Jan 29, 2015Ali Mims, Florida State University
Around the Florida State University campus, goalkeeper Ali Mims is known as “the soccer player who broke her leg.” Mims earned the nickname after sustaining a closed left tibia fracture on Aug. 23, 2002, and spending the better part of two years on crutches. Though medically accurate, the label barely begins to describe the trials and tribulations Mims experienced on her way back to defending the net. After having intramedullary rod placement surgery, Mims began a multi-year journey down a road fraught with complications, 21 separate surgeries, and countless hours of rehab.
But the road also delivered her to the FSU starting lineup at the start of the 2005 season, where she led her team to a Final Four appearance in the NCAA Division I Women’s Soccer Championship. Despite permanent foot and ankle pain and some lost athleticism, Mims recorded seven shutouts on the season and provided plenty of inspiration and leadership for a young but talented team.
Mims’s story begins at the start of her sophomore year when she was competing for the starting goalkeeper position. During a scrimmage at the University of Georgia, she came out to challenge a breakaway in the game’s opening minutes and collided with an opposing attacker. She heard, and felt, her leg snap. For Mims the injury was extremely painful, but X-rays showed it to be a relatively straightforward fracture, and the next day surgeons performed a successful intramedullary rod placement. With the rod in place, doctors told Mims she could expect to fully recover in seven months and be ready for the 2003 season. However, almost immediately post-surgery, Mims’s injury became anything but straightforward.
Andrew Borom, MD, who performed the last 10 of Mims’s surgeries, describes his patient as a walking worst-case scenario. “Ali basically had everything that could possibly go wrong for a tibia fracture,” says Borom, a foot and ankle specialist at Total Orthopedic Care in Tallahassee. “I’ve never seen a series of complications like Ali had—there’s not a problem I can think of that she didn’t suffer from.
“The complications weren’t really anyone’s fault—everything was done exactly right during the initial rod placement,” Borom adds. “But she got an infection and that led to a whole bunch of other problems.”
The first wave of complications hit Mims right off the bat. On her first day post-surgery, she developed signs of compartment syndrome and underwent a fasciotomy that required 10-inch incisions on each side of her leg. Later that same day, Mims’s breathing became labored and she was diagnosed with sustained pulmonary fatty emboli, which led to adult respiratory distress syndrome (ARDS). After five days in the Intensive Care Unit, the emboli resolved and Mims was released from the hospital with open fasciotomy wounds.
Back in Tallahassee, 22 days after leaving the hospital, Mims began developing fevers that doctors linked to infections growing around her fasciotomy sites. After oral antibiotics had no effect, irrigation and debridement were performed to help control the tunneled areas of infection discovered in her distal tibial region. She continued with these weekly procedures for the next four months, until the incision was closed on Jan. 31, 2003.
At that point, Mims and Rhonda Kelly, ATC, Assistant Athletic Trainer at Florida State, began rehab still with the goal of returning in time for the 2003 season. The protocols, which emphasized maintaining a sterile environment to protect Mims’s recently closed wounds, included gait training, low-chain flexibility programs, ankle and foot strengthening with an ankle isolator, a tibial hammer machine, and calf machines, and proprioception work with a BAPS board, foam squares and rollers, and a trampoline. “We wanted to challenge her perception of balance,” says Kelly, who worked one-on-one with Mims for two hours a day after her incisions were closed.
After a few weeks, Mims regained some strength and ROM and was cleared to participate in the team’s spring workouts on a limited basis. But all was not right. Mims had painful tingling at the bottom of her left foot that did not respond to treatment. In addition, the big toe on her left foot contracted whenever her foot dorsiflexed.
“As time progressed, her big toe began clawing up and the pain was increasing,” says Kelly. “It got to where she wasn’t able to continue a normal rehab protocol. Imagine simply walking around with your toe constantly in the curled position. Add the demands of soccer into the equation and you’re talking about a lot of pain.”
