Pain in the ankle joint after a fracture

Rehabilitation program after a fracture

We developed an at-home ankle fracture rehabilitation program because:

• Ankle fracture is one of the most common injuries. Medical statistics provide the following data: this injury occurs at least once in one person out of a hundred. People of both sexes are susceptible to it, but women during menopause are more vulnerable to it due to the development of osteoporosis. Black ice is the time of year when ankle fractures occur most often, because they occur as a result of falling on a sprained leg.
• If your ankle is broken, you should not step on your foot. Consequently, it is extremely difficult for a person who has received such an injury to come to a rehabilitation center
• Lack of rehabilitation treatment after an ankle fracture can lead to dysfunction of the ankle joint and the development of arthrosis.

Pain in the ankle joint after a fracture

HomeArticlesPain in the ankle joint after a fracture

Pain is always caused by swelling in the muscles, which at the time of the fracture are stretched beyond their capacity. It seems that the surgeons did everything for you, the bones have grown together. And the swelling became less, but the pain remained. Even if it’s only when you move, it still hurts! If you get an MRI, you will read in the doctor’s report:

“Moderate trabecular edema of the bone marrow in the distal diaphysis of the right fibula, swelling along the outer or inner surface of the ankle joint in the lateral malleolus, minimal swelling of the subcutaneous fat.”

Nikolay Nikonov

The superficial swelling that you saw has disappeared, but the swelling in the muscles and ligaments remains. It is sometimes unnoticeable. But this swelling is enough to cause pain when exerting yourself. The doctors treating you do not know how to eliminate swelling in the muscles. Therefore, you will be advised to apply a fixation bandage for four weeks. And they will say that the further disappearance of pain will depend on the degree of restoration of joint stability and adaptation of the ankle joint to loads. They will definitely add that if the recovery is incomplete, or instability of the ankle joint is partially preserved, the pain will last for a very long time.

“How long will it hurt?” you ask. “Maybe three months, maybe six months, maybe more...”

That is, doctors don’t know. And they are right, since surgeons do not know whether the swelling will disappear from the muscles with the treatment methods that were recommended to you. After all, swelling in the muscles is not water. Diuretics won't help. Edema in the muscles has a protein structure. These are hormones deposited in muscle cells that the body released at the time of fracture or injury.

Pain can be eliminated if swelling is removed from the muscles mechanically.

The effect on muscles using the Nikonov method is aimed at solving only one problem - eliminating swelling from the muscles and pain in the ankle joint. The muscles become normal in both anatomical and physiological condition. The pain disappears within a few procedures. Impact on muscles using the Nikonov method with fixation of the problem muscle is not a medical, not therapeutic, not a classical massage!

The author of the method of influencing muscles using the Nikonov method, Nikonov Nikolai Borisovich, can use the form below.

Return to list of treatment stories

How to contact Nikolai Borisovich

The information on the site is for informational purposes only, collected from open sources. When copying materials, a hyperlink to is required!

What types of ankle fractures are there?

The clinical classification of ankle fractures is quite extensive.

There are several main types of fractures:

• Unimalleolar - damage to one (medial or lateral malleolus)
• Bimalleolar - simultaneous damage to both ankles
• Trimalleolar - damage to two ankles and the distal epiphysis of the tibia.

Initial consultation with a rehabilitation specialist

+8

Record

Also, with ankle fractures, damage to the ligamentous apparatus of the ankle joint often occurs - ruptures of the tibiofibular syndesmosis, damage to the deltoid ligament

Rehabilitation after a broken ankle consists of 5 steps

• Examination of specialists from the rehabilitation team and drawing up an individual treatment plan;
• Walking on crutches. Mastering this skill is necessary not only for everyday activities, but also for successfully completing subsequent stages of rehabilitation;
• Elimination of edema. Swelling usually accompanies injury. When an ankle is fractured, swelling can persist for a long time. This is due to the peculiarity of the tissues around the ankle joint. Swelling usually limits movement in the joint and makes it painful. In addition, edema disrupts microcirculation and slows down recovery;
• Restoring the supporting load on the ankle joint. This part of rehabilitation is the most important. Extending the regime too early can lead to re-injury, while prolonged limitation of the load, on the contrary, leads to slower bone healing and the development of osteoporosis;
• Restoring the range of motion in the joint. This is necessary for the full functioning of the joint in everyday life.

