4 weeks post ankle surgery

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I landed horribly on my right ankle on Sept 10th 2016 jumping off an inflatable obstacle course (ridiculous I know), dislocating it, tearing the ligament between the tib/fib and breaking the medial malleolus and the fibula in a couple of places. I wanted to share my experience so far (Oct 15th) as this forum has been really helpful to me and I hope my experiences can help others. I'm a 32 year old, active male Brit now living in NYC. Please excuse the length of this post!

I had surgery on Sept 15th after the swelling had reduced enough. I was nicely dosed up on Oxycodone waiting for the surgery but it felt like an eternity. The worse feeling was that nothing was healing and I was just wishing time away until they could get the bones in the correct place. There was constant dull pain and lots of sharp jabs when I moved. The surgery was over in an hour and the nerve block they used in my leg blocked all pain for 24 hours after. When it wore off I was back on the Oxycodone and in pain but in much better spirits as now I knew that as time passed, I was healing. The pain was tolerable thanks to the drugs and the thought that it was healing pain. The doc had me on crutches with no weight bearing (NWB) for 6 weeks. The 2 long screws seen in the pic mean I can't fully extend or pull up my foot until they come out 12 weeks after surgery around mid Dec. The other screws and plate will probably stay in indefinitely. I was in a big cast/splint that was only solid around the back and sides up to my knee and bandaged everywhere else. Sleeping was really tough and I'd be up constantly when I moved the leg too much. A couple of 5mg Oxycodone before sleeping would give me a decent 4-5 hours solid sleep though. I did and still do have it up on two big pillows, usually laid on its side with a bent knee so I can sleep on my side.

On Sept 29th they popped off my cast/splint, took out the stitches and put me into a comparatively luxurious short leg blue fibreglass cast with a lovely soft interior. I got to see my ankle and scars too (see pics), which was a shock as the scars were pretty intense and the ankle was very swollen and bruised. To get my foot into the right position for the new cast the doc had to move it, which was painful but it felt really good to see and feel movement in the ankle.

The new cast was lighter and much nicer but was still a thing around my leg so quickly got annoying. Around the first week of Oct I did starting hopping around the apt a lot more which I couldn't do before as the jolt really hurt the ankle. I was now also able to rest my leg on the floor and let it carry its own weight when I was sat on the couch or at a table, which was a new thing. If my leg was down for a short time my toes would go blue and I'd feel the ankle swelling inside the cast so I was usually sat on the couch with a couple of pillows under my leg. I was also trying to regularly stretch my leg out so the muscles didn't get too tensed up from inactivity.

Yesterday on Oct 15th, they cut off my fibreglass cast and got me into the removable AirCast boot, but still NWB for 2 weeks. My ankle is still swollen but much smaller than 2 weeks ago. The scars look better too. My calf and upper leg muscles have shrunken in a big way over the last 4 weeks, as you can see in the pics. I've started lifting my lower leg with the boot on in reps to start the process of building my upper leg muscle back. I also slept in the boot last night (very loosely fitted) as I was scared about moving it in my sleep or getting out of bed and putting weight on it to pee without thinking. This has been the biggest milestone in the recovery process as I can now see my foot and ankle, wash it (it was disgusting) and start moving it. Just stretching my toes out feels amazing and since last night I've been moving my foot around with my hands to find my limits and start working on increasing them. Now that I can start increasing my range of motion as it's out of the cast, I feel like a major part of the recovery process is under my control, which is an immense psychological boost and gives you quantifiable milestones to meet and exceed. Doc says he wants me doing circles with my foot by the end of Oct and then it's time to start the physio.

The immobility and lack of doing much is by far the worst part of this experience. Id gladly take much more pain in exchange for more mobility. I was lucky to be able to work from home so that really helped to speed up time. I used some of the time to do those little organisational things you never normally have time to do like reorganizing my document folders and creating to do lists and the like. Achieving at least something during the day made me feel useful and part of something rather than someone just waiting to heal. Watching shows all day, which I did more at the beginning did drive me crazy and didn't help the restless feelings. I would venture out for a cigarette (stupid I know) once or twice a day to get some sun and do some people watching which really helps. Early on, I commandeered my housemates wheeled office chair to move around the place which was a game changer. Crutches make moving things like plates of food or drinks around a multistage nightmare. The office chair solved this completely and I'd highly recommend getting a cheap one if you have a suitable floor.

