Pain after a broken ankle has mended

by Jeannie
(UK)

Hello, I fractured my ankle -rotational fracture of the lateral malleolus. After 6 weeks in a cast and boot the consultant discharged me without an examination saying that "after 6 weeks it will be fine to weightbear". Now 9 weeks since breaking it I have been seeing a private physiotherapist as none was offered at the hospital, and now I am walking on one crutch in trainers. But my foot keeps swelling and I am in constant pain( sharp stabbing pains) on the top of my foot, at the base of my toes and the skin feels sore and burning. I also have small white patch under the skin in the hollow of my ankle which when pressed is really sore. Should I go back to my doctor or is this just part of the healing process? I can't walk far without pain and it's so frustrating.

RESPONSE

Hi Jeannie,

The short answer is you should definitely go back to the doctor, but perhaps not the one you saw previously. There is no way to make a diagnosis that an ankle fracture has healed simply because six weeks have passed. Now, I am assuming that the lack of examination also included the fact that he did not take an x-ray.
I will approach this answer two ways: one that an x-ray was not taken and secondly that an x-ray was taken.
1. If no x-ray was taken and the doctor simply looked at you and stated you were healed, then at the very least you need another x-ray to determine if the fracture has healed or at the very least, the progress the fracture site has made over the course of what is now nine weeks.
The simple fact that you are having so much pain would be suggestive to me that there is still an issue going on and that the fracture has not completely healed. An unhealed ankle fracture would cause pain in the area of the ankle. The pain you are feeling in your foot is not a direct result of your fracture but may be related to a change of gait, simply because your ankle will not allow you to walk normally.
2. If an x-ray was taken at six weeks, even though the doctor did not really examine you, then one may assume that radiographically at least the fracture has healed. If that is the actual case, then the pain you are having may be related to additional soft tissue damage, not evident during the initial trauma, or even perhaps due to weakness in your foot and ankle from having been immobilized for six weeks.
Without the luxury of being able to actually examine you and perhaps know more about your medical history, it is difficult for me to go beyond "what if's".
You have now had physical therapy for at least three weeks, according to my math, and apparently you are not appreciably better which should raise a red flag. If you just had some soft tissue injury, with physical therapy, you would be improving and you are not.
So, strictly from that standpoint it would not surprise me if there was still a fracture, especially if no x-ray had been taken.
As I said in my opening statement, I think you should see a doctor. I am not sure how healthcare works in the UK, but if you have the option, seek the opinion of another doctor.

Marc Mitnick DPM
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