Back on the Right Foot

Vacaville resident Jeremy Wirth had taken his dirt bike to his construction job site with plans to ride in a nearby open field after work. What he didn’t plan on was an injury that would hobble him for nearly two decades.

ABOVE: Jeremy Wirth of Vacaville is back to enjoying the outdoors and other activities following a total ankle replacement surgery.

“I’ve ridden motorcycles my whole life,” he recalled. “It was a fairly new bike but I had ridden the area before so I wasn’t worried.”

Unbeknownst to him, however, a new ditch line had recently been dug in that field, changing the terrain dramatically. When he took off, he crashed into that ditch at full speed, shattering his right ankle.

“I knew I was hurt and when I got up, I could see that it was broken,” he said.

Lying in the ditch, the then 26-year-old had to figure out how to get out of it and find help. Unable to kick-start the bike, he managed to use his hands to start it up, pulled himself up on his good leg and hop/rode himself out of the ditch. He was able to flag down a passing 4-wheeler to give him a ride back to his work site and call for an ambulance.

That was 17 years ago. After a couple of surgeries to put screws in place to hold his ankle together, Jeremy figured life with constant pain in his ankle was just his lot in life.

Adding in Ankles

Total joint replacement is a surgical procedure in which parts of an arthritic or damaged joint are removed and replaced with a metal, plastic or ceramic prosthetic. Since 2007, orthopedic surgeons at NorthBay have routinely offered total knee and hip replacements. In 2015, shoulder replacement was added. In 2017, ankle replacement became part of the Joint Replacement Program.

“It’s been bad ever since,” he said. “The pain never really went away but I just learned to live with it.”

Until last year, that is.

“The pain got worse and worse and it limited my hiking and work and all the rest of it,” the avid hunter and outdoorsman explained. “If I hiked in the morning, I was done for the rest of the day.”

A heavy equipment operator, Jeremy found that his ability to work on the mechanical end of things was limited, as well. “I couldn’t crawl around or under the equipment and stuff like that,” he said.

So he asked his doctor for a referral to an orthopedist. That’s when he connected with NorthBay Healthcare foot and ankle surgeon Kevin Miller, D.P.M.

“The fracture that Jeremy suffered was really bad. He had to have screws and plates and hardware implanted,” said Dr. Miller. “They did a good job, actually. But over time, the cartilage in there just broke down and the joint basically collapsed. He became a young guy with an arthritic ankle.”

Cartilage acts as a cushion that lines the joint. When it breaks down, it results in painful bone-on-bone grinding of the joint surface, Dr. Miller explained.

“You wouldn’t believe the places I’ve been. I’ve been to the top of those ridges, up slopes where you can’t see what’s under the grass, uneven terrain and sometimes with nothing more than a deer trail to follow.”
—Jeremy Wirth

There are two types of surgeries frequently recommended in such cases: ankle fusion and ankle replacement.

In ankle fusion, a surgeon fastens together the damaged ankle bones with metal plates and screws. During the healing process, the bones fuse into one combined bone. Ankle fusion usually is successful in relieving arthritis pain, but it also reduces the ankle joint’s ability to move.

In ankle replacement surgery, the ends of the damaged bones are removed and replaced with an artificial joint made of plastic and metal. This artificial joint helps the ankle retain more movement, so it provides more mobility.

“Replacement was really the best choice for Jeremy,” said Dr. Miller. “It allows for a better range of motion. It allows for mobility in a more robust way. He’s a younger guy, only in his 40s, so he wanted to stay mobile, obviously.”

Jeremy had his concerns. “I did a lot of research and watched videos and the people in them were excited because they could walk to their mailbox. I was like, ‘I want to be able to do more than that!’” he said. Reassured that he would be able to have much more mobility, Jeremy had the surgery performed by Dr. Miller in March 2018.

“There was pain during recovery but it was worth it,” he said. “I was in the hospital for one day. That’s it. And then I was on crutches for a while. Eventually they put a boot on me and Dr. Miller told me to get right on it.”

Surgeon Kevin Miller, D.P.M., felt that a total ankle replacement would allow for better range of motion and mobility for Jeremy.
The more he used the ankle and did the recovery exercises, the better it got, he said. “I feel it. When I am on my feet and walking, I know it’s different. The joint pain is gone but I still have stiffness and soreness. There is discomfort, but nothing like before,” he said. “Sometimes I surprise myself. I forget it’s there. I was covering a firewood pile one day and climbing all over the pile and then I stopped and thought ‘Wow, I never knew I’d be able to do that!’ ”

He’s back to hiking and hunting, too.

“I told Dr. Miller they should make a video about me. You wouldn’t believe the places I’ve been,” he said, pointing to the mountain ridgeline around Vacaville. “I’ve been to the top of those ridges, up slopes where you can’t see what’s under the grass, uneven terrain and sometimes with nothing more than a deer trail to follow. It’s steep country but I bought myself a new bow and was able to hunt with my dad. I loved it!”

He has advice for anyone else who’s been told they need to consider a total ankle replacement.

“Go for it,” he said. “If you are that injured and it’s not fixable, and you’re in arthritic pain, it’s worth it.”

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