Im also taking some bone supplements. The doc says they won't do much, and I've read some papers that say they can actually be determinantal as they strengthen the existing bone making the healing process longer as the creation of new bone to heal can take longer to match the existing strength. Ive also read other papers that say it can help when bone is healing so I'm taking it anyway, even just for a psychological boost. It's really just a boost of calcium and other related vits and minerals.

Long term optimistic predictions/guessings for healing is that I'll be cycling carefully by Mid November, finished with crutches and boot but walking very funny by the end of November. The two ligament healing screws will come out mid December, for a hopeful normal walk by Christmas.

I’d be happy to speak to anyone who wants more info. Id also like to speak to people who have been through physio in the states and know about the co-pay costs involved and ways to mitigate this. This country's healthcare standards are high but it is terrible that there are so many financial implications to deal with when you should be concentrating on repairing. A self employed laborer with kids breaking their ankle in the states would be in serious trouble. I was very close to flying home with my broken ankle for treatment if the expected cost here was too high. The government provided and totally free NHS is a beautiful thing back home, please fight to keep it!

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  • Posted

    Thank you so much for taking the time to share.  It sounds like you are definately on the road to recover!  To be young again.....  I had a similar break- xray pics look very similar- I had the splint on 2 weeks after surgery, 5 weeks in a cast and now 7 in the boot.  Unfortunately the outer incision has not healed as it should so my progress w/ the boot was 'halted' after 3 days.  I am now at week 12 s/p surgery and seeing a orthopedic plastic surgeon to hopefully get this thing healed!   I go back tomorrow and will have the 'unna boot bandage' removed and a new one placed..... cannot start PT until after it is healed and unable to do any ROM exercises either.  Frustrating.... but every day I am closer to the end result.  This has been an incredibly difficult journey for sure-  So your question is about the US and our insurance coverage for physio?  It would certainly vary on the type of insurance that a person carries as they all differ.  We have had to pay 5% of all 'acceptable & negotiated' costs and when PT starts- it will be the same.  Where do you live?  It sounds like you have had a lot of good care and followup!  Wishing you much continued success adn getting back on that bike soon.

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    • Posted

      Hi Jan,

      Sounds like you are through the worst of it but I feel your frustration at delays. 

      My insurance will cover 80% of costs, but I have a max out of pocket of $3.5K which is a lot of money to me. Im worried that Ill have to pay a co-pay for every physio visit too which would initially be ~3/week and would be a lot of money to spend. Im hoping that I can negotiate with them to pay a weekly co-pay that covers a number of sessions, but not sure if this is possible. I live in Brooklyn. Im happy so far with my care. Doc could be a bit chirpier but hes obviously good at his job. The only argurment Ive had with him is not letting me get an MRI. Its just me being paranoid but I want to give them a chance to spot any potential soft tissue issues so I can make sure the recovery time is as short as possible.

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  • Posted

    Wow. You are totally on track! Love hearing stories like that. For Physio you can use a towel to flex ankle back and forwards lightly to start. And the Looking for chewing gum- turn foot in and up towards middke- like seeing if you've stepped in gum.

    My plate has to come out, along with the 6 screws, my foot doesn't like it, but surgeon waiting for bone to get stronger.

    I've read mixed things about calcium supplements too. Lol. Smoking can delay healing too haha, but Its a damned stressful journey! Caffeine and anti inflammatories delay bone strengthening too.

    I'm 53 weeks post snapped, displaced fibula, with dislocated ankle. Bone graft 8 months ago due to 100% non union - caused by not being taken to Hospital by paramedic. Medical misadventures the norm. And extreme neglect and misjudgement from ACC, NZs health insurers.

    I need urgent meniscus surgery for other leg, and plate removed, if ACC agree. Not at same time haha. If they don't act soon, I'll keep falling over.

    I see you didn't try a knee scooter. They are brilliant.

