in any of these Vit.s, your just making very expensive urine.

About a year ago I climbed up on a large tree that had fallen across the trail, and hopped off the other side. I should have eased myself off the tree, but I thought I was young and spry. Anyhow I landed a little too hard on my right heel. Though not so dramatic as your slide off of Mt Albert, this little mishap made my heel quite sore. Like you, I could walk tippy-toed without issue. After some weeks I figured the initial injury should have healed, but my foot continued to bother me, with pains that seemed to shift to different areas - probably because I had been limping and transferring stress to new places. I was still able to walk on it, including some hard miles last summer/fall in New Hampshire and Maine, but I was unusually slow with a sore foot and abnormal gait.

A year later, and I still have persistent issues, especially those first steps in the morning, which sounds a lot like plantar fasciitis. Recently I confirmed that I have reduced sensation in that foot, which doesn't sound like PF, so I went to a podiatrist last week. I really liked him! I was concerned he'd tell me to stay off my foot, but no, he said "movement is medicine." Yay! He's outdoorsy and he gets us backpackers. No weird questions about bears, just sensible non-invasive therapy. (By the way, he figures the numbness is due to a problem in my back, not related to PF).

Hopefully your pain won't persist too long and you'll be back out there in a little while.

My guess is it will take a while to heal and it you push it too fast, it will persist or get worse. It's not like your 20 and can bounce back quickly.

Lots of good advice above. And frankly, relatively good news.

Having minimal pain immediately after in incident indicates soft tissue damage more likely than broken bones or severally torn ligaments or tendons. Delayed pain like that is indicative of damage that is worsened as the swelling builds around the injury as in a bad bruise/contusion or a relatively minor sprain or tear. Having very specific pain, only while loading it a certain way or moving a certain way, is also a good sign in that your injury is relatively isolated and you can often learn to move in slightly altered ways to reduce irritation and continue or re-start more regular activities sooner.

As to advice, Dogwood's suggestion of RICE is first and foremost.

My experience with these types of injuries (way to many) is that overuse early can exacerbate the problem significantly. So stay off it and let it heal for a couple weeks before you push for recovery. Staying as active as you can (as you apparently have with your bicycle) is great as long as you listen to your pain and don't irritate the injury.

THEN, being a bit older these days, injuries never heal like we want them too. So, DO start gently exercising the injury through mild (but NOT severe) pain after you've given it a couple weeks to recover without irritation. Then plan on building slowing and accepting mild (BUT NEVER severe) pain as you build strength over the coming months. So yes, as noted above, you will be needing to alter your stride, intensity, and duration for an extended period of time, but get out there and keep going! Definitely use any aides like ankle support, padded heel wedges, angled heal wedges, or whatever to support the injury and/or re-align your stress to an adjacent area. And have as much fun as possible without increasing your pain and thus slowing your already too slow recovery.

I truly hope you are pleasantly surprised by how well this injury recovers after it starts on that positive recovery trajectory.

I started having heel pain after a 2 week AT section hike last fall. I fought through it for months but it kept getting worse. Pretty sure it's Plantar Fascitis. I never went to a doctor, but I've been following advice I've read on WhiteBlaze and it's slowly been getting better. Starting in March, I quit running and switched to swimming and later added cycling once the weather warmed up. I bought a set of Superfeet insoles for my hiking shoes and one of those PF night braces. I've been doing some PF exercises daily. All of these things have helped. This morning I was able to hike 6 miles on moderate terrain with only minimal pain which is a huge improvement from 2 months ago. At this point I'm feeling optimistic that I'll be able to continue section hiking the AT this fall.

Thank you all for the wonderful input.

I went to a foot doctor today.

He thinks one particular tendon or ligament was injured. He put me into an ankle brace and wants to see me in 3 weeks. Interestingly, I wore my Koka Goats and he immediately says, "those are the best, I wear them hiking". He said riding exercise bike is good but no hiking. He is going to see me in three weeks. He took his shoe off to show my his high arches and said his are not as high as mine. Said, "your arches put you half way to a sprain, we'll talk about support in our next visit"

In retrospect, I did the right thing getting off trail (at my age). He said if I let it heal, it will be fine but warned me about doing to much.

Sprains are one of the best reasons to do a lot of training and get in shape before a big hike. I had a lot of ankle rolls as an ultrarunner and hiker until I attained a certain level of ankle strength, then it never happened again no matter what I did.

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Originally Posted by RockDoc

Sprains are one of the best reasons to do a lot of training and get in shape before a big hike. I had a lot of ankle rolls as an ultrarunner and hiker until I attained a certain level of ankle strength, then it never happened again no matter what I did.

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How much training should I have done to have overcome a rolling, twisting fall slamming the right ankle down?

I pretty much hiked everyday with a pack although took some days off here and there. Rain or shine. Easy week was 25 miles. Most weeks were 40-50 miles and some quite a bit more. Always with a pack just above my base weight. Same shoes. Two days per week were intervals up and down very rocky, hilly terrain not unlike the AT.

I also used the balance board every other day.

"Get into shape" is a bit nebulous. According to my Garmin, my VO2max is in the low 60's and I did just over 18 METS on the treadmill last year.

