Hamstring and Hip problems after ankle surgery

by K D
(Charleston, SC)

Hi! I hope you can help me-

I suffered a trimaleor (sp?) fracture of my left ankle on February 19th. I have had 3 surgeries, and currently have 12 pins and 3 brackets in my ankle. I was using a wheelchair and crutches for the last 3 1/2 months.

I started walking with full weight about 3 weeks ago. The problem I am having is that my right leg (the 'good' one) is in constant pain. My hamstrings and quads are constantly feeling like I am having a prolonged charley horse, and if I move in a certain way I get a shooting pain into my hip. Walking is extremely difficult (more of a waddle), and the pain is extremely limiting. I try to stretch as much as possible, but it rarely helps .

If I look at myself in the mirror, I can see where my right hip is higher than the left- probably a result of it being the only leg used for about 12 weeks.

Do you have any suggestions on how to alleviate this pain? I have been looking for articles on gait training, but have yet to find anything useful. I am finally able to walk on my left foot, but now suffer from the pain in the right.

Please help-

KD in Charleston

RESPONSE

Hi KD,

It would have helped me somewhat to know your age and overall health status particularly if you live an active or sedentary life style (prior to the accident) as this might have helped me in determining your prognosis.
Anyway, a couple of things are going on here. You are right that your left leg is probably atrophied (weakened) from lack of use over the last few months. Which then begs the question, have you gone for physical therapy? If not, that is almost a must, as your situation should improve more dramatically with supervised exercise, etc. It might partially explain why the right hip appears higher than the left hip.
The other issue that needs to be addressed is the condition of the left ankle. You state you went through three surgeries which to me means there were complications.
That leads me to the assumption that there may be limitation of motion in the left ankle. That being the case, it will cause problems with your right leg because your gait has been altered with the changes in the left ankle. Furthermore, one of the things we look for after the repair of ankle fractures is the alignment of the foot relative to the tibia and fibular which makes up the ankle joint. If the alignment is not perfect and many times it cannot be because of the trauma sustained and the work needed to repair the ankle, then there will be a "mal-functioning" of the ankle joint which again, will put a strain on the contralateral leg (right leg)
Lastly, between the trauma and the three surgeries, some bone may have been removed which will shorten the left leg ever so slightly. In addition, it would not be far fetched to assume that the subtalar joint which is the joint below the ankle joint may have also been damaged. The consequence of this, depending on the position of the subtalar joint, may also have been to shorten the relative length of the left leg, thus making the right hip appear higher.
So what are you going to do about all this. My suggestion is two fold.
1. Set yourself up with a physical therapist who will give you a set of exercises that you can work on. It does not necessarily mean going for PT three times a week, but exercises and strength training you can do at home or at a gym.
2. Find a good podiatrist in your area. With the use of an orthotic, a device that fits in your shoes, he can adjust your gait somewhat and equal out your limb length issue, both of which will allow you to ambulate in a more normal manner, which in the end, should go a long way to alleviating your right leg pain.

Marc Mitnick DPM
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