After a broken ankle, your leg swells: what to do?

A request to relieve swelling after an ankle fracture is a common reason for patients who have suffered a leg injury to return to the hospital. Swelling distant from the surgical site appears after a fracture and in most cases interferes with normal movement. The leg swells after a broken ankle for natural reasons: lymph and other fluids in the tissues accumulate at the healing site and form a swelling. To relieve swelling, various methods are used to help eliminate swelling and tension.

Causes of swelling after an ankle fracture

Any swelling is an excess accumulation of fluid in tissues or cavities. Swelling accompanies injuries in most cases. In case of an ankle fracture, the causes of swelling are as follows:

Impaired blood flow to the affected area. Swelling in this case may appear immediately after the injury or some time after it.
Violation of the integrity of various structures: muscles, ligaments. In this case, their mobility may be limited or excessive. Both options are fraught with swelling.
Load on the injured limb. In case of a fracture, you need to provide rest to the sore leg, but not everyone follows these recommendations. The tissues are in the process of regeneration, and the load on the limb again provokes their injury. The body responds with swelling.

Separately, swelling of the ankle after a fracture, which occurs after the removal of the plaster, should be considered. The swelling in this case may be lymphatic, that is, the reason lies in the disruption of lymph production or its outflow.

When a fracture occurs, the leg is in a cast for a long time, so fluid circulation is disrupted. After removing the plaster, the process is sharply activated, the influx of lymph increases significantly, and its excess occurs - lymphatic edema.

Possible Causes of Ankle Pain

To answer the question of what to do if your ankle or bone on it is swollen and painful, you must first determine why this is happening. If pain and swelling occur in only one ankle, the reasons for this may be:

damage to one of the joints;
vein pathologies (thrombosis, varicose veins);
reaction to an insect bite;
endocrine disorders;
injuries (for example, the ankle is swollen when the leg is twisted);
diseases of the genitourinary system;
and some other health problems.

The causes of swelling and pain in both legs can be:

multiple injuries;
wearing uncomfortable shoes;
physical inactivity;
excessive weight;
pregnancy;
taking certain medications;
allergic reactions.

Most often, pain in the ankle occurs due to injuries and joint pathologies. The development of the disease is indicated by the constant nature of the pain, the appearance of extraneous sounds when moving the leg and prolonged stiffness of the joint. Swelling, redness of the skin and tenderness in the ankle, big toe or knee may indicate the development of stage 2 of any joint disease:

arthritis;
arthrosis;
gout;
and others.

Arthrosis and arthritis primarily affect cartilage tissue. They are characterized by slowly increasing pain, lameness or weakness in the limb. The affected joint begins to make clicking sounds or crunching sounds when moving. Often, patients try to shift their weight onto the healthy leg while walking. These diseases can be successfully treated in the early stages. At this time, the destruction of the joint has not yet gone too far, so it is possible, using therapeutic methods, to stop the development of the pathology and restore the joint tissue. In advanced cases, surgical intervention is often required. Swelling and severe pain can also occur due to gout. Gout attacks are characterized by:

sudden onset of acute pain, usually at night;
a feeling of fullness and burning in the affected joint;
temperature increase;
intoxication;
headache.

With gout, the extremities are most often affected; the ankle on the inside, the big toe, or the entire foot may swell. Such an attack lasts several days, then the disease stops bothering the person for a while, but if left untreated, the attacks will recur more and more often, and tophi may appear on the skin - small bumps containing uric acid crystals. Gout is associated with metabolic disorders (develops due to the accumulation of excess uric acid in the body) and destroys cartilage and joints, so if you suspect it, you should immediately visit a doctor. Modern treatment methods make it possible to achieve stable remission in this disease and get rid of acute attacks.

What to do to relieve swelling?

Immediately after receiving a fracture, before the doctor arrives, cold is applied to the affected area. This measure helps reduce swelling and pain. The injured limb must remain motionless. You should take any measures yourself only if the victim is bleeding or if you have to wait too long for a doctor.

The doctor reduces the fracture, but a cast is not always applied - if there is no displacement, there may be no need for it.

During treatment, you should make some dietary changes. Avoiding alcohol and limiting salt and foods containing it will help reduce swelling and the risk of its occurrence. Alcohol provokes fluid retention in the body, inhibits recovery processes, and is also contraindicated when taking certain medications.