    Keep writing the good story. Great reading! 👏🐯🚶🚶🚶🏃🏃🏃👣👣👣👐🌞

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  • Posted

    Hi Charlie,

    It was nice to read your story and I can appreciate what you've been through as I broke my left ankle around the same time. I had a trimalleolar fracture where I broke all 3 bones and when I injured mine (stepping out of an SUV in high heels wedges) my foot, instead of facing 12 o'clock, was facing 7 o'clock.. completely dislocated. I injured mine on Sept 12th, 2016 but unlike you, I had to wait until September 29th to have my ORIF surgery. So 2.5 weeks of time spent not healing, waiting for the swelling to go down. Talk about frustrating. I'm in California (I just returned from spending 2 years in Suffolk, UK) and from my experience and that of others, they DO NOT like prescribing narcotics for pain. I only got a few days worth, and I ended up going to the ER for the pain, where they gave me injections of morphine and then sent me home to take my Tylenol. (Luckily I brought back some left over co codomol from the UK from an unrelated surgery I had whilst there).

    Everyone seems to know so much about how many plates and screws and pins and wires they have in them but I haven't a clue. All I was told after surgery by my sister who spoke with the surgeon was that they ended up doing 2 incisions on each side of my ankle so 4 incisions total. I was given a nerve block that luckily for me lasted 3 to 4 days. I was given Oxycodone (was very surprised) that I was very frugal with and hoarded, knowing darn well I wouldn't be getting a refill. And when I eventually did request a refill was denied.

    So now 17 days after surgery my biggest issue is the nerve pain I'm having across my toes and outside of my foot. My 4th toe and pinky toe are both about 95% still numb. The only way I can describe this nerve pain is that it feels like vaunted feels when you pull something out of the oven and burn your fingers. It also feels like I've been stung by a wasp or better yet, like when I was in England and didn't know what Stinging Nettles were and I pulled weeds for a few hours and dealt with the sting from those for a few days! Ouch!! I did some reading on this forum and decided I would go buy some topical medication and bought a product called Neurogen. Came home, sprayed it on my toes (mind you, I've cut away to top part of my cast covering my toes because it was too irritating) and all it did was make the burning worse, as in I cried all night long and tried to wash the medicine off but the burn wouldn't go away. Then I read about Gabapentin for nerve pain and thought ah, I'll call my surgeons office and ask if they'll prescribe that for me. I was told... the doctor will not prescribe that for just your toes and he doesn't like to prescribe it because it makes you sleepy. So..... ok.. they are "only my toes and outside of my foot" however, they hurt like hell and are irritating me to distraction, enough that I can't focus on my online classes. And I don't drive or operate machinery so why would I care if the Gabapentin makes me sleepy? I can't sleep well anyways with this cast on and this pain. I feel like calling my GP in England and saying hey, this is what's happened to me, I can send her xrays and a copy of the operative report, and see if she'll prescribe anything, however she probably wouldn't want to "step on any toes", no pun intended.

    I do go see my surgeon this week for my 1st follow up, where I'm told they will take the cast off and xray my ankle, then put a new one on. And of course I'm going to plead my case for the Gabapentin and say look, Tylenol is NOT helping at all, not one bit, and this is really bothering me.. a lot. I'm not asking for narcotics, I just want to try and calm these nerves down. Oh, and I was also told that they don't think physical therapy will be necessary. I am a student and don't have insurance so I believe that is why they are not recommending PT, however in ALL that I have read about trimalleolar fractures with dislocation, one of the severest types of fractures, not once have I read of one single case where the patient didn't go on to PT after surgery. Am I to administer my OWN PT and have to learn online how to do it all myself? Yes, I know PT is all about the patient doing most of the work however I thought I'd at least get to work with a professional physical therapist for at least a few sessions. Oh well.. this whole thing has been a nightmare and whilst I'm grateful I received surgery to fix this badly broken ankle, I'm left in a lot of pain with no pain management options and no upcoming PT. I am elevating it all the time and try to massage my toes. I take my Tylenol but don't notice any relief. I try to imagine when I'll be able to walk normal again and ride my bike again!

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    • Posted

      Hi Cher,

      I’ve always known that heels were life threatening. Flats forever!

      I’ve got a similar sounding tingling/pain/irritation at the back of my foot around the base of the Achilles tendon. I definitely know the feeling of stinging nettles and it is close to that. It kind of feels like a big blister when I’m resting any weight on it. No idea what it is but I’m trying to massage it as much as I can handle but no real change. I’ve felt it since the first week post surgery. Ill ask my doc about it and see if he knows what it might be in case it’s the same issue as yours.

