Post-Cast Recovery: Addressing Pain and Mobility Issues After a Fracture

Issues Following Cast Removal After Fracture

Hello Doctor, two months ago I had a car accident and fractured the third metatarsal of my second toe.
I was in a cast for six weeks, and when it was removed, there was still a small gap at the fracture site.
The doctor said it would heal on its own and that I could start walking, but now, two months later, I still feel some pain at the fracture site.
Additionally, because I was in the cast for so long without movement, I have developed a hard lump on the sole of my foot.
The doctor mentioned that there might be muscle fibrosis.
What should I do about this? Also, the joint connecting my foot and calf is difficult to bend, making it hard for me to squat, and I feel a lot of strain.
I also hit my knee against a railing during the accident, but I didn't treat it properly; I just applied a medicated patch and occasionally massaged it.
Now my knee hurts when I walk, and my gait has become uneven.
What should I do? I really want to walk normally again! Please help me, thank you.

Wang Ying'en, 10~19 year old female. Ask Date: 2016/04/06

Dr. Chen Yongxue reply Orthopedics

After applying a cast, joint stiffness is a common issue that is bound to occur.
However, after the cast is removed, it is essential to engage in rehabilitation activities diligently and not to fear pain.
The more consistently you rehabilitate, the lower the chance of stiffness.
Additionally, rehabilitation is time-sensitive; those who are afraid of pain and avoid movement may miss the critical window for recovery, leading to irreversible stiffness.
Furthermore, regarding knee joint issues, it is unlikely that a single impact would cause such significant long-term effects.
Please follow up with an orthopedic clinic for further evaluation.
Thank you.

Reply Date: 2016/04/06

More Info

Post-cast recovery can be a challenging period, especially after a fracture. It is not uncommon to experience pain and mobility issues even after the cast has been removed. Based on your description, it seems you are dealing with a few interconnected problems: residual pain at the fracture site, stiffness in the ankle joint, and potential muscle fibrosis due to prolonged immobilization.

Firstly, regarding the pain at the fracture site, it is important to understand that bone healing can take time. Even if the doctor mentioned that the fracture would fill in on its own, the healing process can vary significantly from person to person. Factors such as age, overall health, and the specific nature of the fracture can influence recovery. If you are still experiencing pain two months post-cast, it may be worthwhile to follow up with your orthopedic doctor. They might recommend imaging studies, such as an X-ray, to ensure that the bone is healing properly and to rule out any complications, such as non-union or malunion of the fracture.

As for the stiffness in your ankle joint, this is also a common issue after being in a cast for an extended period. When a joint is immobilized, the surrounding muscles can weaken, and the joint itself can become stiff due to lack of movement. This condition is often referred to as "joint stiffness" or "ankle stiffness." To address this, physical therapy is highly recommended. A physical therapist can provide you with a tailored rehabilitation program that includes exercises to improve range of motion, strengthen the muscles around the joint, and enhance overall mobility. Gentle stretching and strengthening exercises can help restore function and reduce stiffness.

Additionally, you mentioned the presence of hard lumps on your foot, which may indicate muscle fibrosis or scar tissue formation. This can occur when muscles are not used for an extended period. Again, a physical therapist can assist in addressing this issue through specific techniques such as manual therapy, ultrasound therapy, or targeted exercises to help break down the fibrous tissue and improve flexibility.

Regarding your knee pain, it is essential to assess whether the pain is due to the previous injury or if it is related to compensatory movements caused by your altered gait. If you have been limping due to pain in your foot, this can place additional stress on your knee joint, leading to discomfort. It would be beneficial to have a comprehensive evaluation of your knee by a healthcare professional. They may suggest imaging studies to rule out any underlying issues, such as ligament injuries or cartilage damage.

In summary, here are some steps you can take to facilitate your recovery:
1. Follow Up with Your Doctor: Schedule an appointment with your orthopedic surgeon to discuss your ongoing pain and any concerns about your fracture healing.

2. Engage in Physical Therapy: A physical therapist can provide a structured rehabilitation program to address stiffness, improve strength, and enhance mobility.

3. Perform Gentle Exercises: Incorporate gentle stretching and strengthening exercises as recommended by your therapist to regain range of motion in your ankle and knee.

4. Monitor Your Pain: Keep track of your pain levels and any changes in your symptoms. If your pain worsens or new symptoms arise, seek medical attention promptly.

5. Be Patient: Recovery can take time, and it is essential to be patient with your body as it heals. Gradual progress is often the key to a successful recovery.

By taking these steps, you can work towards regaining normal function and alleviating pain in your foot and knee. Remember, communication with your healthcare team is vital to ensure you receive the appropriate care and support throughout your recovery journey.

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