Footwear coming back from an ankle injury

[Sumi Wada]

I broke my ankle while hiking 2.5 months ago but am finally on the cusp of starting physical therapy. I have good sports medicine connections and am getting great care BUT their attitudes about hiking/backpacking are pretty "traditional." Their eyes went big when they found out I'd been backpacking in lightweight trail runners in pretty rugged country and the consensus is that they contributed to my injury. I'm already starting to hear the chanting for "supportive footwear".

I'm curious about what other hikers have done/worn while still coming back from an ankle injury. I'm sure I'll ultimately want go back to hiking in low trail runners but I'm certainly open to wearing boots or whatever as my ankle gets back in shape. I understand about working to strengthen my ankle; that's really not my question. I just know that it won't happen overnight (I'm 51 and old bones heal slowly!) and trying to decide what to wear during the process. I have some easy hikes planned for the fall.

If you have personal experience to share, I'd appreciate it.

[Nick Gatel]

Hopefully Jennifer Mitol will chime in. She is a PT with expertise. Obviously boots are not going to help strengthen the ankle, but might be helpful until it heals completely. Lots of folks older than you using trail runners.

[Jake D]

Tell the PT that you would like to be treated like a soccer player or football player who needs ankle strength and mobility without heavy boots. Sometimes they need to be pushed into an area they are more familiar with. you should be doing tons of balance work on various surfaces.

[Ben C]

I have had 2 severe ankle dislocations (and numerous run-of-the-mill sprains) from a life of competitive volleyball. I would recommend an Active Ankle brace for support while regaining strength. They have a hard plastic outer shell with a foam inner. There is a hinge that allows ankle flexion but the hard shell really completely prevents any side-to-side rotation. They are almost mandatory among the volleyball crowd and I'm not sure why they don't have broader appeal. Its possible the Active Ankle might rub a blister over long walks but I would give it a try.

That being said, I am a believer in ankle strengthening and now walk in low trail runners at 47 years old. But everyone is different, so I would see how you progress.

[Billy Ray]

would be curious to know exactly how you broke your ankle… terrain, circumstance, what footwear you were using at the time…. weight of pack, etc.

thanks,

Bill

[Sumi Wada]

@Bill, I broke it in the Grand Canyon, going down Tanner trail. We were about 5 miles into the Canyon, close to the bottom of the Redwall descent; steep, loose trail. My forward foot slipped a little and my back foot twisted underneath me; I heard it crack.

This was an 8-day hike with my son. My trailhead pack weight was 29lb with 3L of water and 8 days of food.

I was wearing Montrail Bajadas, a trail running shoe. This was my third backpack in the Grand Canyon in trail runners. I was hiking with trekking poles.

Trail near the top of the Redwall:

The last picture I took before I broke the ankle:

[Billy Ray]

Sumi,

Thanks for your report. Always instructive to get the details.

Wondering, how did you get out?
And… was it soft tissue damage or actual broken bone?

If it was broken bone you might want to be tested for Osteoporosis… before you go out hiking again… even people as young as you can have it…

I guess I am a 'trad' hiker as, personally, I would choose a boot that covered my ankle… not because I would ever think that I might break my ankle, but because it's so easy to kick up rocks on a route like that… rocks can kick up and hit your ankle… I've had a hematoma on my ankle before and it is extremely painful… lots of nerves in that area and having a hematoma pressing them against the bone… very bad.

I might do that hike with a low top hiker shoe if it were a day hike… I'm more agile without a back. But with a pack I like something covering my ankle bones. Just my preference… no one right way…

bill

[Mike Farrell]

I broke my ankle and cut tendons and ligaments, it was three years to get back to 100%. I wore Asolo 520 boots while recovering and still do. I found that the stiffness of the sole greatly helped my ankle. I have other boots that are much lighter but do not have nearly the support as the Asolos. Try on a pair and you will see. My lighter boots are fine for anything other than backpacking.

[Sumi Wada]

@Bill, actual break. My mother has osteoporosis so it's something I'm aware of and am being screened for.

As for getting out, I was probably as lucky as you can get. Some guys hiking out took my info to contact rangers at the rim. Other hikers on their way down helped me to a small but flat saddle maybe 50ft down where we could make camp and a helicopter could land. It was about 1pm when it happened, took an hour to get to the saddle. We still had enough water and were prepared to spend the night.

We didn't see any other hikers after that, so like I said, we were really lucky. We only had so much water, so we would have had to make a pro-active decision. My son was prepared to hike out on his own and get help.