Drug therapy

After a broken ankle, your doctor may prescribe several medications. They are necessary to relieve swelling, eliminate pain and accelerate regeneration.

Various topical products help relieve swelling:

Non-steroidal anti-inflammatory drugs . These medications provide a comprehensive effect, relieving swelling and pain. They often resort to Diclofenac, Ketonal. At the same time, drugs of the same group in tablets can be prescribed - they relieve pain better, but also help eliminate swelling. Ibuprofen and Nimesulide are usually used.
Anticoagulants . These drugs also provide a combined effect, including a decongestant effect and prevention of thrombus formation. Heparin-based medications are often prescribed: heparin ointment, Lyoton 1000, Lavenum.
Venotonics and venoprotectors . Drugs in this group relieve swelling well and additionally provide anti-inflammatory, antioxidant and anti-clotting effects. They usually resort to Troxerutin or Troxevasin.

diuretics may be prescribed . These drugs provide a diuretic effect, that is, they remove excess fluid from the body. They resort to Furosemide, Veroshpiron (Spironolactone), Torasemide.

Preparations for internal and external use should only be used in consultation with a doctor. Drug therapy is selected individually for each patient, and only a specialist can correctly assess the situation.

Massage

It is better to entrust this procedure to a specialist, but you can do the massage yourself. This measure allows you to disperse stagnant fluid and reduce swelling.

Massage of the affected limb should be done carefully. Stroking, rubbing, and light pinching are allowed. All movements should be soft.

To begin with, it is enough to massage for 5 minutes. Then the duration of the procedure can be increased to 10-15 minutes. Massage can be combined with the application of topical products.

To choose a product for external use, we suggest you read here about the most effective decongestant ointments.

Physiotherapy

This direction in medicine is very popular for various injuries, including a broken ankle. For swelling, the following procedures may be prescribed:

laser therapy – stimulation of metabolic processes in the body;
electrophoresis – performed with medications, ensures an increase in their effectiveness;
magnetotherapy – relieving swelling, pain, activating regenerative processes;
UV irradiation – normalization of blood flow to the affected area;
amplipulse therapy – normalization of microcirculation, elimination of hematomas, relief of painful sensations;
UHF therapy – removal of swelling, elimination of pain.

Physiotherapy should be carried out according to indications. The type of procedure and duration of therapy is determined by the attending physician. There are contraindications, including absolute ones.

ethnoscience

Traditional medicine will help eliminate swelling after an ankle fracture. The following remedies are effective:

Fir oil. The product should be gently rubbed into the affected area twice a day - in the morning and before bed. Fir oil not only reduces swelling, but also accelerates regenerative processes, and also provides a lot of other healing effects.
If the skin is not damaged, you can use a salt compress to relieve swelling. To do this, you need to prepare a 1:10 solution using distilled water. Fold the bandage several times, soak it in liquid and apply it to the swollen area. The compress should be changed several times - this should be done immediately after it dries. At night, the lotion can be fixed with polyethylene. If the leg is in a cast, then the compress is applied above it.
Dilute the blue clay with a small amount of warm water to form a thick mass. Form it into a cake and apply it to the affected area. You can use this remedy several times a day.
For swelling and hematoma, it is good to use laundry soap and salt. You should prepare a strip of linen fabric, moisten it generously with cold water, soap it and sprinkle with salt (use a fine-grained product). After 10 minutes, shake the cloth to remove excess salt and apply to the affected area.
Grind raw potatoes on a grater, apply the pulp to the swollen area, secure with film and insulate. Keep the compress for 2 hours.
Brew arnica: 1 tbsp. l. for 0.4 liters of boiling water. Leave for an hour, then filter. Moisten a bandage folded several times in the resulting infusion and apply to the affected area. It is enough to keep this lotion for 15 minutes. The procedure should be performed before bedtime.
Onions are useful for relieving swelling after a fracture. You can grind it into a paste and make a bandage, or squeeze out the juice and apply it to swollen areas. It is also useful to introduce onions into your diet - you should eat them raw, adding them to various dishes. The product has a diuretic effect, which means it is effective against edema.
Take a leaf of regular cabbage, rinse it well with your hands, apply it to the swollen area and fix it. This compress can be kept for up to 4 hours.

Traditional medicine should not replace basic treatment. Various prescriptions should be used additionally, having previously agreed with your doctor. The products may have contraindications and side effects.

