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The response to the question below was authored by Marc Mitnick DPM

ankle pain from growth plate fracture

by Teresa
(Florida)

My daughter fractured her growth plate in her right ankle 6 years ago. The orthopedic doctor casted it for 6 weeks and sent her to PT and we have been back to him on several follow up appoints up to about year and a half following her accident. Since then she has had multiple x-rays and MRI's of her ankle and she still continues to complain of her ankle hurting like a "toothache" and it swells all the time like their is fluid built up around it. She is in tears most of the time with it and is now 15 years old. I have taken her to three doctors and none want to perform surgery due to they say she is still in her growing stage. I need help and want her better!

Thank you,
Teresa

ANSWER

Hi Teresa,

Unfortunately, there is no simple answer here. I will make the assumption that all the x-rays and the MRI show that the fracture has healed, at least on the films.
I think we can assume even with a "healed" fracture, there has been some damage to the growth plate that is not detectable on x-ray or MRI.
So in theory surgery might sound like the next best option. The problem here, as has been pointed out to you by your doctors is the simple fact that the surgical rule of thumb is that you never operate on a bone that has yet to have fused. The problem becomes one where if your daughter has surgery on the right ankle (I assume the fracture was one of the actual leg bones), there is the real likelihood that the left leg bones will continue to form and grow and your daughter will be left with what is known as a limb length imbalance. Her left leg will be slightly longer than the right.
Additionally, stunting the growth on one of the right leg bones could actually throw off the architecture of the right ankle and she would end up with right ankle issues on a permanent basis.
Your daughter is now 15 years old, she is not that far off from fusion of the growth plates. Until that occurs, you and your doctor need to take steps to "protect" the painful area with either strapping, casting, or perhaps even cushioning the heel of foot so when she comes down on her heel it does not send a jarring force into the ankle which will just aggravate it. There is no specific brace, strap, etc. that I can recommend, so I think it will be a case of trial and error until you find something that allows your daughter to walk more comfortably until the time comes that surgery may be entertained.

Marc Mitnick DPM
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Aug 31, 2011
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Ankle Pain
by: Teresa

Thank you for your answer to my question. However, the the last MRI that was done in 2009 does state possible fracture and the x-ray shows nothing. I took it upon myself to get copies of the x-rays and MRI in case I need to take her back to another Ortho doctor. So in the meantime I assume you are stating the best option would to be for me to wait until she is completely growing before surgery is performed? I am just tired of seeing her in pain all the time and she does wear an ankle brace everyday.

Thank again!

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Columbia University Department of Rehabilitation

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Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

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San Diego, CA

Dr. Mitnick, Just want to say thank you so very much for your quick response and very informative reply! After reading what you had to say, I called the doctor's office and was able to get in and see him the same day as my injury. Toe was x-rayed and luckily, it is not broken or fractured. Very badly bruised and will probably lose the toe nail. And although my toe and toe nail are still very black and blue and very sore, they ARE both starting to feel a little better. So again, thank you! I am so very happy that I came across your website. The service you provide is outstanding and immeasurable!

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ankle pain from growth plate fracture

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