Advice on recovery from ankle fracture

[PETDOC]

So 55 days after my left ankle fracture/repair and 15 days after being permitted to start bearing weight on my foot, recovery seems to be going well. I have been dutifully doing a series of exercises twice daily that appear to have as primary functions re-establishing a good range of motion and proprioception. I am now able to walk on a level surface, and if done slowly and deliberately, appear normal over shorter distances. With uneven surfaces or on longer walks I limp. My ankle feels stiff and the greatest discomfort comes from my distal fibula (has plate with 6 screws and a lag screw); however, when going down stairs I experience a minor sharp pain where the medial malleolus was reattached with a screw.
Learning to ascend and descend stairs correctly has been a real chore. I use the movement in my right foot as a template to mimic with my left foot. Recreating the correct motion going up the stairs has been far,far easier than for going down. I am convinced that moving up and down stairs will require strengthening exercises vs. the range of motion/propriception exercises I'm presently doing.
Swelling is still ever present, but slowly decreasing. The compression sock on my left foot reduces the swelling immensely. I remove it before going to bed. The following morning my ankle, although modestly swollen, looks almost normal, but after the AM exercises it swells quite a bit.
I asked the physical therapist for someone with my ankle fracture who is in good shape and motivated what the expected time interval would be before walking normally. He said if you define "normally" as a normal gait, but with a variable level of discomfort---- 6-8 weeks. Two weeks down, four to go; my dogs are counting the days!

[DC2wheels]

Petdoc,

I have been reading through most of this thread with interest.

Been close to your problem personally -my really bad ankle sprain several years ago- and helping co-treat others.
I'm a Chiropractor.

Good to see you mention proprioception exercises that the P.T. gave you. That is REALLY important for recovery.

I have had many patients tell me that their ankle is weak, months or years after a severe sprain. They were never told about proprioception. BIG difference even if they do proprio years after the injury.

(BTW, for anyone else who is interested, go here...... http://http://www.epodiatry.com/ankle-sprain.htm)

Best of luck and hang in there. We are all pulling for you.

John

[scooteraug02]

Petdoc,

Wouldn't the compression sock provide benefit while sleeping? Is it uncomfortable to sleep with it on? Also the compression socks are touted as performance socks to be used while running, biking etc. so, wouldn't they help during your exercises as well and prevent swelling? I am just wondering. Trying to understand how and if they work.

[PETDOC]

Originally Posted by scooteraug02

Petdoc,
Wouldn't the compression sock provide benefit while sleeping? Is it uncomfortable to sleep with it on? Also the compression socks are touted as performance socks to be used while running, biking etc. so, wouldn't they help during your exercises as well and prevent swelling? I am just wondering. Trying to understand how and if they work.

Scooteraug02,
I am unsure as to the answer to all of your questions. The compression sock reduces my ankle/foot size so it can comfortably fit into most of my shoes, but I'm always aware of its presence and it causes a mild discomfort. The discomfort is magnified when I go to bed because I no longer have the distraction of moving around. When in bed my foot is elevated and this alone reduces swelling, so I'd rather sleep without the sensation of the sock.
I assume the function of a compression sock is to augment lymph flow. Under normal circumstances you have cell-free fluid moving out of your capillaries (small end arteries) into your tissues. This becomes lymph fluid which diffuses into your lymphatics. The lymphatics are small vessels that have valves which prevent back-flow, but they require external pressure (physical compression by movement) to propel the fluid forward. The lymph eventually empties back into your circulation (blood) near your heart. If you are inactive or have tissue inflammation the lymph will accumulate in your tissue and cause swelling.
The compression sock may help to reduce swelling during my exercises, but the post exercise ice pack is far more effective on a bare foot.

Dave

[scooteraug02]

Dave,

Thanks that is a good explanation and it clears up what my massage lady says about massage.

They say the benefit for post exercise recovery is they help flush the lactic acid quicker. Owner's Manual: Do Compression Socks Work?

Rick

[dmitrizouev]

Hey bro, get 2 x 4 on a floor.Place you toes on it ,half way of the foot. Then lift you hills off the floor ,do it several times a day.You can start after you take the boot off,then ride the pedal bike. Pedal a lot, I got back on an ice ,and played hockey in 4 month after similar fracture,Good lack.

[PETDOC]

Originally Posted by dmitrizouev

Hey bro, get 2 x 4 on a floor.Place you toes on it ,half way of the foot. Then lift you hills off the floor ,do it several times a day.You can start after you take the boot off,then ride the pedal bike. Pedal a lot, I got back on an ice ,and played hockey in 4 month after similar fracture,Good lack.

I have started doing a similar exercise using a stair step. I place the balls of my feet on the edge of the step with heels hanging off and raise myself up on my toes, initially mostly with my right foot, then slowly lower my heels. I have progressively shifted more weight to my left foot. As the strength in my left foot has improved I've been able to use it more during the lifting motion and now almost entirely in the lowering motion. I stopped using my boot 13 days ago.
Yesterday, 58 days post fracture/repair, I took my 5 dogs on a 1 mile walk through the woods. I live in pretty hilly to steep terrain so I chose the route where the steepest parts were mostly downhill. It went well, but approximately half way I began to not fully roll my left foot and not push off the ball of my foot and toes. I focused on doing that for the rest of the walk, but it did cause more (dull) pain over my distal fibula.
A couple of quick questions regarding your recovery--
How long after the fracture did your ankle continue to swell?
Did you have the plate and screws removed? If you did how long after the surgery were they removed and what kind of aftercare was required (i.e., were you back in a boot)?

