Fractured Ankle-Rehabilitation

[injured]

Hi,
I fractured my right ankle on July 14th and was just wondering what rehabilitation i need to be doing on it as it still has pain when i point my toes.

Here is what the scans showed:

"There is fairly maked soft tissue swelling over the lateral malleous. There is an incomplete undisplaced traverse fracture through the distal fibula. The ankle mortis is in normal alignment."

I never got it put in a cast and never saw a physiotherapist, but did go back and have another scan on the 27th August and here is what was said:

"The previously demonstrated lucency through the lateral malleous is not seen on todays examination and there is a significant reduction in the degree of soft tissue swelling. The appearances suggest sound fracture union. The ankle mortise remains in satisfactorily alignment."

The main thing i was wondering is what i need to do to help rehabilitate the ankle as it is still sore and i cannot point my toes straight without pain, this is evident when trying to kick a pillow like a football and that hurts pretty bad.

Any suggestions would be much appreciated

Josh

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[msk101]

Hi Josh,

The Xray report most recently suggests that the break has healed in your ankle. The main part of your ankle joint wasn't affected by the break itself but because of all the inflammation and swelling that went along with the little break, the movement can remain restricted. A physio will definitely be able to assess what in particular is restricting your range of movement at this stage and suggest ways to help it. Where exactly do you feel the pain when you point your toes?? are you limping at all?? what shoes do you usually wear?? how long are you on your feet each day?? still swollen at all??

As a general rule, it takes about 6-8 weeks for a simple fracture to heal - which means the time for the bones to bond together again. but the break will still be getting stronger over the next few months. It's normal to have ongoing swelling (especially if you have a big day on your feet), and soreness for a few more months.

Although you didn't get a cast on your foot, you still probably limped around for a while and didn't walk normally or use your ankle "normally" for a long while... this means that during this time everything else around your ankle (muscles and ligaments, and joints) can get weaker or stiffer. Most often the calf muscles (and achilles tendon) can get tight, and so can the muscle that acts to lift your foot up (tibialis anterior) - stretches for these are often useful.

There is a big ligament complex (ATFL - anterior talo fibular ligament) which attaches to the tip of the fibula (the bone you broke) and that can also be damaged when you break that bone. it's a biggie in terms of ankle stability, flexibility and support. you might benefit from some physio soft tissue work on this. I would also suggest you'd benefit from some specific joint mobilisiations at the ankle joint and through the rest of your foot to make sure everything "unsticks". You're also going to need to work on your balance (proprioception).

At this point you're at the point where I would suggest any exercises you do are allowed to be uncomfortable but not outright painful - again this is hard to be more specific because everyone's pain tolerance is different.

So in general.... stretch calf and front of ankle, work on balance, get some physio to mobilise the joints and assess the ligaments for stability, and make sure you're wearing supportive good footwear. I wouldn't anticipate any long term problems or issues for you.

Cheers
msk101

[injured]

Cheers mate, it probably didnt help that i played footy 2 weeks after doing it lol (so stupid) but it is alot better than then. The most annoying thing is that i cant really go to the gym to continue my fitness training for the pre season, but i guess the more rest the better.

Oh and the part where it was hurting when i stretched my toes out is the top of my foot where it joins with the leg (not sure of the name of it), but that has been getting better aswell

Thanks for all your help mate

[alophysio]

i agree with msk101 above.

The restriction you feel in the foot can also be the scarring that comes with a fracture. Things like swelling affect the tensons and joints. Because you have a clean break, it would have bled and so there is almost certainly going to be scarring around there.

A few sessions with a good physio will help.

[wolseley]

Hello all from Canada!

I found this thread while googing 'lateral malleous' as I am trying to find some information prior to a ortho visit this afternoon. I was hoping to have a better understanding of my 'condition' prior to the visit and first wanted to say - thank you to all -for providing a starting point to my research.