Kelly’s concern about Mims’s symptoms was justified by Borom, who diagnosed her with several ailments. First, he found nerve entrapment that was a side effect of Mims’s earlier compartment syndrome. This had produced dysesthesia, or a painful pins-and-needles sensation at the bottom of Mims’s foot. Because dysesthesia is not treatable beyond pain management, Mims will likely be on medication for the condition for the rest of her life.
Borom also honed in on Mims’s big toe. “When her left foot dorsiflexed, it caused a severe contracture of her big toe, which would rub uncomfortably against the top of her shoe,” says Borom. “After discussing the options, we elected to fuse the big toe into a straightened position, and also release the tendons of all five toes to prevent clawing and contracture.”
Around the same time as this procedure, Mims also had the locking rod screws from her tibial rod removed to relieve some soft tissue irritation they were causing. Mims was again on crutches and in a walking boot for five weeks, performing mild ankle and toe ROM exercises. Once out of the boot she began aquatic therapy with Kelly to work on flexibility and strengthening. But just as Mims was noticing improvement in her rehab, further testing revealed chronic osteomyelitis, a latent deep infection around the screw removal sites. Borom surmised that the condition had carried over from her initial injury and was awakened by the screw removal. The diagnosis meant more surgeries to clear the infection and an end to her goal of coming back for the 2003 season.
That fall, Mims experienced a torrent of conflicting emotions. “When I was alone, especially at night, I would cry myself to sleep and ask, ‘Is it really worth going through all this pain just to play soccer?'” she says. “There were plenty of times when I couldn’t see the light at the end of the tunnel. It seemed like I was taking one step forward and two steps back every day.”
Mims says the support she received from her teammates, coaches, as well as Kelly, Borom and other sports medicine personnel at Total Orthopedic Care, helped keep her motivated through those dark times. “My teammates and coaches were very good at reminding me that, ‘Hey, we haven’t forgot about you and we can’t wait for you to be back out there with us,'” says Mims. “It helped to hear that stuff all the time. It got me back on track and focused on what I was fighting for.
“The hardest part was watching practices and games and knowing I couldn’t contribute,” says Mims. “Yet it was also the best part of my day, because that’s what I love to do and be around.”
During that time Mims also heard plenty of voices urging her to look at the big picture. Returning to play was an option, but some doctors warned that playing could lead to long-term problems. “They told Ali, ‘We can’t guarantee that what you’re doing now won’t affect you 10 or 20 years from now,'” says Kelly. “But Ali had a passion, and I don’t think anyone could have swayed her drive to continue competing in athletics.”
After one last surgery—her 21st in all—to remove an antibiotic rod and clean up some of the hardware around her big toe in November 2003, Mims once again began rehab. “That spring she had a lot of work to do because she hadn’t quite recovered from having her toe tendons released and the hardware removed,” says Kelly. “We started with the same basic protocols as before. At first we did a lot of underwater treadmill work so that we weren’t loading the area unnecessarily, which would have made her compensate for the injury.”
As Mims grew stronger, she began land-based exercises, and Kelly introduced other strengthening work such as towel gathers, wobble board and Thera-Band exercises, ladder drills, and tibial hammer and proprioceptive training drills. During those months she also began concentrating on goalkeeper-specific drills. “There wasn’t a day when she didn’t give 100 percent in rehab,” says Kelly. “She never complained, never whined. She said, ‘Just tell me what I need to do to get back on the field.'”
After this final period of rehab, Mims finally rejoined her teammates for the 2004 season. She served as a backup, appearing in three games, starting one, and didn’t allow a goal. Mims was still not at the top of her game, but was beginning to taste some of the fruits of her labor.
That spring, Mims received a bachelor’s degree in business and enrolled in FSU’s MBA program. When the 2005 season opened, she was granted two medical redshirt years and was named the starting goalkeeper. She was charged with anchoring the backline for one of the ACC’s most inexperienced teams. Picked in the preseason to finish sixth in the league and unranked in national polls, FSU relied on a stingy defense and plenty of hustle as the team powered its way to the Champions Cup Final Four.