I was actually pretty comfortable by then; I had a small roll of athletic tape, so I'd taped my ankle as soon as it happened and then splinted it with my crocs and duct tape. Took a handful of ibuprofen at the same time. We set up camp, made dinner and settled down with a book. We heard the chopper looking for us just before sunset; we'd set the tarp so that we'd be easier to spot. They flew us out then took me by ambulance to the hospital in Flagstaff (South Rim clinic was closed by the time we got out.)

I've been hiking in the Canyon for about 10 years now and have been hiking the last few years in low trail runners. Some of the trails have been even more rugged than this one. I don't remember anyone ever kicking up rocks, to be honest with you. Slipping on the loose scree is always an issue.

[Sumi Wada]

@Mike, can you give me more detail on how the stiff sole helps your ankle? Did you normally wear high boots before you broke your ankle?

[Dena Kelley]

I sprained my ankle so badly a few years ago that it took a full year to heal. My doctor told me that I'd have been better off breaking it, it would have healed faster. For a while I wore boots for hiking, but boots are hot, heavy and I blister in them more easily even when they fit well. I had discussed with my doctor my "weak ankle" and he said in most cases it's not weak ankles but rather a weak connection between the ankle and the brain that makes the brain's commands to the ankle to happen too slowly. He gave me exercises to do (which I imagine the OP has been prescribed in physical therapy) including balance training with eyes closed. Yoga balance poses are very good for this, also. I now hike in trail runners and I've found my balance is much improved and my "brain/ankle" connection is also improved. Anyway, just a thought. My issue was a sprain, not a break, and I'm not sure how much translates over.

[jscott]

Asolo boots tend to have stiff soles that do translate to good ankle stabilization. Powermatics are very heavy and very very comfortable.

I have a lace up ankle brace with a figure eight addition. This is highly adjustable. After lacing the initial wrap, you wrap around the figure eight straps and pull up, then attach to velcro fasteners. I used this after I broke and sprained my ankle some years ago. It works comfortably inside of a shoe/boot. No blisters. But I can't remember the brand name! I'm at lunch at work…Anyway, the store where I bought it has a picture of the Cal women's basketball team–not an ad!–some of whom use and endorse this brace. It's the Kobe Bryant brace.

This design gives good lateral stabilization and can be used to supplement a less heavy boot or shoe. And if you find that you don't need it, it's light to carry.

[Mike Farrell]

Sumi,
I was wearing boots with a 6" upper when my ankle broke. The stiff sole keeps the boot from twisting. If you can hold your boot by the toe and the heal and twist it, your foot will also twist while in there. I have a really nice pair of Lowa boots and the entire inside of the boot is buttery soft leather. They however are not stiff enough in the sole. Wearing the Asolo boots are a night and day difference. The height of the upper does not seem to make a difference like the sole does.

[Roger Caffin]

> I'm already starting to hear the chanting for "supportive footwear".
There is no substitute for (their) ignorance.

All supportive footwear will do is prevent your ankle from developing strength. Both bone and muscle strengthen from exercise. (Just don't go too far!)

I broke a bone in my foot half way through a several-month walk in Europe. Slid down a very steep greasy track – my fault.
I gave it 4 days of rest, then started carefully walking again – in joggers, with pack. Took a couple of weeks, but the exercise worked.

51 years old = junior.

Cheers

[Ross L]

On the flip side, I have been wearing leather boots for some 35 years, over 20 of which in 11" high Meindl Canadas. Ten years of that were guiding in the northern rockies of Canada, often carrying obscene loads off trail in steep terrain (weak clients). So far no broken or macerated feet, no twisted knees, just the occasional sprained ankle while wearing running shoes. I do own and use a couple of pair of New Balance trail runners, so I am not a complete dinosaur. I totally agree that the strengthening of foot, ankle and knee joints is the first line of defense. I train year round, and that is what keeps my old carcass going.

59 years old = senior

Cheers

[jscott]

edit

[Jennifer Mitol]

Okie dokie. Here's my professional take:

First of all, a question: what did you break and how many bones? Bimalleolar? Trimalleolar? Any pins/plates? Do you know if they had to fuse any part of your foot or ankle?

That will change my answer ever so slightly, but not too much.

As for trail runners – depending on the specifics of your fracture, I wouldn't fret about it. I would actually encourage you to use running shoes before boots. If you wear higher cut boots it actually changes the way your ankle works, and not necessarily in a good way. And honestly, if something bad is going to happen to your foot or ankle the boot is NOT going to stop it. The higher, stiffer top is high and stiff enough to stop your leg from translating over your foot properly, but not high and stiff enough to prevent any sprains or breaks.

