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The response to the question below was authored by Marc Mitnick DPM
Extreme pain in lower Tib/Fib / Ankle / Foot - Broke Tib/Fib 10 years ago
by Becca
(Newfoundland)
Ten years ago I had a spiral break in my Tibia (4inches) directly above my ankle bone, and a clean break in my Fibia 2inches below my knee (bumb still sticks out here). There were never any xrays taken of my ankle/foot and no surgery was done. I was placed in a cast to my hip for 7 months. During the last week of my casting, my surgon died (no replacement). When the cast was removed at the local hospital, no PT was suggested by the attending physician. Within a few weeks I could clearly see the lower part of my leg / foot did not properly line up straight. From my knee down my leg twists slightly to the right, and my foot twists even more to the right. Now in order to point my foot straight, my hip has to overextend to the left which causes pain and discomfort. I revisited my family doctor and was told the bones should line themselves up as my body grew - I did not think so, as I was already 28 years old. Over the next few years, I tried to walk straight, which caused a hip / lower back pain. I went to PT for 8wks with little progress. Over the past few years the pain subsided, and I haved walked with my right foot pointing outwards. Now, I am experiencing extreme pain in my lower leg / ankle / foot area. I approched my local doctor about this, but he thinks the only way to fix it is to rebreak my leg, add pins/plates, see what happens, and it he says it may not even heal properly. This process will take at least 8 mths to a year for healing, which I don't have to put my life on hold. Last year I have returned to school to train to do conservation work, and I have completed one year of a five year program. I cannot pause my life for this extreme opperation, however, without something done to fix my problem, I may not even beable to complete my education program. Witin the next year I must be able
Hi Becca,
Unfortunately, there is no easy answer. Your leg was under treated in its initial treatment and now you are left with the end result.
This becomes a quality of life issue and because of your relatively young age, we are talking about having to live with this problem for many years.
In order for you to walk, you have to keep your foot pointed outward. Over time this has caused a compensation, probably, primarily at your hip joint. The problem with this beyond the obvious is that at a young age your body can adapt to the stress because of the flexibility of your ligaments, but as we age, the musculo-skeletal system tightens up and people in general become less adaptable to the stress placed on the body.
You may have reached that point.
In your new career you state you will have to be active. Well....it seems to me with your present state, your leg will not allow you to do the things that have to be done.
You have to make a decision. Something like an orthotic with adequate cushioning may give you some relief, short term, but it is not a solution.
What you should consider doing is seeing a specialist who deals with these kind of situations and explore your options. My "guess" is you are probably a candidate for what is known as a derotational osteotomy where the bone is broken and then twisted in a manner to better align your foot.
Yes, there you will have to put your life on hold to some extent, but you need to think long term. If you could have successful surgery, this would give you great relief for a good number of years.
Read my article on surgical consideration and give this possibility a lot of thought. Make sure you see a specialist qualified in this type of surgery.
Marc Mitnick DPM
DISCLAIMER:
ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
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