Mims plays with pain and limitation, however. She controls her foot and leg pain by taking medication three times a day, but it is always present. She continues to suffer from dysesthesia, which she compares to walking on seashells.
“There are times when my leg really hurts, especially after a hard week of practice,” says Mims. “But usually, I’m pretty good about blocking out the pain because it’s always there and I’ve gotten used to it.”
And there’s no doubt the accumulation of surgeries has robbed much of her athleticism, specifically quickness and leaping ability. “I’m about 90 percent of what I was pre-injury and I probably won’t ever be better than that, so I have to make do with the abilities I have,” Mims says. “Come game time, most of goalkeeping is mental anyway. It also helps that because of the position I play, a lot of the speed I’m missing isn’t that important. If I were a field player, I never would have been able to return.”
Mims has also gotten used to understanding her limitations, and forces her ego to take a back seat come game time. “When my leg is hurting, someone else will step in and take a couple goal kicks for me,” she says. “I’ve learned when not to push it.”
And when the team’s quarterfinal game against the University of North Carolina at the 2005 NCAA tournament ended in a 1-1 tie, Mims knew she would be giving up the spotlight during the shootout. Reserve goalkeeper Minna Pyykko took Mims’s place, making a dramatic save to lead FSU to a 5-4 edge in penalty kicks.
“It was something decided before the game started,” says Mims. “If we went to a shootout, Minna would go in. I had done my job, so I got to sit back and watch her do hers. It was great.”
Looking ahead, Mims is excited about the 2006 season and competing for a national championship. But a day doesn’t go by when she isn’t reminded of the past, and the help and support she received from her physicians (including Doug Henderson, MD, an orthopedist at the Tallahassee Orthopedic Clinic who helped handle Mims’s case) as well as her athletic trainer. “Rhonda has been by my side every step of the way,” says Mims, noting that Kelly accompanied her on every doctor’s visit—50 trips to Borom’s office in 2003 alone. “She put so much time into me—not only in rehab, but into designing the program and thinking about what would be best for me.
“Rhonda did everything possible to get it right,” Mims continues. “She wants all of her patients to return stronger than they were before. She doesn’t just treat the injury, she treats the person.”
For Kelly, that approach starts with getting to know her patient. “You have to look at the big picture of an individual, not just the cards they’ve been dealt,” says Kelly. “When you ask about all the facets of their life and show a genuine interest, it builds trust between you and the athlete. You have to work hard to gain it and it’s essential that you don’t lose it, especially when dealing with such a sensitive and drawn out injury like Ali’s.”
Mims also credits Borom’s thorough approach as a big reason for her comeback. “He really cared about me—not just getting me back on the field, but also what was best for my life after soccer,” says Mims. “He answered all my questions and left no stone unturned. I feel blessed that this experience has left me with really great friendships with both Rhonda and Dr. Borom.”
In 2005, Borom attended one of Mims’s first starts, which he says was like watching one of his own kids play. Since then, he has attended at least six more games. “I’ve seen people with much lesser injuries just totally give up—and I’ve seen people with similar injuries go on complete disability and never work for the rest of their lives,” says Borom. “And Ali’s out there playing soccer—and playing well.”
“It was a tough road, but it’s made me the player and person I am today,” says Mims. “A lot of people know me as ‘the soccer player who broke her leg’ and I’m not really bothered by it.
“Most of those people—and none of my current teammates—were even here when the injury happened,” she continues. “They just hear the stories. I really hope those stories can inspire other people going through an injury and encourage them to not give up.”
PROFILE: Ali Mims
- Injury: Closed left tibia fracture
- Rehab Hurdle: Overcoming 21 surgeries and multiple setbacks
- Quote from ATC: “There wasn’t a day when she didn’t give 100 percent in rehab. She never complained, never whined. She said, ‘Just tell me what I need to do to get back on the field.'”
- Result: Returned to become the starting goalkeeper for Florida State and led her team to the 2005 NCAA Champions Cup Final Four.