Brian and "The Big Snow of 2010".
It was January of what 38-year old Brian calls the ‘big snow year of 2010’ when he hit a patch of solid snow while skiing on Vail Mountain and was thrown violently forward.
Since he didn’t come out of his ski, he wasn’t sure what happened, but he knew it was bad. Somehow he managed to ski down to his car at the base of the mountain. Trying to take off his boot proved excruciatingly painful. He thought he might have torn a calf muscle.
As soon as he got home, he called Vail-Summit Orthopaedics to make an appointment. “I was not familiar with Dr. John Paul Elton, but I’ve always used Vail-Summit Orthopaedics for ski injuries so that’s why I called,” recalls Brian.
Dr. John Paul Elton is a Harvard-trained foot and ankle specialist who joined Vail-Summit Orthopaedics in 2010 after completing his Fellowship Training at Brigham and Women's Hospital in Boston. He told Brian he had ruptured his Achilles tendon and discussed operative and non-operative treatment options. Brian elected to have the rupture repaired, which can require a long recovery period.
Once Dr. Elton determined Brian’s Achilles tendon was ruptured, he ordered an MRI to confirm the diagnosis. “Then he started explaining what he was going to do by literally pulling out a pen and drawing on the paper I was sitting on,” recalls Brian.
Dr. Elton is one of the few foot and ankle surgeons in the United States utilizing a new technique to repair Achilles ruptures using a minimally invasive technique. He published a paper on the topic for the American Orthopaedic Foot & Ankle Society in 2010.
Dr. Elton says the new technique has been shown to have equivalent outcomes with less risk of wound or infection problems than with older techniques. His preference is to repair all Achilles ruptures with this technique, but says a minority of ruptures are not amenable to this technique for one reason or another.
“At the time, I didn’t know all he did was ankles,” says Brian. “Once I started asking around, I learned he is the ‘go-to’ guy for anything to do with feet and ankles. His humbleness and simplicity in explaining things comforted me.”
The older method of treating Achilles ruptures was to either place the patient’s leg in a cast to immobilize the ruptured tendon, or use a very large incision on the back of the leg. The cast does not allow motion at the ankle and Brian says that’s exactly the opposite of what Dr. Elton wanted him to do. “He wanted me to get my range of motion back as soon as possible.”
The minimally invasive or limited open approach to repairing the tendon requires a small incision on the back of the leg overlying the rupture that is just large enough to put the tendon ends back together and repair it with strong sutures in the tendon. The patient is placed in a splint for about 10 days, then a removable boot so they can start walking on it and moving the ankle.
Since it was such a great snow year, Brian was determined to get back on the slopes one more time before the end of the season. Three months after his surgery, his 5-year old niece came out. Brian skied the bunny slope with her. “My surgery made it possible for me to ski with my niece for her very first time, which was cool.”
Today, Brian is 100%. And when he’s on skies or doing anything athletic, he says he can’t tell which Achilles was ruptured.
To Fuse or Not To Fuse?
For Joshua, a 46-year-old yacht captain and avid skier and kite-surfer, ankle fusion wasn't the solution to the crippling pain he felt at the joint.
And yet, that's what doctors back home in Savannah, Georgia suggested. It would have limited his professional abilities and much of his recreational life.
“The thought of a fusion was making me sick to my stomach and keeping me up at night,” Joshua said. “Being able to ski and kite-surf for me are the most important activities in my life. My job is super dependent on my mobility. Now, (they were) frankly threatening my profession. It was really difficult for me to get my head around.”
Given the choice of fusion or no fusion, Joshua opted for the third choice: Call other doctors.
The injury happened in Silverton in February, where Joshua collided with a large piece of avalanche debris early in the day. Eventually, it was diagnosed as a fractured lateral process of the talus and a subluxated peroneal tendon. When the ankle moved, the fracture caused pain, but so did the tendon, which could snap up over the bone and shoot pain up the leg.
As the ankle worsened, so did Joshua' knee; muscle atrophy in the upper leg affected a pre-existing minor knee injury.
A former Vail Valley resident of eight years, Joshua tapped friends for referrals, and landed on Vail-Summit Orthopedics.
He made an appointment that fit into his travel and work schedule, and prepared to fly to Vail on July 4. During the consultation, Joshua breathed a sigh of relief when Dr. William Sterett and Dr. John Paul Elton said fusion might not be necessary.
“It was a huge glimmer of hope for me,” Joshua said, adding that Elton helped him figure out how to continue to work as a captain throughout the summer by prescribing a brace.
Surgery was scheduled for just prior to Thanksgiving for both knee and ankle surgery – difficult as that was. Joshua credits the support staff for being kind, helpful and understanding as they sorted through logistics, including insurance, which Summers was happy to hear happy to hear would fully cover the surgery after his out-of-pocket expenses.
As of early January, Joshua was six weeks out from surgery. He'd just begun to put weight on the ankle.
“I'm confident that both repairs were successful. It's going to be a long road. Hope a year from now I'll be 100 percent,” added Joshua.
One-hundred percent to go ski in Portillo, Chile with his wife, that is.