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post ankle surgery

by Nancy
(Wisconsin)

I had surgery on Aug 30th for a broken distal fibuala. I am now suppose to be weight bearing as tolerated. I am in a ASO brace now with my regular shoe. What I have been noticing lately is that every once in a while, I will feel shifting or pulling in the incision area. Today, I noticed a bump above and slightly over from top of my incision area. Is that just scar tissue? Should I feel shifting or pulling in that area?


Thanks,

Nancy

RESPONSE
Hi Nancy,

I do not know how big a lump you noticed but if it near the incision the first thing you have to consider is what is known as an inclusion cyst which is a cyst that forms usually from an inflammatory reaction to the deep sutures that were put in during surgery.
An inclusion cyst is my second choice. My first thought as to the bulge you are noticing is the movement of one of the screws which was placed in the broken ankle.
I assume you had hardware inserted in the lateral ankle as it is rare that someone has ankle surgery and no hardware is implanted to secure the fracture site.
Movement, particularly the more you start moving around may have the propensity to loosen up some of the screws. What happens is as the screw slowly begins to back out, it starts to protrude into the skin. In general, if you press on the lump, it should be very hard.
This of course is an issue you should take up with your surgeon, (keep in mind, I could be totally wrong, since I do not have the luxury of actually examining you) but in any event your doctor will be able to tell if that is the case.
What happens next depends on how bad the lump is. In some cases if the screw backs out far enough it could push hard enough into the skin to cause a breakdown in the skin.
The possibility of this happening has to be evaluated by your surgeon. If that is a possibility you may require a small surgical procedure to re-implant the hardware.
Since you only recently had the surgery, the possibility of removing the hardware permanently is remote as one can assume the fracture site is not stable enough to warrant the removal of the hardware.
There are no specific guidelines but many times people who have had hardware in their ankle for years can safely have it removed as the fracture site is so old, it can be assumed to be stable enough to no longer require stabilization with hardware.
Speak to your surgeon.

Marc Mitnick DPM
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