Ankle rehab...how am I doing?

[Courier]

Hello,

I'm a patient concerned about the length of time it is taking me to get walking again. Having searched the internet for similar stories, its obvious that every injury is different. However, I have recieved comments where it seems people don't think I'm trying. Although I'm seeing a physiotherapist weekly who is very positive and encouraging )

Sometimes I wonder whether I'm being too precious about it and would love to get a range of opinions on my progress...

Here are the details....

I was a passenger in a car crash on 13th September 09.
I braced for the impact and broke my fibula and two bones in my ankle.
I had surgery where a screw was placed in each of my broken ankle bones
A plate, fixed with six screws was attached to my fibula.

It was an open wound and so a removable cast was fitted as the hospital wanted to be able to check my wound after two weeks.

I couldn't exercise (or move very much at all) at this point anyway due to severe bruising from my seatbelt.

I didn't find out until 6 weeks that I was allowed to take it off myself to flex my foot and that this had been expected.

I was 'non-load bearing' for 10 weeks (from the accident) and then given a rubber 'shoe' for the cast so I could start weight bearing. I was encouraged to take the cast off to walk (well, weight-bear) 'for increasing periods indoors'.

I haven't seen my surgeon since November, and have also had to have an MRI scan on my knee (the same leg) which is still swollen, sore and has some numbness in the skin. The results are in and I'll find out on 3rd Feb.

After a couple of weeks (12 weeks after the accident) the swelling in my foot had receded enough for me to put a shoe on, so I ditched the cast, unprompted, as when we went out doing anything the cast was stopping movement which I felt would be beneficial.

It has now been 16 weeks since the accident.

I can hobble comfortably with a single crutch but still need two to negotiate steps and icy surfaces. I can 'shuffle' without crutches for short periods, when either my foot becomes painful, or I get strong soreness in the knee.

I am happy that most of the movement in my foot has returned.

I have not yet been officially instructed to come off the Tramadol and Diclofenic prescribed after my operation. My GP has been issuing me with repeat prescriptions on the same dosage I was on when I left the hospital (800mg of Tramadol, 150mg of Diclofenic daily)...I have reduced the dosage myself and havent taken any for the last 3 days.

At this stage, I'm assuming that I am fully healed and its just a case of waking my muscles up, so to speak.

Its approaching four months now. Am I doing ok?

Thank you x x x

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[physiodan]

Hi Courier,

I had a much milder injury compared to yours and it took me about 3 months to ditch the crutches and another 3 before my walking returned to "normal". My ankle was incredibly swollen also and this was my major issue (along with pain on weight bearing). Typical healing times of lower limbs are 12-24 weeks, and going by you injury, my guess would be you would be in the latter timeframe.

In terms of medication it does seem like you were on quite a high dose, and strange the surgeon didn't do a clinic review, but perhaps things are different from how things are done in NZ. From a physio perspective you need to have enough medication to enable you to perform the exercises prescribed by the physio - as this is vital that you get your range and strength back. For me I tried accupuncture, and further down the track went to a massage therapist for about a year before the swelling / scar tissue in my ankle went down. Everybody is different of course and as long as you are managing the exercises prescribed by your physio you should be on track to return to function - but it is a long process unfortunately.

All the best with your MRI scan and don't forget to discuss any concerns you have with your physio.

[physiobob]

Sounds to me like you're actually doing really well. An open compound fracture with plates and screws in the bones of the foot/ankle as well. It's the later (not the fibula) that would be more of a concern, especially that they heal effectively. Don't overdo it at this stage as you want to see on the MRI that there's good healing and blood flow to those fractured in the foot.

You seem positive and yes it is a matter of just getting on with in initially. I wouldn't think activities like running would be on the cards yet. Your physio will be able to provide a structured reloading program once the surgeon has given the all clear. You will need to do a bit more dynamic rehab if you do want to get back to sports involving running and it is worth it.

Often injuries to the knee are overlooked after an acute trauma to the ankle. All focus would have been on the ankle and as that was non-weightbearing you might not have noticed the knee issue until you began full weight-bearing. You might have some articular damage there as well so again be careful not to aggravate the knee at this stage until you get those results.

Best of luck

[Courier]

Thank you both, I just get worried that after such a long time not load bearing, and keeping my foot off the floor, I might be too hesitant in pushing it.

I saw my physiotherapist the other day for the first time in three weeks and he was very happy. Once my ankle warms up through the day, I can walk reasonably well for about 10 metres before it gets painful...the pain is actually in my shin, which it odd. But thats the improvement from the last time I wrote on here, so I have to feel happy with that.

I am taking paracetamol and Ibuprofen as and when I need them. I think its my GP, not my surgeon, who is responsible for my pain relief, but I've had to change doctors in the mean time aswell so I'm out on a limb with it at the moment. I think both of these are safe to take indefinately and they give me enough relief to do my exercises

Thank you for the time frame, physiodan. I think sometimes people shy away from even giving a ball-park estimate for healing time, just in case they get held to it when theres a variation, but its useful for me to know that.

As for the knee, you are spot on physiobob. When I was first in hospital I had bruises all over the place and obviously wasn't walking on the leg. I noticed the numbness in my skin weeks after, as the other bruises were receding, so it will be good to get a diagnosis.

Its rare that the knee is painful, but it often feels uncomfortable and doesn't have a smooth motion. Last night I knocked it and there was a ripping sound, although the pain went off quickly.

My surgeon mentioned the possibility of an arthroscopy. I'd be tempted not to poke about to be honest but if its not healing on its own after 4 months then maybe it will need a helping hand.

Thank you once again. My physiotherapist is brilliant, its just I forget somethings beause, like knocking my knee last night...I'd normally forget about that by the time I see him.

Regards x x