      I’m surprised that they are reluctant to give you painkillers. I was given 1 week worth of Oxycodone at the ER and 2 weeks worth after the surgery. That’s 2 weeks worth taking them every 3 hours so in reality they would last a lot longer. Id just push for them as theres no point enduring pain when you don’t have to.

      I’m no doctor, but I’m pretty sure it’ll help to do at least a few PT sessions. Your injury sounds much worse than mine and my doc has said I would start aggressive PT of ~3 sessions a week as soon as I’m weight bearing. I probably wont do that much as I cant afford the multiple co-pays but Id definitely begin with a couple of sessions to get going then do it at home until I’ve reached the next level, then go back for more, then do some at home and so on. Most people I’ve spoken to do most of their PT at home, but learn the things to do at a few sessions.

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    • Posted

      Any word from your doc on what the blistering issue is? I broke my tibia 3 weeks ago and had surgery. I've developed a weird blister-y type of thing on my ankle, and am very curious as to what it is. It could be from rubbing on my air cast, or it might be something to actually worry about. Would definitely love to hear about any insight you have. 

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    • Posted

      Hi Erica, I know your question was directed to someone else, but I remember how nervous I was before my surgery. I had 2 ziptights and a plate and couldn't put weight on it for 8 weeks and then it took another 8 weeks to walk unassisted. Right after surgery, I remember lots of swelling and tightness more than acute pain. (I was on percocet for a day and a half and then ibuprofen after that.) The shower was the hardest part. Make sure you have help. I highly recommend a scooter. After about 9 months I felt back to normal. I just feel it sometimes in the humidity - it doesn't hurt per se, but it is a little stiff. Good luck and best wishes for a speedy recovery!!

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    • Posted

      Thank you Shannon! Every piece of positive information is so helpful emotionally. I know it's going to be a long recovery. I guess it's normal to feel helpless when things are out of your control.

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    • Posted

      Yes! Just remember it feels like a long time but it is just a short period in your life. Use the time you can't be active to plan vacations, organize pictures, email old friends... and then you'll be better before you know it! Good luck!

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  • Posted

    Hi Charlie, your break sound very similar to mine. Broken ankle in 3 places and screws and rod with 2 longer screws/pins that have to be removed in 3 months. I fell down my stairs at 2am tripped over the dark cat. This was on October 14th and had surgery the very next day. I was in a splint cast for 2 weeks and now I'm in an air cast for 4 days and wow it's horrible to sleep in 😥

    How are you doing now? I tried to look at your photos and x-rays but I have no idea how to see them on this site....

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    • Posted

      Hi Pam. I know the feeling of sleeping in those things, it was a major hassle. I managed to find a decent position and stuck to it, which helped. When I got frustrated with it, Id just neck a couple of Oxycodone before bed and usually sleep through any discomfort. If you’re in an air cast, you will probably have the option to sleep without it. I did the first night in it because I was scared of moving the ankle in my sleep, but after that I had it up un-booted on 2 deep feather pillows that when my foot sunk into them, made a protective wall around the ankle. With the other leg down and away I felt more comfortable knowing that I couldn’t kick myself with the good foot. The pillow tower also kept my foot relatively immobile and elevated. The first couple of nights was quite nerve wracking though and I woke up frequently to make sure I hadn’t moved too much off the tower.

       I’m now 7 weeks post op and in a boot when Im moving around and also experimenting with the exciting world of weight bearing. Started physio last night and the doc moved my foot in ways I haven’t seen for ages! It felt fantastic! I cant move my foot very far on my own, but when the doc moves it, theres actually quite a lot of possible motion before the pain begins. Im at roughly 60% when the doc does the moving and about 20% when Im doing it unaided. It really does feel good. Got a load of exercises to do to increase my range of motion, build back the muscle and Im also standing on scales with my healing foot trying to increase my weight bearing tolerance. The first day I was allowed to weight bear I could manage 10kg of weight before it hurt too much (I weigh 80kg), the next day after leaning on my knee when sitting, pushing against things when sat on the couch, I could manage 20kg, the next day 30kg and so on. I can now take 50% of my weight on the bad ankle so can do those amazingly small but important things like stand up straight when brushing my teeth or cooking. My now chunky left leg is so happy for the relief.