Don't worry too much about telling your PT about getting out BACKPACKING. Just say you want to get back to trail running and that you need a great deal of balance, agility, and proprioceptive training. Make sure they are doing joint mobilizations on you…if not, let me know and ill try to find you a new PT who will. If you've had surgery, or been in a boot for any length of time, your foot and ankle are going to be a bit of an immobile brick. Simply stretching the muscles isn't going to cut it…the joint capsules themselves are scarred and fibrotic and will need to be stretched individually…something you cannot do yourself.

Your attitude of thinking your rehab is going to take a while is a good one – but honestly, if you are in pretty good shape and are diligent about your exercises, it won't be as long as you think before you can get back out on the trail. You won't necessarily be the fastest or surest footed out there, but it shouldn't be too long before you can strap a lightweight pack on your back and hit the trails. For your first trip you may want to consider one of those old-school looking lace up braces. Don't use it a lot, but for your first trip it might not be a bad idea. You might not need it at all…just see how you feel.

Feel free to email me with any questions…I'm always happy to help. I do my best to battle all the bad medicine – including PT – that's floating out there all too frequently.

And that offer actually goes to anyone who has questions about any of this kind of thing…as several of you have mentioned the medical system doesn't always have good answers, so if I can help you wade thorough some of the crap I'm more than happy to help if I can.

jenmitol AT gmail DOT com

Good luck….

[Jennifer Mitol]

And in case I didn't address your original question well enough…I'd actually start right away in trail runners. Heck, as soon as you can fit em on your feet, go for it. Don't listen to what they are saying about them contributing to your injury…that's a load of crap. There's plenty of evidence out there in the military research about boots and injuries and such…

Anyway…you want to hike in trail runners? Then hike in trail runners. Walk around in trail runners…go to PT in them ;)

[Billy Ray]

Everyone's feet and ankles are different. Some people can get away with trail runners. Some can't. Listen to your body. Listen to your body more than to what is popular, or what anyone else says… even doctors and PTs…

my 2 cents…

bill

[Sumi Wada]

Broken fibula. No surgery. We actually worked pretty hard to avoid surgery. My doc x-ray'ed and re-casted me for 6 weeks before pronouncing that I wouldn't need surgery.

And just to be clear, I have absolutely no issues with my medical treatment. My best friend runs the sports medicine program here and my doc specializes in sports medicine orthopedics, works with the NFL and such. As far as my ankle is concerned, I trust him. The same goes for the physical therapist. I really have faith that my ankle will come back and, as I said in my earlier post, I assume that I'll be backpacking in trail runners again in the long run.

So, my question really isn't about treatment or PT. I was just curious what kind of footwear other hikers chose to wear when they first started hiking again, presumably before their ankles were 100%. My doc gave me the OK to plan a backpacking trip for November. I'm sure I'll be doing some light hiking in October. But neither he or the PT are backpackers and they were both surprised that I don't backpack in traditional boots — I think they just have this mental image of "backpackers" and they're all wearing big burly leather boots and carrying half their body weight.

[Jennifer Mitol]

Sumi that's great to hear. Sounds like you're in good hands and that's great.

Given that information, I have no qualms whatsoever about recommending that you just go back to the shoes you were using prior to your injury. And I would not recommend starting with boots then transitioning to runners…just ease back into backpacking with the trail runners.

Good luck!

[Roger Caffin]

> And I would not recommend starting with boots then transitioning to runners
Indeed, I would even rather hesitantly suggest that the lighter the footwear, the less strain on the injured part of your foot.
In other words, putting big heavy boots on an injured foot would just increase the strain on the recovering bits.

What so many medicos do not understand is that the weight of a light-weight pack is but a small fraction of your body weight. Most of the load on your feet comes not from the pack but your own body.

Shoulder injuries excepted!

Cheers

[Sumi Wada]

I don't think that the weight of the boot/shoe is a factor. After all, I've been lugging around a knee-high cast and then a big clunky orthopedic boot for the last 3 months.

The issue is protecting the integrity of the ankle joint, so that the spacing in the joint isn't compressed. They're most concerned about anything high-impact; I definitely won't be running for a while. Doc didn't recommend any kind of braces against lateral movement, just wants me to stick to low-impact exercise and wear something cushy for a while.

[al B]

Thank you for this thread. Please update on your recovery.
I hike about 2-3 hundred miles a year, mostly on the AT and some with my scout troop.
I’m 4 and 6 weeks out from surgery on the right and left ankles due to pilon fractures from a brush with a ladder.  The left is much worse than the right. So far PT has been range of motion.  I plan to start weight bearing in 4 weeks.
My trekking shoe of choice before the accident was the Altra Lone Peak 3.0. which I will wear through rehab. I have an older pair of Asolo boots if ankle support is needed. Any additional advice would be greatly appreciated.

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