So this is potentially a bit misplaced and it might have been better for me to explain rehab, prosthetics etc. first so this post would make a little bit more sense, but skiing was one of the most important things for me to get back into and was a huge part of my motivation in rehab. The thought that I might have not been able to ski again after amputation was a big worry. However, pre-amputation, putting any weight through my right foot and ankle hurt a lot, so skiing had become horribly painful and turning with my right leg a challenge. Throughout the course of a day skiing with my bad foot, it would get worse and worse, and I would regularly get to a point where every turn hurt so much that I would do anything I could to limit having to turn. Whilst skiing last Easter it became clear that realistically, skiing wasn’t going to be a possibility any more unless something changed. As hard as that was, it was helpful in that it was just another positive tick in favour of amputation.
Following amputation, I was scared of skiing again. Scared it would be extremely painful, scared I would struggle to turn and scared I wouldn’t be able to do it full stop. But I was hopeful that in time, I would be able to relearn how to do ski and as the sensitivity in my leg went down it would be possible. So as soon as I got back home from rehab with my prosthetic leg, I tried the boot on for size and was very fortunate that it slid straight in. I was over the first big hurdle! I’d worked hard in rehab building up my core, back and leg strength and improving my balance because you need to be a lot stronger when you are controlling something that isn’t part of your body and you don’t have muscles directly attaching to it. I also spent a while every day on a wobble board, trying to help my brain figure out this prosthetic leg thing and despite my parents concern for the wellbeing of the floor, I tramped around the house in ski boots every day to get my leg used to the feel of the heavier weight.
I had no idea whether or not I’d actually be able to ski again and was interested in having some lessons, but needed a doctor’s letter saying I was fit to do so and I could only be taught after a certain amount of time post op. This seemed like a lot of hassle and, actually, I much prefer to try and figure things out for myself, on my own. So I searched the internet for days, trying to find information about what skiing would be like after an amputation, but I struggled to find anything. If you’re a veteran who has lost a limb, there are camps and organisations that help you learn or get back on skis. However, not falling in that category but still keen to get skiing again it was very difficult to find guidance about what I’d need and how to get it. I came across the organisation Ski2Freedom and emailed them. The founder, Catherine Cosby, gave me some great practical advice and, more importantly, some extremely valuable encouragement. All I needed was someone to reassure me that there really was no problem getting back on skis and this gave me the push required to get on with it. So, I went along to an indoor snow centre and had a try, with my dad nervously watching from the sidelines. Had anyone else there known I was skiing with only one leg, they might have given me a bit of a wider berth, but luckily my ski pants cover my leg completely so no one knew any different. This was my first attempt:
It was okay, but there was a lot of pressure going through the end of my leg and down the front of my tibia, because my knee was trying to resist the flexion that comes from setting up the leg at an okay angle for skiing, and after an hour on the snow it was quite sore. So I went back to my wonderful prosthetist and she padded it out in different places to unload the tibia which helped a lot. The socket has to be fitting well, because any little rubs or areas of soreness will be exacerbated by the extra forces involved in skiing. I have been using my initial, basic leg for skiing, which is the standard set up given out on the NHS for people to learn to walk on. Initially, it was only held on with a gel sleeve, which was fine for walking around a bit, but not enough for skiing so my prosthetist added a cuff strap. This is a leather strap attached to the prosthesis which buckles up around the thigh. When it’s done up really tightly it anchors the leg on quite nicely and in four weeks of skiing so far this winter it hasn’t fallen off yet! (Although chairlifts without foot rests are particularly difficult as the weight of the ski and boot really pull at my stump if they are just hanging). I was lucky that the (very simple) multiflex foot on my first leg has foam coming up to the bottom of my socket around the ankle area, so this provided something for the boot to grip onto, whereas my current everyday leg which just has the carbon fibre pole would have needed something put onto it. Below is the foam insert from the leg I use for skiing, my carbon fibre leg looks far slicker but this one is much comfier for skiing at the moment. The orange foam is where extra bits have been added to change the pressure distribution on my leg as my leg has changed shaped since the original casting.