Each stage of rehabilitation has its own objectives and treatment methods.

The basis of rehabilitation after an ankle fracture is

• exercise therapy classes with an instructor;
• massage;
• physiotherapy.

During the program, patients are monitored by an orthopedic traumatologist and a rehabilitation specialist.

As additional procedures, the program may include:

• CPM therapy;
• Hirudotherapy;
• Kinesio taping;
• Myostimulation;
• Manual therapy and osteopathy.

Manual therapy

Kinesio taping

Hirudotherapy

Amplipulse (SMT therapy)

Myostimulation (electrical stimulation)

We will also help you choose orthopedic products (orthoses or bandages) for the ankle joint and show you how to wear them correctly.

Ankle fractures

An ankle fracture is an intra-articular injury, therefore, in addition to the help of a traumatologist, with intra-articular injuries it is always necessary to work with a rehabilitation specialist.

• To get a broken ankle, you have to twist your foot.

In winter this happens much more often. Therefore, ankle fractures are the most common winter injury. The foot can be turned outward or inward. As a rule, an ankle fracture is a combination of ligament and bone injuries, where ligament injuries play no less a role than bone injuries and fractures. The possibility of conservative or surgical treatment depends on this combination of soft tissue damage and bone fractures.

If you break your ankle, you should see a doctor as soon as possible. Correct diagnosis is important here, since ankle fractures can be very, very diverse. It is necessary to obtain an expert opinion - whether it is necessary to operate, and if to operate, what and how exactly.

• Mechanism of ankle fracture

If we talk about the anatomy of the ankle joint, we distinguish the outer malleolus, which is a natural continuation of the fibula, and the inner malleolus, which ends with the tibia. And in fact, the outer ankle and inner ankle with the tibia form what is called the ankle joint. This fork contains the talus bone, the main movements of which are flexion and extension. A person’s foot can rotate outward-inward, can supinate or pronate, i.e. bend inward or outward, but within certain limits. When these limits are abruptly and unintentionally violated, a turning point occurs. For example, a person slipped, the entire load went to one foot - the bone could not withstand the load. Sometimes they talk about a trimalleolar fracture and a “posterior malleolus.” In reality, the posterior ankle does not exist. But there is such a term because there are powerful posterior ligaments of the tibiofibular syndesmosis, and they are fixed to the posterior parts of the tibia. This is sometimes called the Volkmann triangle. And with a number of injuries, the ligaments turn out to be stronger than the bone, and Volkmann’s triangle comes off. In this case, they talk about a trimalleolar fracture.

• Difficulties in diagnosis

As a rule, a CT or MRI is not necessary to diagnose an ankle fracture; in 90% of cases, a conventional radiograph in two or three projections is sufficient. MRI for ankle fractures does not provide any additional information other than what the doctor determines based on the mechanism of injury. However, there are situations when a CT scan is necessary.

There is an opinion that a patient can take an x-ray in any clinic and bring results to the attending physician. No, that's wrong. In order for the doctor to be able to examine small details and make the right decision, the x-ray must be of very good quality. On a poor quality x-ray, some details will simply not be visible. And the choice of technique and the result of treatment depend on small details. To diagnose an ankle fracture, an anteroposterior radiograph is performed. This projection allows the physician to assess the position of the bones and the integrity of the tibiofibular syndesmosis. The fact is that the tibia and fibula together form the fork of the ankle joint. This fork has some mobility, it is not a rigid fusion between two bones. The tibia and fibula remain separate, but they are united by a tight connective tissue junction. And this connection - the so-called tibiofibular syndesmosis - can be susceptible to rupture. Radiation diagnosticians at the Ilyinsk Hospital have extensive experience in conducting x-ray examinations for ankle injuries. They are fluent in special techniques and provide orthopedic traumatologists with high-quality diagnostic images and their interpretation. More information about the radiation diagnostics department of the Ilyinskaya Hospital can be found here.