[Eyes Shut]

So, 4 weeks after my accident, I stopped the Vicodin and switched to Tylenol. I was only taking the Vicodin in the evenings the last 2 weeks anyway, but I could really tell the difference -- no more of that nice "relaxed" feeling in the evening that I got with the Vicodin. Fortunately, my pain level is not very bad and I only get twinges in the evenings and at night. No weight-bearing yet. I see the OS again in 2 weeks and will see what he says after more x-rays.

[steveyak]

just saw this thread, and while I have not had any ankle injuries riding(knock on wood) I have had a few skydiving. and accupuncture saved the day I wood recommend it to anyone. I feel it is the only thing that got me back on track pretty quikly. I also load up on the pineapple for it's bromelain the only natural anti inflamitory I know of and I hate to say it but stop drinking until recovered.

[PETDOC]

Originally Posted by steveyak

.......... and I hate to say it but stop drinking until recovered.

When I read alcohol consumption was bad for bone healing I also totally abstained for the first 4 weeks post fracture. I did a brief literature search on alcohol and fracture healing. The majority of the papers are in rodents where a large percent of their caloric intake (e.g, 30%) is replaced by alcohol. I asked the orthopedic surgeon about the connection of alcohol and poor bone healing. She said it was primarily in people who drank and failed to consume a normal diet; more caused by a nutritional deficiency vs an inhibitory effect by alcohol. After that I began having a glass of wine with dinner.

[DrK]

Originally Posted by Hootowl

As a start I would get your vitamin D-3 levels checked. Get a good, bioavailable multi mineral/magnesium supplement, and check your urine PH 3X/day.
If you're eating the SAD diet (standard american diet) you'll probably find you're on the acidic side of neutral (7). If so, you're loosing minerals from your bones to buffer that acidic PH which makes it hard for you to repair the fracture.

As a family doc on the mend for a slight fracture of the metatarsal from a lowside on extremely overinflated tires in a turn taken too fast, take VIT D, Calcium supplements. Read a lot of books to keep youself distracted!! Get some serious boots and don't skimp! As far as the Ph Level in the Urine? That's interesting...i'll look into it!

stay positive

[middleview]

Three days ago I had my first unplanned "moving violation" getoff, and my R1200GSA fell on my right leg/angle when the bike slid out from under me in a parking lot oil slick. I didn't break anything, but I scared the shit out of myself. I do have a bad sprain and damaged ligament/muscle below knee on calf. Your thread/story and posts here have been instructional and inspiring in the ingenuity and patience displayed by yourself and other posters.

Everyone certainly puts my plight in proper perspective - On my 3rd day I'm hobbling around in pretty good fashion. As an expat in Belgium I will get x-rays on Monday on the "scheduled" basis and ensure I really didn't break anything, but I feel it's a good bet. One poster noted the rotation from contact with ground and I wonder if I also encountered this, but it was alleviated because the concrete was incredibly smooth. Otherwise, I think I aggravated the injury by twisting out from under the bike abruptly and then afterward standing up and trying to pick it up (stupid!!!! - I was eventually helped after 3 shot at what I've previously done simply). Adrenalin wore off a couple hours, and I'm recovering from the added aggravation!

PETDOC, and everyone else, hang in there and thanks for sharing your experiences.

[PETDOC]

I saw the orthopedic surgeon 2 days ago, 10 weeks after my bimalleolar ankle fracture/repair. This included 40 days on 1 leg and crutches; 4 weeks with a splint (10 days) then cast and 2 weeks with a boot. Things are going great! Two days prior to the appointment I walked the dog pack 2 miles. No limp, but the distal fibula was sore near the end. During daily exercises, when maximally flexing my ankle the point of reattachment of the medial mallelolus will sometimes produce a sharp pain. I can do stairs normally to the eye, but especially going down there is a lack of adequate flexion.
My left ankle when measured around the malleoli is 2 centimeters larger in circumference than the right ankle. It looks like a small tree trunk. The orthopedic surgeon said it will be a year before the swelling is gone and she suspects the swelling is the biggest impediment to me regaining normal range of motion.
I asked about hardware removal. She said to wait for a minimum of 6 months. Based on research I discovered that with a plate removal the risk of re-fracture is 2% and virtually all occur within 90 days of the surgery. I didn't ask, but suspect at the very least after plate removal I'll be back in the boot for some time. My current plan is to schedule plate removal for November as there are too many things I want to do this spring and summer, including riding to the BMW MOA National Rally in July. A friend will take me back to Spartanburg, SC next Saturday so I can ride my GS home!
I want to sincerely thank everyone who shared their experiences/advice regarding ankle fractures on this thread. When I sat up in the dirt after the crash and saw my foot flopped over at a right angle I didn't know if I would ever walk again normally. It was a very scary moment for me. I am ecstatic at how much I have recovered to date and now expect to eventually return to normal.

[kraven]

I'm happy for you, man.
Your attitude and willingness to both be patient and do the arduous recovery stuff is the winning combo here.

Glad you're sharing this.

[Eyes Shut]

That's good news, Petdoc!

I see my OS today and will get x-rays and an update. It's been 6 weeks since my accident.

Update: I had the cast removed and am now in a boot. X-rays showed everything in proper alignment. But doc says no weight-bearing for 6 more weeks.