The only other adaptations were foam wedges added under the foot in the boot to mimic the dorsiflexion that you’d have with a normal ankle skiing so the leg isn’t set at vertical. I also put the foot in a plastic bag which makes getting into and out of the boot a lot easier, but it just stays in the boot most of the time and I switch legs, rather than switching shoes. As my leg has shrunk over the last four months I’ve had leather liners added to keep the fit tight and on that leg now I’m up to six, which isn’t ideal – 2 or 3 is the norm before getting recast for a new socket, but as this isn’t my main leg, it isn’t a priority and has done the job quite well for now! Hopefully, in time, I will be able to get a specialised leg specifically for skiing that would allow me more control and stability and would protect my knee, because at the moment my knee is doing all of the work and at risk of being seriously injured if I were to have a big fall. So a bit of knee protection and something around my thigh which would take some of the pressure away from my stump would be ideal.
At exactly three months post op I went away with my family and we had a lovely week cruising around a little resort, where I gradually built up confidence and started to trust the leg a bit more. I then worked over half term in a Swiss ski resort and survived a week chasing four year olds around on Kinderland, and have just got back from a wonderful week skiing with friends which showed me that even with something as active as skiing, there is no reason why I can’t participate just as anyone else would. As cheesy as it sounds, I really can get around any of the potential barriers with a bit of creativity, perseverance and hard work. Skiing has shown me that although it may need to be done a little differently, it can still be done. The main issues/differences I have come across so far are:
- Not having feedback from my foot and ankle means that my brain doesn’t know where the ski is and I find myself looking down a lot (not great – looking ahead is quite important…). This makes it harder on snow that isn’t perfectly groomed and is bumpy or slushy, but I’m sure that over time my proprioception will improve and I’ll trust the leg/brain combo to do the right thing.
- I have very little movement with this foot from what would be my ankle joint so can’t push through and flex my ankle which makes me quite upright. With a different foot or set up that allows more dorsiflexion this should improve.
- Flat bits, or whenever I am not on an edge (T-bars, drag lifts etc.), are difficult because I don’t have control coming from my foot, so if I am not actively pushing over on the side of the ski it wobbles around a lot and is liable to catch an edge and send me flying.
- I have always been a serial pole dragger, which I think is an attempt to try to help me balance and mimics three track skiing (one ski and two hand held outriggers) which is something that higher leg amputees often do, giving three points of contact with the ski and two outriggers, rather than two legs. As I am using my prosthesis I don’t need outriggers, but it’s like my arms are trying to help out. Dragging my poles is something I’ve always done having a dodgy foot and I can tell when I’m doing it a lot because my wrists get very sore, but I think that as my balance and strength improve I’ll stop dragging them quite so much.
- Throughout the day the leg shrinks and I need to add more socks to fill the gap and keep the fit tight, but this has only really involved adding one half or full thin sock at lunch time, as long as I start with it right in the morning.
- A poorly-timed blister on the scar on the bottom of my leg from my every day leg fitting badly caused a few minor problems on my last trip. Luckily it didn’t rub in my ski leg which showed me that it really is all about the fit. Despite the extra forces on it, skiing didn’t irritate it too much and although it was never going to heal up over that week, it didn’t get any worse and I popped a blister plaster on every day, kept an eye on it and was able to ski all week.
I’m still scared of falling and my leg twisting or something nasty happening because the last thing I want is to have an accident and a major setback, but I’ve had a few falls and nothing out of the ordinary has happened which is comforting. I always aim high, but being able to ski like this at four months post op was not something that I’d ever even dreamed of doing. Even just half an hour of flying down the mountain made all of the pain and heartache of the last year seem worthwhile. I get such an incredible sense of freedom from skiing. It’s just me and my skis, a bit of adrenaline and the breathtaking beauty and wildness of the mountains. It’s unreal. And it really is quite magical being able to ski again.
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