Surgery for an ankle fracture

Ankle fractures are one of the most common reasons for visiting orthopedic traumatologists.

Conservative treatment using plaster immobilization is possible in situations of isolated fractures of the outer or inner ankles without displacement of bone fragments and damage to ligamentous structures. Even in cases of such isolated injuries, the period of immobilization cannot be less than 6 weeks, which ultimately significantly complicates rehabilitation and can lead to longer periods of disability in comparison with surgical treatment. The advantages of conservative treatment of ankle fractures are the absence of risks associated with surgery and anesthesia, as well as the absence of the need to remove metal fixators in the future.

So, the vast majority of ankle fractures require surgical intervention, in the absence of contraindications. Various classifications exist to assist in surgical planning and understanding the relationships between the various anatomical structures in the ankle and foot that may be affected by ankle fractures. The most widespread in international practice, detailed and assessing all aspects of both the injury itself and possible ways of treating it, is the AO classification. You can find it on the website of the International Association of Osteosynthesis.

Unfortunately, this classification is quite complex and cumbersome; we will not present it here in full, since only one third of it, belonging to group A, looks something like this:

Simplifying as much as possible, we can reduce ankle fractures to single/double/triple-malleolar fractures and their equivalents. Conservative treatment is only applicable in cases of unimalleolar fractures. In the conservative treatment of two- and three-malleolar fractures and their equivalents, secondary displacement is almost inevitable, which further leads to disruption of the relationship between the talus and the corresponding articular surfaces of the tibia and fibula, which in turn leads to improper load distribution and wear of the articular cartilage and the formation of post-traumatic arthrosis with severe impairment of the function of support and walking within 1-2 years after the injury. This is precisely what explains the increased interest of orthopedic surgeons in this type of injury over the past 2 decades.

The main goal of surgical treatment of an ankle fracture is to restore the normal relationship of the bones in the ankle joint. Even if the talus is displaced outward by 1 mm, the area of its contact with the tibial plateau decreases by 40%. It turns out that when the outer ankle is fused with a seemingly small displacement of 1 mm outward, 60% of the area will bear 100% of the load.

The second important point is to provide conditions for fracture healing due to close contact of bone fragments and their reliable fixation, preventing movement of fragments among themselves.

The third goal is to avoid immobilization. The plaster cast itself can cause significant harm to its owner in 6 weeks, leading to disruption of tissue nutrition, muscle atrophy, increasing the risk of deep vein thrombosis of the lower extremities, preventing movement in the joint, which can ultimately lead to its contracture. When osteosynthesis is performed correctly, movements in the ankle joint are allowed the very next day after surgery. You can see an article on surgery for an ankle fracture by following this link.

At our center, we try to provide assistance to patients with fractures of any location, including ankle fractures, as quickly and efficiently as possible. A complete preoperative examination and surgery are performed within the first 24 hours after presentation. In most cases, discharge under the supervision of a traumatologist at the clinic occurs on the second day after treatment and surgery. When you contact us, you will have X-rays taken to confirm the diagnosis, and transport plaster immobilization will be applied. Immediately before surgery, antibiotics are administered intravenously for prophylactic purposes. It is possible to use spinal anesthesia or endotracheal anesthesia. In order to reduce the stress from surgery, you will be put into a medicated sleep 10 minutes before the operation, and you will also wake up 10 minutes after its completion. During the operation, the orthopedic surgeon will perform an open comparison of the fragments with their fixation with plates and screws. You will need crutches after surgery, as full weight bearing is still not recommended until the fracture has healed. The next day after the operation, you will be bandaged, taught how to walk correctly with additional support on crutches and what exercises to do to develop movements and strengthen the muscles of the lower leg, after which you can be discharged home.

When an ankle is fractured, a surgical intervention is performed called: open reduction and internal fixation, or osteosynthesis. To access the broken bone, incisions are made outside the projection of large neurovascular bundles.

The broken bone is exposed, bone fragments are compared, and temporary fixation is performed using bone holders, knitting needles, and bone pins. Next, osteosynthesis is performed using plates and screws. The temporary fixation is removed.

Hemostasis is performed, the wound is sutured layer by layer, an aseptic bandage and elastic compression are applied.

