Fractured ankle and now arthritis?

by Midhael
(Arizona)

Badly fractured my ankle after slipping on ice when exiting my car....61 years old.......inside of ankle....operation......months of physical therapy....everything seemed fine....was walking 2-3 miles a day on my treadmill and taking daily walks in our local park and out into the desert....other than a bit of stiffness I thought I was home free....then one morning I got out of bed to use the bathroom and fell flat on my face.....felt like someone had jumped up and down on my arch.....pain and swelling increased to the point that I thought my skin would explode so went and had an X-ray....two different doctors looked at X-rays...one was the operating surgeon on initial fracture...both said no new breaks or fractures but looked like I had a bit of arthritis....talus bone.....I stayed off foot for months and took daily doses of ibuprofen to reduce the swelling.....now after 10 months I can walk around the house without the use of a cane with minimal pain but quite a bit of stiffness but going for a walk in the park...on sidewalks or grass results in quite a bit of pain after a few hundred yards....still a bit of swelling in the ankle and weakness at times......is this due to arthritis or should I be concerned about something else going on.........thanks for your thoughts.....

RESPONSE

Hi,

After reading your narrative, the first thing that came to mind was that the pain in your foot is probably directly related to your fractured ankle surgery.

First of all, the talus bone makes up the "floor" of your ankle joint. In addition, the talus bone and the bone underneath it, the calcaneus (heel bone) come together to form the subtalar joint which is a very important joint in the foot that essentially absorbs shock at you walk.

The talus bone also articulates with the bone in front of it, the navicular bone to form the talo-navicular joint.

So, if you have developed arthritis in the talus bone, it is either in the subtalar joint or the talo-navicular joint.

If you woke up with excruciating pain, I would suspect it was the subtalar joint that was the culprit as it is a more complex joint than the talo-navicular joint.

So, how is this related to your ankle surgery? You state you had a very severe ankle fracture and as you can imagine, the more complex the ankle fracture, the more difficult it is to put everything back together. Your surgeons first concern is to repair the broken bones and his second objective is to get the ankle joint to line up properly so that you can walk as normal as possible.

My best guess here is that there may be a mild deviation of the ankle joint as a result of the ankle surgery. This is not to lay blame on your surgeon as sometimes it is impossible to get perfect alignment when dealing with a severely broken ankle. As I previously stated, his first goal is to get all the bones back together.

So what I think may have happened is that initially you were fine after surgery and able to resume all your walking, but all that time, due to a slight mal-alignment, you may have been irritating the subtalar joint until one day it just started to really hurt.

The analogy would be driving a car with unbalanced tires. What happens? The tires wear out prematurely.

This would be my first guess, however, you cannot rule out the possibility of some soft tissue damage as well, particularly the ligaments that attach to the talus, calcaneus and navicular bones.

You might ask your doctor to perform an MRI to get a better overall picture of your foot as an x-ray has limited benefit in that it cannot show pathology in the soft tissues.

At the end of the day, you may need to consider an orthotics, to better balance and align your foot so that the joints in the foot are not over stressed.

Lastly, you cannot live on ibuprofen as that drug as well as all anti-inflammatories can have an adverse effect on your health when taken long term.

Marc Mitnick DPM
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