Is there some specific exercises that are better than just hiking with a pack in hilly terrain? I also did a lot of hiking along rocky river beds. I do not light weights or go to the gym. Is that what I should have been doing?

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Originally Posted by Big_Old_Dog

How much training should I have done to have overcome a rolling, twisting fall slamming the right ankle down?

I pretty much hiked everyday with a pack . . . Rain or shine. Easy week was 25 miles. Most weeks were 40-50 miles and some quite a bit more. Always with a pack just above my base weight. Same shoes. Two days per week were intervals up and down very rocky, hilly terrain not unlike the AT.
I also used the balance board every other day.
. . .Is there some specific exercises that are better than just hiking with a pack in hilly terrain? I also did a lot of hiking along rocky river beds. I do not light weights or go to the gym. Is that what I should have been doing?

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Sound to me like you are doing all the right things. There is no doubt that one can do supplemental training to build stabilizing muscles that are not necessarily well developed during your normal activities (like a balance board among others). Maybe you could do more. Or, maybe you did all you could do except stop aging and control every random event in your life. ;)

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Originally Posted by nsherry61

Sound to me like you are doing all the right things. There is no doubt that one can do supplemental training to build stabilizing muscles that are not necessarily well developed during your normal activities (like a balance board among others). Maybe you could do more. Or, maybe you did all you could do except stop aging and control every random event in your life. ;)

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I was curious if there was something specific I could do in the future.

The general advice I read from hikers is that you can only get fit on trail and it just takes like 6 weeks to get your hiking legs.

I disagree 100% with that sentiment. It was odd for me to see 20-25 year olds doing 6-10 miles per day. They don't look fit at all. Still sleeping in their tents at 9 am and camped at shelters at 2 pm. There really is not a lot of good information about training regimens for thru hiking or distance backpacking.

In my case, the injury might not have been random. The Ortho Doc said my extremely high arch is "halfway to an injury" or something like that. I did get "fitted" at an REI from a so-called expert. She never said I needed orthotics. The Doc yesterday thinks a foot support for my arch might have prevented or minimized the injury when I fell. Frankly, I have no idea. I did my best to train. I met tons of young hikers leaving the trail due to knees and shin splints. Like going down Blood Mountain NOBO, you have to take each step easy and deliberate. I probably descended slower than I went up. The youngsters would bound off rocks. The stress like that is off the charts. The Ortho said my poorly supported very high arch could have created the stress over time and the injury was just like icing on the cake, so to speak. Again, I don't know and am using my own words to describe what I understood him to be telling me. Just trying to learn, so, I can get back on trail. He said no hiking, limited walking. I am allowed to ride the exercise bike. For once, I will listen and do as told.

I know that the balance board and hiking on rocky, steep trails made my lower limbs stronger. It is visible. My feet also got bigger over the past year. The biggie? I pretty much completely lost any ankle twisting or rolling. It is like I developed shock absorbers inside.

I was thinking of ordering some "Sole" inserts to try but not sure. Maybe wait until my followup to see what the good doc says

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Originally Posted by Big_Old_Dog

. . . I was thinking of ordering someins "Sole" inserts to try but not sure. . .

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I have the opposite problem with my feet. I have a low and collapsed arch that I've had to manage my whole life. About 15 years ago I started using SuperFeet insoles with good results. But, my feet have continued to "evolve" creating new problems over time. My second most recent "evolution" was posterior tibial tendonitis in my right ankle area. The treatment, 2+ months in a walking boot followed by a year in an ankle brace with really good arch support.

Apparently the SuperFeet weren't supporting my arch in the way it needed. So, I moved to using the Sole insoles with higher and more central (instead of primarily rearward) arch support. They are now working well for me.

As an unrequested update: My podiatrist now wants me to wear stiffer soles to help manage my newest foot strain issues. Since I don't want to start wearing stiff boots, I'm looking to get some carbon fiber insoles to stiffen the super-soft Altra shoes that have been working so well for me in other ways.

Good luck. It can be super discouraging staying off your feet, but, being able to walk and hike again later is well worth the frustrating wait.

The hardest part of healing for me is to stay the course of treatment, therapy, or rest when it seems the rest of the world is out in the forest enjoying life. Pretty much every injury I had through my early 40s I made worse by disregarding medical advice and cutting recovery time short. Shin splints turn into stress fractures and plantar faciiitis turned into difficult knee issues which subsequently killed hiking for the balance of those seasons to get the proper surgery and heal up everything.

Having been in this situation more than a few times I can sympathize. As Slo-Go'en suggested, it's tempting when you are starting to feel better, but don't push the injury or a worse one is likely to develop that can be far more difficult to overcome than the initial problem.

Thanks all. I have been resting on the couch. I am allowed to ride the exercise bike IF I wear the brace the Ortho foot doc gave me.

If the ankle does not resolve in 3 weeks, Doc says he will do an MRI. He thinks I tore a ligament that oges to the Cuboid bone below and inside of the ankle bone. I am a little surprised because I have had sprains playing sports and they can hurt worse than broken bones. This thing only hurts when I walk on it and I have to limp. I fell on Mt Albert. I was hiking with someone who took the road. Maybe I shoulda cheated like that walker.