Subtalar fusion

[Jake Leuty]

Rip,

I broke my heel in 2006 and my doc now says I could benefit from a fusion of the subtalar joint. Have you ever trained anyone with this? Do you think it will restrict my training long term?

In case it matters, I am 32 and 240 lbs at 5’9”.

My lifts are:
DL 455
Sq 385
Press 197
Bench 295

[Will Morris]

Rip,

I broke my heel in 2006 and my doc now says I could benefit from a fusion of the subtalar joint. Have you ever trained anyone with this? Do you think it will restrict my training long term?

In case it matters, I am 32 and 240 lbs at 5’9”.

My lifts are:
DL 455
Sq 385
Press 197
Bench 295

Calcaneal fractures are exceptionally problematic, especially from a pain control standpoint. To answer your questions: 1) Yes, I have trained people with this. In fact, calcaneal comminuted fractures are among the primary reasons why American Servicemembers opt to have their legs amputated after being exposed to blast trauma. #2: yes, absolutely it will. You will find a way to manage and you will train through it, because you just really don't have an option.

[Jake Leuty]

Thank you for the response. It’s good to hear others experiences with this because I have never met another person with a broken heel. My pain is pretty substantial now especially after a long day on my feet, but I have learned to train through it. The doctor says a subtalar fusion would significantly reduce my pain, but I am more concerned about my ability to squat than the pain. I don’t trust him to know much about squatting. I have a few more questions:

Do you think I will still be able to squat with my knees over my toes after this surgery?

Will the compressive force of a heavy dead lift damage or shorten the lifespan of the hardware holding the subtalar joint together?

Aside from my wife and child, training is the most important thing in my life. Am I better off just living with the pain than having this joint fused?

Should I be asking my doctor if this could one day lead to amputation?

Thanks again.

[Jake Leuty]

Also, do I really need to see a PT when it comes time for rehab, or can I just work on mobility and strength train? I only have functional fitness quacks in my area.

[Will Morris]

Thank you for the response. It’s good to hear others experiences with this because I have never met another person with a broken heel. My pain is pretty substantial now especially after a long day on my feet, but I have learned to train through it. The doctor says a subtalar fusion would significantly reduce my pain, but I am more concerned about my ability to squat than the pain. I don’t trust him to know much about squatting. I have a few more questions:

Do you think I will still be able to squat with my knees over my toes after this surgery? You will almost certainly have some range of motion restrictions, but I have seen people get functional ROM back after a subtalar fusion.

Will the compressive force of a heavy dead lift damage or shorten the lifespan of the hardware holding the subtalar joint together? Not likely. You transmit far more force through your ankle when you run, go upstairs, etc.

Aside from my wife and child, training is the most important thing in my life. Am I better off just living with the pain than having this joint fused? I'd probably have to defer to you and your surgeon on this one. All I can say is this: be an informed consumer of healthcare. Ask the questions that need to be asked of the surgeon prior to the incision.

Should I be asking my doctor if this could one day lead to amputation? Out of sheer morbid curiosity, I'd say yes. I'd say that just to see the look of horror on your surgeon's face when you ask that. Please understand that I referenced blast injuries (i.e. Improvised Explosive Devices that detonate and shatter the calcaneus into fragments. Those don't tend to get any better and are a leading cause of elective trans-tibial amputations. Unless I am missing something major from your medical history, I don't think you should have this anywhere on your radar. Really, it shouldn't even enter your mind. There is ZERO indication for such a procedure short of poly-trauma, blast injury, or volumetric soft tissue loss.

Thanks again.

Do you need PT? Well, probably. And this is because the surgeon is going to order it. Find someone who has the title "Board-Certified Clinical Specialist in Orthopaedic Physical Therapy" or "B-C CS in Sports Physical Therapy". Sometimes, they erroneously abbreviate the title into OCS or SCS.

[Jake Leuty]

I appreciate all of your help thus far. I am scheduled to have surgery January 14th. A couple more questions:

When the doctor says that I have achieve “bony union” and OK’s me to be full weight bearing, can I begin NLP in earnest in your opinion?

Also, would you recommend adding any extra exercises specific to my injured area such as weighted calf raises?

Thank you,

Jake

[Will Morris]

I appreciate all of your help thus far. I am scheduled to have surgery January 14th. A couple more questions:

When the doctor says that I have achieve “bony union” and OK’s me to be full weight bearing, can I begin NLP in earnest in your opinion?I know what I would do, but that is your decision to make.

Also, would you recommend adding any extra exercises specific to my injured area such as weighted calf raises?I wouldn't. I think you'll find heavy calf raises to be provocative of pain.

Thank you,

Jake

As above

[Jake Leuty]

I get out of my cast next week. As you predicted, my Dr. is ordering me to see a PT. I cannot find anyone in my area who has so much as a squat rack. I would liken the thought of handing these fools my money with that of offering to pay extra on your taxes. In your experience, can I hire an SSC DPT, be coached online and have the Dr.'s/insurance requirement satisfied? I am assuming if I refuse to see a PT my insurance might refuse to cover any future complications. Is that correct?

Thanks,

Jake