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The response to the question below was authored by Marc Mitnick DPM
Fractured Fibula Lateral Malleolus
by Barbara
(Southern California)
I fractured my ankle & tore ligaments July 28, 2014. The podiatrist put me in a boot cast & told me to return in 4 wks. Then called me the next morning to say I needed a MRI & surgery immediately! This alarmed me so I decided to seek a 2nd opinion from an orthopedic surgeon that same day. He took 8 x-rays & told me he felt it was a stable & clean fracture that he felt would heal. The original boot cast was way too big so I was placed in one my size & sent home for 3 wks. of total bed rest & elevation of leg. Week 3 he looked at it, still swollen & blue. Suggested I wait another 2 wks. then he would x-ray again. 5th week & he feels surgery is definitely not necessary, but I must keep the boot cast on another month. I can now begin putting weight on my leg with the aid of crutches (not full body weight) & do minor foot motions with boot off. At the end of Sept. He will do new x-rays & if all looks good, he will remove boot cast & place me in a small brace for 4-5 wks. Rehab will be after that. This is a long process, but so far I feel this is best especially hearing the horror stories that some people have expressed here. I think people rush into it too soon & many times the doctor doesn't give good advice. Yes, it's boring being inactive, but if it means you will recover with no future problems it is worth it. Hopefully this will be my case. I do have one question...in week 7 going on 8 wks. is it normal to have a hot achy pain every once in awhile at the site?
RESPONSE
Hi Barbara,
Based solely on your narrative it sounds like you are progressing as expected. According to my calculations it has been six weeks since your injury and you have not mentioned any
I would suggest you see if there is any correlation between the times you put some weight on the foot and the incidence of pain. It would not be far-fetched to assume there might be some pain in your ankle when you place partial weightbearing on the foot as the fracture is not yet healed and the fibula bone, the bone that you fractured can be a slow healing bone.
The only part of your narrative that I do not understand is why the original podiatrist called you the next day and told you that you needed immediate surgery before he did an MRI? Does not make any sense to me.
I agree with your philosophy of going for the conservative treatment rather than immediate surgery. I like the fact that your orthopedist was thorough enough to evaluate your fracture and take a conservative approach.
Too many patients are un-informed about the potential risks of surgery and just assume because surgery is being offered to them that there are potential problems.
Ankle fractures can be tricky because of the way the fibula bone ends up broken and because of the inherent poor healing capacity of the fibula bone.
In general, if the fracture is clean and the space between the fracture line is small, and other factors are considered such as the patient age, overall health and a non-smoker, then taking the conservative route makes a lot of sense.
From a practical standpoint not having surgery and taking the conservative route instead really only set you back a shorter period of time then you may think. In either scenario there would have been a period of non-weightbearing along with physical therapy.
Marc Mitnick DPM
DISCLAIMER
ADDITIONAL REFERENCES
University of Rochester Medical Center
American Academy of Pediatrics
Columbia University Department of Rehabilitation
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