After the operation, the leg should be elevated, ice is placed through a bandage on the surgical area (best is a soft rubber heating pad filled with ice and cold water) for 30 minutes every 3 hours. This helps reduce swelling and pain in the intervention area. After surgery, you will be given painkillers and anti-inflammatory medications. On the evening of the day of surgery or the day after surgery, a physical therapy instructor will teach you how to walk correctly with additional support on crutches and show you exercises that you will need to perform to maintain the mass and strength of the lower leg muscles. You will be bandaged the morning of the next day after surgery. After this, you can be discharged under the supervision of a traumatologist at your place of residence. At home, you should also continue to use limb elevation and ice to help swelling and pain go down more quickly. 2 weeks after the operation you will need to come to the clinic to have the stitches removed. After 6 weeks, X-ray control is performed and if there are signs of consolidation, weight bearing on the leg is allowed. It usually takes about 2 more weeks to fully restore limb function. At this stage, it is very useful to work with a physical therapy instructor. Forced (sports) loads on the leg are not recommended until 6-12 months after the injury.

There are a number of complications typical for any surgical intervention and for any type of anesthesia. Surgery for broken ankles is no exception. These include infection, damage to blood vessels and nerves, bleeding, and deep vein thrombosis. Their risk does not exceed 2% of the total number of interventions.

There are also specific complications. These include stiffness of the ankle joint, weakness of the lower leg muscles, and the formation of post-traumatic arthrosis of the ankle joint. These risks largely depend on the morphology of the fracture, the presence of concomitant diseases, such as diabetes, autoimmune diseases requiring steroid medications, and smoking.

The plates and screws used in modern surgical practice are made of either titanium alloy or surgical steel, which do not cause a reaction from the body. Their removal is indicated in cases where they cause irritation of soft tissues due to mechanical damage, in cases of infectious complications, as well as when the patient insists. It is also often necessary to remove the positioning screw after 6-8 weeks when fixing the tibiofibular syndesmosis. Complete removal of metal fixators for ankle fractures is recommended no earlier than 12 months after surgery.

Patient T., 80 years old. Trauma 3 weeks before treatment, she received a fracture of both ankles of the right leg with displacement, subluxation of the foot outward. I contacted the RTP, an X-ray was taken, and a plaster cast was applied. Due to persistent severe swelling and pain, she went to the K+31 clinic.

X-rays in the cast reveal a significant outward subluxation of the talus and a consolidating fracture of the lower third of the fibula.

On the day of presentation, the patient was thoroughly examined, surgical treatment was performed, open reduction, osteosynthesis of the fracture of the lower third of the fibula with a plate, the inner ankle with a screw, the inner ankle was additionally fixed with an anchor.

On control radiographs after surgery, the position of the fragments and metal fixators is correct, and the subluxation of the talus has been eliminated.

The patient was discharged on the 2nd day after surgery for outpatient follow-up care.

Patient L., 50 years old, injured at home, received a closed fracture of both ankles with a dislocation of the foot outward and backward. This case is interesting due to the significant damage to the soft tissue that occurred during the injury and required significant efforts to combat swelling, as well as the morphology of the fracture of the medial malleolus, which broke in one large block along with the posterior edge of the tibia, which required its fixation with a plate and screws.

Due to severe swelling of the soft tissues, a high risk of necrosis of the wound edges and infectious complications, the patient underwent skeletal traction, vascular and metabolic therapy, lymphatic drainage, and physiotherapy for preoperative preparation. After the swelling subsided, on the 3rd day after admission, surgical intervention was performed: open reduction, osteosynthesis of fractures of the outer and inner malleoli with plates and screws.

After 4 days, the patient was discharged for outpatient follow-up treatment. Postoperative wounds healed by primary intention, the sutures were removed after 14 days.

6 weeks after the initial intervention, the positioning screw was removed, and the patient began to actively develop movements in the ankle joint.

The range of motion 8 weeks after injury and surgery for this severe injury is close to full. The patient walks with full support, without using crutches or a cane, does not limp, and is not bothered by pain. Moderate swelling in the ankle joint remains.

You can see another article on ankle fractures here.

Preventing swelling after an ankle fracture

To avoid swelling, you must follow these recommendations:

when the fracture is fixed, position the affected limb horizontally with a slight elevation;
a slight elevation of the injured leg should be provided for at least a week after applying the plaster;
in a standing position, you cannot lean on the injured leg - such a measure may be required even after the cast is removed;
if a temporary plaster cast is applied, then it is necessary to use an elastic bandage over it - it should provide reliable fixation, but not put too much pressure, otherwise the blood flow will be disrupted;
Before removing the plaster, be sure to take an x-ray - the image is necessary to check the condition of the soft tissues and bone structures.

