Fractured Ankle Physio

[pudding_bowl]

Definately a good idea to get it checked that it healed properly... the reality may be that yes it's absolutely fine and you should be walking on it. It happens sometimes that the pain is horrendous but the therapy needs to be hard to get it better - in that situation pain killers are very helpful. But best to get an xray to confirm if there hasn't been one done.

Good luck

[Hopalong80]

13 weeks on.....
A liittle update, I had my hospital appointment yesterday, another x-ray etc.. should have been quite straight forward considering my last visit was ok.
I am a smoker I have been told it doesnt help with bone healing rather aggressively by the consultant before. This same consultant I had the pleasure of seeing yesterday and here goes:
He couldn't believe he was loooking at the xray of a 29 year old and thought it was someone older as it looks as though I have osteoporosis (this wasn't the case when I saw him 10 weeks ago?) I have also been told that my ankle could crumble underneath me and end up with a useless ankle. I told him that i have CRPS to which he might aswell had laughed in my face to reply with WHO told you that, so I said my physio and he went on well with that aside you have very little change in the xray from 6 weeks ago. He is blaming all this on the fact that I smoke and I am not saying that I know it doesn't help but you would think that alarm bells would be ringing to the fact that my bones have changed that much on 10 weeks.
I have been told to wear the boot and try and have some time out of it walking (even though I have been told it could crumble) when asked how I know if I'm doing damage "You'll know" and that was that!
I really thought I was making progress with the CRPS the pain is slightly better and I have more ROM thanks to a great physio and now I am scared to walk on it.
Has anyone any idea why my foot is showing signs of osteoporosis in such a short space of time? I'm so worried I'm going to lose the use of my ankle or re-fracture it.

Many Thanks again Liz

[gcoe]

Hi Liz
This sounds a very alarming interview. If I was in your situation I would find this all quite distressing and confusing. I think you need some reassurance about your condition – whether you have osteoporosis and how severe it is.

My comments are:

Plain xrays are not accurate for measuring osteoporosis. The gold standard for diagnosing osteoporosis is a bone densitometry test or DEXA scan. Not only does the scan diagnose osteoporosis but also quantifies the severity. DEXA scans sample vulnerable bones in the body so you probably should also include the lower legs in the scan as these aren’t usually sampled.

CRPS does result in local (not generalised) bone thinning, whether that is what you have or don’t have. From what you described earlier I would maintain that you are quite likely to have CRPS and that your physio is right. Bone thinning on xray may well be evidence for that. It could also be a combination of background abnormally thin bones for your age group and the reaction to the injury.

Disuse increases the bone thinning effect whereas more use stimulates the bone-building. I don’t know what the bones are really like so I would be loathe to contradict the your surgeons advice about the risk of bone collapse from walking but I would imagine that walking on it at this stage is a good thing and avoiding walking only makes matters worse. However if there is such a risk, the bone can be stimulated to build by applying an appropriate amount of force that will stimulate the bone but not put you at risk of bone collapse. Partial weight bearing may be an option (ie using a stick or crutches) However this needs to be properly assessed and you need to be advised about getting the maximum bone building benefit with the least amount of risk.

If you have osteoporosis at your age then I think you should have it looked at in more detail. You probably don’t know the state of your other bones and this is important in case you have a systemic cause of osteoporosis. This is very important for your future health as osteoporosis is a progressive problem that continues to increase as you get older. Osteoporosis is primarily a metabolic disease so you could get an opinion from an endocrinologist – preferably with an interest in osteoporosis. If the bone thinning is limited to the injured leg then that is again suggestive of CRPS.

Smoking is a risk factor for osteoporosis but is only one factor. My understanding is that the effects of smoking reduces oestrogen production and over a lifetime this results in lower bone density. Smoking can also bring on earlier menopause that can really increase osteoporosis. So my understanding is that the effect of smoking on osteoporosis would show much later in your life rather than now. Obviously that is not a reason for giving up smoking now – and given your situation you would be well advised to, but I think it is unlikely to be a single cause of osteoporosis at your age.

Liz I think it would be worthwhile getting this checked as you are quite young and your bones need to last you a long time. There are useful treatments available and lifestyle changes you can make to get more healthy bones, if that is the problem.

[Hopalong80]

Thanks for your reply Gcoe!!

I have decided to go private and pay to see an Orthopaedic Surgeon in a weeks time. I'm hoping they will give me a bit more time and look into things more thoroughly.

I am extremely worried about the prospect of osteoporosis at 29 yrs old and hope they will check all the possible reasons, including checking if it is just in my injured ankle.

I see my physio tuesday and hope she will be able to help with safe exercises for the time being.

Thanks again for putting my mind at rest a little!

Liz