Nerve pain after ankle fusion

by Jeff
(Hawesville, KY)

My wife fell and broke bones in her ankle and leg. After the first operation she was still in pain so she goes to an orthopedist at the University of Kentucky. All he said he could do was fuse the ankle. It took maybe a year to 16 months for it too fully fuse. Now 3 years later she has swelling and pain almost constantly. Some days it doesn't hurt at all, even 3 or 4 days in a row. But those are rare. The U.K. Orthopedist said it was nerve pain from the trauma of the break and having to wait a week for the first surgery. Is there anything that can be done about the nerve pain and swelling?

RESPONSE

Hi Jeff,

Your wife's options are greatly limited.

The nerve damage may be partially due to damage from her fall, but there is a better then fair chance that there was also nerve damage from the two surgeries that she had.

There are five different nerves that travel down the leg, past the ankle and into the foot. It is not uncommon for one of these nerves to be damaged particularly when you are dealing with trauma and the incisions have to be placed in a certain manner to get to the fractured bone(s) in an effort to make the repair.

Adding insult to injury your wife then underwent a second operation, an ankle fusion which probably created additional incisions. So the odds were greatly in her favor that she would have some degree of nerve damage.

The good news according to you is that there are times when she can go a few days with little to no pain, but I assume that is offset by the "bad" days where she must be in quite a bit of pain and ambulating becomes a real chore.

Three years post surgery is a fairly long time to recommend physical therapy as PT works best early on.

Has she consulted with a neurologist. Most of them will probably put her on oral medication to alleviate or at least reduce the neurological symptoms. Drugs like Neurontin or Cymbalta come to mind.

I am not sure if neurologists do this or not, but you might look into nerve stimulation in an effort to revitalize the affected nerves. I do not think it will solve her problem but it may reduce some of her symptoms.

Is there a correlation between her swelling and her pain? If she does notice on her bad pain days that the ankle is also swollen, then taking measures to reduce the swelling, generally through compression, perhaps compression stocking or Ace bandage wrapping may, again, give her some relief.

The problem with fusing the ankle joint is that it changes her gait and although it reduced the pain from the previous fractured ankle, a joint fusion creates its own set of problems. She really had no choice but to have the fusion, but she is stuck with the consequences.

The fact that her gait has changed from the fusion may be the precipitating factor in the ankle swelling and keeping compression on it, that may in effect help reduce the neurological symptoms.

Of course, I am just guessing here simply because I do not have the luxury of examining your wife, but it the nerve pain seems to worsen the more the ankle swells, then she may have to wear permanent compression, particularly on days when she knows she is going to be doing a lot of walking.

In short, all of these suggestions may make your wife's situation more tolerable, but she is still going to have issues going forward.

Marc Mitnick DPM
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