There are many details on the x-ray that the traumatologist pays attention to. Sometimes it is necessary to take an x-ray of the entire lower leg. The fact is that the outer malleolus is part of the fibula. And with a fracture of the ankles, the fracture of the fibula can be very far from the ankle joint area, under the knee joint, for example. Suppose the foot was dislocated outward, and at the moment of dislocation the fibula went far upward and did not break, being strong. And the syndesmosis was torn along its entire length. In this case, the fibula deviated so far that a fracture occurred in its upper part. And if you only look at the ankle x-ray, it may seem like a small amount of damage. But in fact, this is a severe injury, since the interosseous membrane is torn throughout.

A CT scan is performed for fractures of the medial malleolus, when the foot is turned inward rather than outward. The fact is that the talus, which is located in the fork of the ankle joint, can press down on the inner ankle. Then you will get not only a fracture, but also a depression, an impression of the fragment. And this is practically not visible on a regular x-ray, but on a CT scan it is clear that there is a whole fragment that needs to be put in place. CT is also indicated for fractures of the posterior edge of the tibia. There is one more point: the tibia and fibula have a fairly “close relationship”, i.e. The fibula should lie exactly in the notch that nature has created on the tibia. Sometimes it is impossible to understand from ordinary radiographs whether it lies in this notch or not, and in this case a CT scan helps.

• Indications for surgical treatment

The question that most worries patients is whether an ankle fracture can be treated without surgery, conservatively? Yes. It is possible if the ankle fracture is stable. Research on this issue was carried out back in the 60-70s, and since then there has been a consensus on what to call a stable ankle fracture. A fracture is stable when one structure is damaged: either one bone or one ligament. For example, a fracture of the lateral malleolus without rupture of the internal ligaments can be treated conservatively. But a fracture of the outer ankle with a rupture of the internal deltoid ligament is impossible, because this is already damage to two structures, an unstable fracture. In this situation, conservative treatment can lead to adverse consequences and surgical treatment is required. And when they talk about a bimalleolar fracture, then regardless of the position of the fragments, surgical treatment is almost always necessary. On the radiograph the position of the fragments is the same. But it is unknown what will happen to the fragments in a few seconds. Even with changes in toe position—not to mention changes in ankle position—shifts can occur. Bimalleolar and trimalleolar fractures are almost always indications for surgical treatment.

• Surgery

For relatively mild soft tissue damage, surgery can be performed within the first 24 hours: from 6 to 10 hours from the moment of injury. In case of severe injuries, doctors are sometimes forced to wait until the swelling subsides—up to 10 days. The appearance of wrinkles on the skin means that the swelling has gone away. As for fixation, in the event of an ankle fracture, there is no need for the latest metal structures. You just need a reliable plate that allows you to fix the fibula. For the inner ankle, screws are usually sufficient. Sometimes orthopedists use screws in combination with some types of plates and even wires. For the posterior edge of the tibia, if it is torn off, screws are also used, rarely plates. The condition of the soft tissue determines whether external fixation is needed after surgery (immobilization). There may be a small fracture of the outer malleolus, but severe soft tissue damage. In this case, it is necessary to apply a modern fixing bandage for 7 - 10 days, in severe cases - for 2 weeks.

• Postoperative period

An ankle fracture is an intra-articular injury. And in case of intra-articular injuries, it is always necessary to work with a rehabilitation specialist. The patient must strictly follow the recommendations of the rehabilitator - serious work will have to be done to restore mobility in the joint and restore the load. With an intra-articular fracture, patients have to use crutches. It is very rare that there are injuries when the doctor may recommend not limiting the load. As a rule, it is limited to a period of 6 weeks to 2.5 months, depending on the nature and location of the fractures. But there are no situations where a patient must “wear” a leg after surgery; the leg must always be “started”, otherwise local osteoporosis will develop.