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12 weeks after Syndesmotic unstable ankle fracture (fibula break below knee)

by Beth
(Merritt BC Canada)

I went 1-week after injury waiting for surgery, then had to travel to a larger city to have my surgery. I had broken my fibula and a complete syndesmotic tear. Oct 4th had surgery to right ankle with 1-syndesmotic screw placed just above outer ankle. I was 2-weeks in a splint. Had fiber-glass cast put on for 4-weeks. Then was sized for a Air-boot cast and have had this for 6-weeks, with instructions to only partially weight bear, but NOT to walk. I am limited to small amount of time I can even partially weight bear on foot, without increasing pain level to extreme. I live in a small BC town and have had no advice or therapy from a physio therapist.


On Dec 22, 2011 - I again travel to larger city to have ortho specialist now remove the 1-syndesmotic screw. Ankle & foot is still extremely painful and foot & ankle swells and turns purple.

My Question:

Why is my pain still so bad? After the injury, my heel felt crushed and still after 12 weeks, my heel still feels crushed.

I will be speaking to the orthopedist again about this on Dec 22. But on my last visit he almost looked baffled and he said - I shouldn't have high levels of pain at this point.

But I do have extreme discomfort & pain even when I sit on the bed with my feet on the bed. The back of my heel feels crushed and I have to continually re-position it as the pressure of even having it on the bed is almost too much to handle.

Could my heel feeling like is 'fresh' crushed, be nerve damage from this injury?

I am asking you my question , to hear what your opinion might be.

Thank you

Beth

RESPONSE

Hi Beth,

I would agree that there is probably cause for concern. In general as people get better, the amount of pain they are experiencing also begins to subside. I would not expect you to be pain free at this point, but since you have been non-weightbearing, I would expect that you would be experiencing far less pain.
The fact that the heel hurts concerns me in that the first thing I would think of is a calcaneal fracture (heel bone fracture). You do not describe the type of accident you had, but if the majority of your pain is coming from the heel then the heel itself needs to be examined. It may require more than just an x-ray. An MRI would probably be more appropriate as it would pick up a possible fracture that an x-ray might miss.
My other concern is the possibility of RSD or Reflex Sympathetic Dystrophy which is a neurological condition that occurs when a limb is immobilized with the possibility the immobilization is too tight. This is a condition that is best diagnosed by a neurologist or an anesthesiologist with a specialty in pain management.
This condition has to be ruled out because it can have chronic long term implications. Mention this to your surgeon as well, so it can be ruled out.
Do not be afraid to express your concerns to your surgeon as he or she is the best one to help you. If your surgeon cannot understand why you are still having so much pain then it is up to the surgeon to investigate further.

Marc Mitnick DPM
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Dec 21, 2011
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response / thank you - 12 weeks after Syndesmotic unstable ankle fracture
by: Beth

Thanks Marc for your response.

My injury occured walking down a set of three stairs. I took my first step down onto the first stair with my left foot and my LEFT ankle rolled over (old repeating injury) and I lunged to the right to get off of left foot attempting to step onto RIGHT foot. My right foot/heel bounced off the second stair, over the third stair to the bottom - I then landed onto the cement and on impact the right ankle rolled (turned in) and the knee snapped to the left. (with a distinct snapping) On impact I was ejected to the left and ended up on ground, not being able to get up. Leg and ankle/foot felt like it was floping. I could not stand or be helped to stand up. (pain level was 10/10). BC Ambulance was called and transported me to our medical centre.

Ankle was xrayed and I spent the night in medical centre/ was released the next morning with only a 1-tensor bandage being applied. Right Leg/ "foot & ankle" felt like it was twisted around and pointing at the floor. I purchased a Air Brace to stablize the foot. I was bed ridden. One week later my gp-doc called and told to attend Kamloops hospital for emergency surgery to 'fix the ankle'.

I read the RSD link, you provided:

12-week later:

Feels like a vice-grip is hooked onto each side (back of foot) latching onto my ankle (just below /behind ankle) and is being clamped and twisted.

Hence: Heel feels crushed. Foot/ankle still gives the feeling it is twisted and pointing in abnormal sideways or downwards direction/position. I have to actully look at foot to assure myself and see it is not in that position.

Ligament in bottom of foot from sides of ankle/heel up to toes burns, spasams and feels like it twisting my foot/toes.

Pain is severe, constant or burning. This pain was immediate after injury. Pain has reduced from 10/10 to approximately 7/10 but after 12-weeks the pain level concerns me.

The skin on the foot and ankle has been tight and shiny and dry. To the point of side of ankle skin breaking to deep levels of skin breakage & peeling. It appeared as shattered glass, (on both inner and outer side of foot) We keep apping coconut oil to aide the skin and to help or prevent the spliting/cracking of the foot/ankle skin & heel callous.

Complications for current injury:
1994 I had a patellectomy of the right knee - and this recent injury has weakened the right knee. (crucial ligament feels to be slipping)

I have up to 3 inches of muscle wasting in the calf and down to the ankle/foot. Muscle wasting of right ankle of 3/4 inch smaller than left ankle.

On the RSD page - The photo of the feet redness / looks similar to mine. Except mine is a definet dark purple.

I will address these issues with the Orthopaedic-Specialist when I see him on Dec 22.

Thank you for your response and your time.

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