After removing the plaster, it is necessary to follow the rules of the rehabilitation period. You can reduce the risk of swelling during this period by strictly following all doctor’s instructions. It is useful to massage, dispersing stagnant fluid. Physical activity should be limited, sudden movements should be avoided, and an elastic bandage or a special orthosis for the ankle joint should be used to fix the leg.

Swelling after an ankle fracture is common. Several factors provoke its occurrence. Swelling can be eliminated using various methods, including drug therapy, massage, physiotherapy, and folk remedies. It is more effective to use several directions at once, not forgetting the doctor’s recommendations.

What to do if swelling occurs

An elastic bandage helps control swelling
If your ankle becomes swollen while wearing a cast, you should contact your doctor and undergo physical therapy. You can begin the procedures even before removing the immobilizing bandage. While wearing a plaster compress, you can sign up for a therapeutic massage. It is done through the pad, gently, so as not to damage either it or the patient’s leg.

If swelling appears only after removing the plaster cast, it can be eliminated using external means. You can use cream to relieve swelling and healing, folk recipes.

When the patient begins to walk, the swelling should subside. For this, a special elastic bandage is applied. It can be made from an elastic bandage or purchased at orthopedic salons and pharmacies. Such a bandage relieves pain, maintains joints in the correct position, and removes swelling in a conservative way.

The most serious attention should be paid to situations where swelling is accompanied by severe pain, hematomas are noticeable, and there is a sensation of itching and burning.

It is likely that inflammation develops or the bone does not heal properly, and there is a risk of rupture of blood vessels and re-injury of the ankle. In such a situation, you cannot leave everything to chance; you must immediately consult a doctor.

Ointments to eliminate swelling

The easiest and fastest way to remove swelling is to buy ointment at any available pharmacy. The following drugs are available without a prescription:

ichthyol ointment;
ketoprofen ointment.

The compositions are applied to the problem area according to the recipe 1-3 times a day. You can’t overdo it so as not to get vasoconstriction.

Before use, you need to familiarize yourself with the list of contraindications. The swelling may remain for several hours, but will then resolve.

Physical therapy to reduce swelling

Electrical stimulation of leg muscles
Physiotherapy helps restore blood flow, tissue regeneration, and stimulate muscles and skin. To relieve swelling, the following procedures are usually prescribed:

Electrical muscle stimulation. The swelling may go away in 2-3 days. The damaged area will heal quickly. At the same time, the time required for recovery will be reduced several times.
Water procedures. They are prescribed after the removal of the plaster or other lining. Most often, hydromassage is chosen to stimulate blood flow, accelerate regeneration and restore muscles. All together this gives a positive effect and almost instantly relieves swelling. But only temporarily, it can occur again.
Phonophoresis. It is prescribed much less frequently, but it will permanently reduce the likelihood of swelling.
Ultraviolet rays are used as non-standard therapeutic methods of treatment. They have a beneficial effect on the ankle if they are directed in a beam at one point.
Electrophoresis. Exposure to direct current, which promotes deep penetration of the drug into the tissue.

Physiotherapy may be prescribed both before and after the cast is removed. It is mandatory for those who have severely reduced limb mobility and are predisposed to edema.

Massage to relieve symptoms

Therapeutic massage to relieve swelling
Professional slow massage should be carried out in three stages: warming up, warming up and moving fluid.

Sometimes masters in massage parlors and clinics use special massage devices to quickly get rid of swelling. Manual therapy and lymphatic drainage are the most effective ways to deal with fluid stagnant in soft tissues. However, massage is not suitable for patients who have just had their cast removed. They are susceptible to secondary injuries to bones, muscles and blood vessels. You can break a bone a second time. Experts recommend resorting to them only after a three-month course of recovery from the moment of fracture.

If the massage is performed incorrectly, it can lead to unpleasant external changes.

The limb becomes more prominent and strong over time. If you massage only it, a difference will be noticeable, which will have to be eliminated with another course of procedures.

After rubbing, movements are made with one and two hands to the side, across the foot. Light pinches, blows, and pats are acceptable. The master must go over the entire surface of the leg.