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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