      The physio filled me with confidence when he said last night that Id be 100% weight bearing and walking (in the boot) within 2 weeks. Maybe he’s being too optimistic, but I think that well placed optimism at this stage can really help accelerate the healing process.

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    • Posted

      hi guys,  

      I'm finding so much useful info here.  I fell off the sea wall, had to be rescued by the fire service and have broken my ankle in 4 places.  

      I have a very similar experience, waiting for swelling to go down for ORIF surgery; back slab cast for 2 weeks and now a fiberglass cast for the last week and a bit.  

      I get the nerve pain....the stinging nettles / knife being drawn across the back of my ankle and am controlling it with meditation and paracetamol.  

      I'm non-weight bearing of course - with the four breaks, and my age, I've been told this could be for as long as 12 weeks, so I'm mainly staying in bed with my leg elevated.  I have to inject myself daily with Clexane.

      Whenever I do get up, I feel the blood rush to my leg and my toes turn deep red/purple and swell.  So does the ball of my foot.

      My concern is that in the last two days, the speed of that swelling has become faster.  It goes back to normal reasonably quickly when I elevate my leg but it's still a bit worrisome.  I'm back to the hospital for x-rays and possible cast replacement in a few days, so it will get checked out then, but I wondered if anyone here had experienced that?

       

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    • Posted

      Hi Sue

      I am fell on ice in a parking lot on January 10th 2018 and suffered a bimalleur fracture of my left ankle.  At first I thought  I had sprained it so I didn't go to doctor until the 12th. On the 12th when pain didn't subside I went.  

      At that time was given a boot and told by the PA that it was a clean break. But Ortho has final word.  By the time I went to ortho 4 days later I could actually stand on my foot without much pain.  So I assumed i was on the mend.  WRONG.   

      I was shocked to discover I needed surgery and plates put in to repair damage and hopefully avoid ankle arthritis.  

      I had surgery on January 24. It took over 24 hours for the nerve block to wear off. I hated not being able to move my toes so I was happy when it did. They gave me oxycodone and morphine for pain which I took for 4 days. 

      Tuesday the stitches came out. One of them was right on a nerve.  That one was hell to get out.

      I was put in a fiberglass cast but felt constant pressure from swelling on my foot.  So I called doctor's office and they had me come in to cut the cast in half to relieve the pressure.  It feels a little better now

      It is good to read experience similar to mine.  I have 2 weeks more in this cast and then I go to a boot.  But I probably have 5 more weeks before I can walk. This does trueky suck but I will get through it.

      Hope you are doing better b

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    • Posted

      Hi Shelley

      Hope everything is going well.  I'm coming to the end of my 7 weeks spent mainly in bed.  I found I have a trimalleur plus a spiral fracture to my fibula.   I have two plates and 14 screws.  Elevation has been an absolute must.  Because of my age and a dodgy shoulder, crutches have been horrendous and I actually had a fall off the crutches which was VERY scary!  I don't think I did much damage, I worked on the basis that if I'd ripped out one of the screws I'd be doing a lot of yelling.  

      On Wednesday, subject to x-rays, I'll move to a moon boot and 10% weight bearing.  So Excited.  And  I've also found the solution to the awful crutches and dodgy shoulder and have ordered a hands-free crutch.  An I Walk 2.0.  FREEDOM is just around the corner! LOL

      I was initially told it could be up to two years for full limp-free recovery, but I'm aiming for 6 months.  Pain is minimal.  Some neural pain easily managed with paracetamol, but there is still heaps of swelling whenever i put my leg down.

      Roll on Wednesday - X rays and Boot!

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    • Posted

      Hi I'm so sorry that happened to you ,I literally feel your pain.Im glad I found this site.I felt alone with this.I am 50 years old pretty active young at heart .We had so much ice back in February I fell down 5 steps broke my Tibula and Fibula I have 2 plates and 12 screws.I had a hard cast for 4 weeks and just the other day they put the huge walking cast.I have to gradually put weight and start walking on it.Its so painful and I never imagined healing time would be so long.Leaving the house is quite the chore I go down on my bottom.I miss doing everything.I think that's the hardest part.Any suggestions or advice for me? I pray you heal and recover soon.

      Noreen

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