Dear Sir, I understand completely why youre hesitant about ankle fusion, especially given your current level of activity. Its commendable that youve maintained such an active lifestyle. Given your history, its not uncommon to experience persistent pain, even after initial healing. While the bone itself may have healed, such significant trauma can lead to a cascade of issues over time, impacting the surrounding soft tissues, joint mechanics, and potentially leading to arthritic changes. Its also very possible that a significant component of your pain is indeed related to soft tissue dysfunction. This could include Scar tissue limitations The healing process itself can lead to restricted soft tissue mobility around the ankle, affecting normal movement patterns. Muscle imbalances and weakness Over time, you may have developed compensatory movement patterns to avoid pain, leading to some muscles becoming weak or overused. Ligamentous laxity or tightness The ligaments supporting the ankle could have been affected by the initial trauma, leading to instability or stiffness. Nerve irritation Sometimes, nerves in the area can become entrapped or irritated due to swelling, scar tissue, or altered mechanics. Tendinopathy Chronic stress on the tendons around the ankle due to altered biomechanics can also lead to pain. Regarding your question about other treatment options beyond surgery, as a physical therapist, my primary focus is to explore and optimize conservative management strategies before considering invasive procedures. Here are several options 1. Comprehensive Physical Therapy Evaluation and Treatment This would be my first and strongest recommendation, looking at Mobility Assessing the range of motion in your ankle, subtalar joint, and midfoot. Strength Evaluating the strength of all the muscles surrounding your ankle and lower leg. Balance and Proprioception How your body senses its position in space, which is often compromised after significant injury. Gait Analysis Observing your walking pattern to identify any compensatory movements or inefficiencies. Soft Tissue Assessment Palpating for areas of tenderness, tightness, or scar tissue. Based on this, your treatment plan could include Manual Therapy Handson techniques to improve joint mobility, reduce soft tissue restrictions, and address scar tissue. This could involve joint mobilizations, soft tissue massage, and stretching. Therapeutic Exercise Targeted exercises to improve strength, flexibility, balance, and coordination of the muscles around your ankle and lower leg. We would focus on restoring optimal movement patterns. Neuromuscular Reeducation Exercises to retrain your nervous system to control your ankle and foot more efficiently. Modalities As appropriate, we might use modalities like Cold laser, electrical stimulation, or coldheat therapy to manage pain and inflammation. Activity Modification and Pacing Strategies Wed discuss how to manage your daily activities and exercise to minimize pain flares while still staying active. 2. Optimizing Orthotics and Footwear You mentioned using custom orthotics from the VA, which is excellent. Sometimes, slight adjustments or a different type of orthotic can make a significant difference in pressure distribution and pain relief, especially if your foot mechanics have changed over time. 3. Corticosteroid Injections Cortisone You asked about cortisone. Yes, a corticosteroid injection can certainly be an option. Its important to understand that cortisone typically provides temporary relief by reducing inflammation, but it doesnt address the underlying mechanical issues. It can, however, be a valuable tool to reduce pain enough to allow you to participate more effectively in physical therapy and strengthen the surrounding structures. This would be a discussion to have with your physician, but its certainly a path worth exploring. 4. Other Injection Therapies While cortisone is the most common, your physician might also consider other injections, such as Hyaluronic Acid Injections Less common in the ankle but sometimes used for joint lubrication. PlateletRich Plasma PRP or Prolotherapy These are more advanced options that aim to stimulate healing, but their effectiveness for chronic calcaneal pain needs to be discussed with a specialist. 5. Pain Management Consultation If conservative physical therapy and injections dont provide sufficient relief, a pain management specialist could offer additional strategies. This might include nerve blocks or other interventional procedures, always with the goal of improving your quality of life and function. 6. Acupuncture or Dry Needling Some patients find relief from chronic pain through these alternative therapies, which can target trigger points or nerve pathways to reduce pain. Its crucial to understand that fusion is a significant and irreversible surgery. While it can effectively eliminate pain from a severely arthritic joint by stopping motion, it inherently leads to a loss of mobility, which is precisely your concern. Given your current functional level, I strongly advocate for exhausting all conservative, nonsurgical options first. I recommend scheduling an initial evaluation with a physical therapy to thoroughly assess your situation and develop a personalized treatment plan aimed at addressing the root causes of your pain, not just the symptoms. Good luck!

For chronic pain after a crushed calcaneus, alternatives to ankle fusion include cortisone injections, advanced orthotics, physical therapy, and regenerative treatments like PRP. Updated imaging may clarify soft tissue vs. arthritis. A pain management specialist or orthopedic review is recommended before considering surgery. Mobilitypreserving options are still possible.

There are. we have 2 alternatives. Im not sure where you are located, but if you are near oceanside, ca reach us at 76060633598. we can help you

If you still have motion, fusion is not the answer. Injections with other types of conservative treatments can be accomplished.

Without seeing X-rays, I would say that if the patient is still active, but having some pain, cortisone injections are often possible and good pain relievers temporarily. Also bracing can also help relieve the pain and good shoes.

Focus on locoregional therapy, such as massage with pain relieving agent such as a chest rub or Woodlock Oil, and acupuncture with Moxibustion. Change your diet to organic green Mediterranean diet, low gluten and non-GMO. Consult Functional Medicine to optimize body's innate wound healing abilities. Vitamin D/B, and thyroid/parathyroid has to be optimized. No iron deficiency anemia.

I would highly recommend you seek a Local Physical Therapist specializing in Orthopeadics.