I snapped my peroneal retinaculum on my right ankle while high stepping four months ago and had surgery to repair it a month later. I have been going to a physical therapist and she has told me I can do light running and easy climbing. I have concerns about climbing, especially since I don’t think my PT understands the strains placed on the ankles. I’ve been climbing in my post-surgery boot because I’m worried about snapping the ligament again. Have you ever seen a climber who has gone through this injury? Has the person snapped it again?
Jason Lumsden / Via e-mail
The majority of ankle injuries in climbers are either sprains that occur walking to the crag, or talus fractures that happen on impact. Peroneal retinaculum ruptures caused by climbing are next in line, but they are a distant third place.
When a climber rocks onto a high foothold, or sits down onto one foot, the ankle is pushed into extreme dorsiflexion (the opposite direction is called plantaflexion, which happens when you point your toe).
The tendons of peroneus longus and peroneus brevis pass behind the outside knuckle (lateral malleolus) of the ankle. When you maximally dorsiflex the foot, these tendons, under enormous load, are physically and architecturally anchored behind the malleolus.
The peroneal retinaculum performs much like the pulleys in your fingers, holding the tendons in place and close to the bone to enable motion of the foot. In 82 percent of the population, the peroneal tendons are located in a sulcus behind the lateral malleolus (which is actually the end of the fibula bone), making their position more structurally robust. Eleven percent of you don’t have a sulcus, and the remainder have a convex surface. Respective translation— shitty, and shittier!
When you combine shit anatomy with a big load, the retinaculum is subject to the cutting force of the tendons; it’s a bit like pulling a string through a folded piece of paper.
I would follow the advice of your PT. Surgery followed by rest, then progressive loading is the only option to achieve full capacity (and some). The surgery involves reattaching the retinaculum and/ or supplementing it with some harvested tendon tissue, along with deepening the posterior groove so that the tendons are essentially hooked behind the malleolus.
Gentle climbing on a toprope is fine for now. Avoid extreme rock-over positions with the same focus that you avoid poking yourself in the eye with a branding iron. This loading, more than anything else, needs to be progressive over the ensuing months such that the retinaculum, +/- a tendon graft, has time to heal and strengthen.
Eschew the sharp end of the rope for now since many factors beyond your control dictate how you impact the wall. Absorbing any force with that foot early in the rehab process is beyond bad.
The reality is that surgery will likely afford you an even stronger peroneal tendon restraint. If anything, I would be worried about the other ankle!
I’ve had excellent success dealing with “dodgy elbows” and maintaining my shoulders by implementing the advice from your articles in Rock and Ice—I’m a bit of a disciple now. But over the last six or seven years, my lower back has become the focus of my attention. Thirty years of being crap at highball bouldering—i.e. never doing a problem first try—and I now have degenerative disc disease with bone spurs throughout my lumbar spine. Things are getting worse and slowing me down. I’m nearly 45 years old.
Stuart Lancaster / Shipley, U.K.
I like you, Stuart. I feel we are astrologically linked. For starters, you and I both think I am excellent. I, too, have some bone spurs, and I live in Shipley, albeit in Australia.
The roaring 40s are a great time. The kids are old enough to look after themselves, but still sweet, and there is some spare time for climbing and surfing. Even shagging could be back on the agenda.
Alas, your body is dying. You and I have peaked, Stuart. What used to be just an inkling of decline is now downright alarming. My climbing grades are diminishing even as I implement new and improved training techniques.
Think not about how the degeneration is slowing you down, but how climbing is slowing the degeneration! You see, the endgame of your musculoskeletal health is all about strength and stability. You will lose the game, and no amount of denial will change that, but at least you can draw it out as long as possible. Imagine where you would now be had you sat on the couch and watched “My Kitchen Sux” for the last decade.
A weekly appointment with your chiro, osteo, PT or bondage mistress will do wonderful things for their bank accounts, and may even help you, but the lasting benefits pale when compared to outright strength training. If exercise was in a pill, we’d all be taking it. The reason everyone is not exercising is because people are fucking lazy! They may be whining about their decrepit knees, but you know what, were laziness not a lifetime pursuit, they would have thought about it 20 years ago. To them I say: Suck it up.
Your best bet is to supplement your climbing with some even more difficult exercises. The most effective, all things considered, is an exercise-ball program. Fun, convenient, partytrick heaven, and its application in the bedroom will enliven your marriage, assuming that equipment still works.