Here is my situation. 6 six years ago I fractured my ankle -what I was told was the lateral malleous - after a horrific fall down some stairs. I was holding my three month old son at the time and had just picked him up from his caregiver. Her steps were under repair and they were covered in slick ice. I wasn't paying close enough attention and ended up stepping too close to the repair site. Given the icy conditions, I wasn't able to gain a proper gripping and suddenly found myself falling from the fourth step up. Since I had my little guy in my arms, my only thought was to protect him from damage, so I turned somewhat and took the full brunt of the impact on my side. My ankle, in particular, bore the full force of the trauma.

I was instantly wracked with severe shooting pain up my leg and down my foot but assumed I had merely twisted it and carried on. By the next morning, however, the pain was so severe, my husband insisted taking me up to the emergency room. It was there they diagnosed a fracture of the lateral malleous and I was fitted with a plaster cast.

We were in Northern Alberta at the time - six hours north of Edmonton (if you can even envision life that far north!) and it was mid February. My husband was deployed only days after the cast was fitted, and with four small children, no hubby and trying to get around to work, home, etc with a plaster cast on, I committed one of the stupidest mistakes of my life. I removed the cast after only 10 days!

Things appeared to be ok but about a month after that removal, I began to have shooting pains up my leg and foot again. It became so bad, I was unable to sleep at night. I returned to the emergency, sat through a lengthy lecture, and was given yet another cast. This time, I lasted the four weeks and upon its removal, hoped to have my old ankle back.

Less than a year later, I tripped over some lego on the stairs and took a tumble. Once again, severe pain and once again, a trip to the emergency. This time I was told it was only a strain/sprain and sent home in a tensor bandage. A few days later, I recieved a phone call from the hospital who informed me that a review by the radiologist showed that there was a small fracture again - same place. I was put into a half-cast at this point and told to be careful. This incident would soon be the template for 6 years worth of trouble and leads me to the visit this afternoon.

Since that initial accident, I have 're-fractured' my ankle exactly twelve times; the latest incident being last week. I have taken a few falls after my ankle has just completely given out on me - the strangest thing to just have just ankle collapse on you; I have re-fractured an embarrassing THREE times on the golf course (it has become the club joke to see me during a tournament without a cast, and then see me at the dinner that night with a cast on after a quick trip to the emergency room). I have fractured it while in Egypt after climbing down a tomb and losing my foothold, I have fractured it while on a hike in the mountains and I have fractured it while at the beach (having it caught in some rocks in the water and then falling over on it) This latest break was the result of a tumble after tripping over our lazy Black Lab.

One of the biggest probems I have had to date was trying to have a proper diagnosis of the break at the time of the accident. On several occassions I was told that it was merely sprained and the emergency room dr(very busy chaps/chapettes, all of them ) have missed the -what I have been lead to understand are - very difficult to see crack. Often I will find that I will 'tweak' my ankle and after a few days 'rest', feel all better, only to 'tweak' it again in a few months time. Besides the twelve 'official' incidents, I am quite sure I have damaged it on numerous other occassions, only to have it 'fixed' after a good night's rest.

A year ago, I was given the recommendation to have surgery. I did not follow up the advice out of my fear of being off-my-feet for up to six weeks. A hysterctomy a few years ago was nothing short of a disaster, having my husband trying to fend for the kids alongside his crazy work schedule. He insists that I just go and do it, but I am very worried about how the family would survive. Adding to my distress is the simple fact that as a military spouse, I have had a dozen different docs look at my ankle and provide a medical plan, only to find myself relocating to a new home shortly afterwards. I have also had doc's who felt that there was nothing really wrong with me at all and I have some trouble convincing them that I have had so many problems.

I guess after all that, my question is - what should I be doing? Will surgery get me 'back on my feet' (no pun intended, of course) Will it really be 6 weeks of recovery? What should I be telling the ER docs who refuse to believe it is actually a fracture they are seeing, and not a bad strain? What if this ortho this afternoon fails to believe the seriousness of the limitations this issue is causing in my life? What is the better route - deal with each incident or just go in for surgery?

Will this ever heal on its own? Do I have any hope or is arthritis just the next thing I have to look forward to? Any one willing to help answer any of these questions?

Desperate in Trenton - Sheila J