Managing Ankle Fractures: Pain, Recovery, and Exercises to Prevent Muscle Atrophy

Ankle fracture exercise issues?

If someone has a fibula fracture on the outer side of the ankle and has been in a cast for three months without removal, and the ankle is still not completely reduced in swelling, it is normal to experience pain on the left side of the ankle when attempting to walk with a crutch as advised by the doctor.
Pain can be a common response during the healing process, especially if the area is still sensitive or if there is residual swelling.
To prevent muscle atrophy while in a cast, you can consider the following exercises, as long as they do not cause pain:
1.
Isometric Exercises: Tensing the muscles around the ankle without moving the joint can help maintain muscle strength.
For example, try to tighten the calf muscles or the muscles around the thigh.
2.
Range of Motion Exercises: If permitted by your doctor, gently moving the toes and foot within a pain-free range can help maintain flexibility.
3.
Upper Body Exercises: Engaging in upper body workouts, such as seated arm raises or resistance band exercises, can help maintain overall fitness.
4.
Non-weight-bearing Activities: If you have access to a stationary bike or a leg extension machine that does not put weight on the injured ankle, these can be beneficial.
Always consult with your healthcare provider or a physical therapist before starting any new exercise regimen to ensure it is safe and appropriate for your specific condition.

Mr. Huang, 30~39 year old female. Ask Date: 2017/03/07

Dr. Shi Guozheng reply Orthopedics

It is normal to perform up and down movements of the ankle joint after the cast is removed, as well as eversion and inversion exercises.
You can try putting weight on it; if there is no pain, you can gradually increase the load.

Reply Date: 2017/03/07

More Info

Managing an ankle fracture, particularly one involving the fibula, requires careful attention to pain management, recovery strategies, and exercises to prevent muscle atrophy. It’s common for patients to experience pain and swelling even after several weeks of immobilization in a cast. Here’s a comprehensive overview of what you might expect and what you can do to aid your recovery.

Understanding Pain and Swelling
After three months in a cast, it’s not unusual to still experience some pain and swelling around the ankle, especially if you’ve recently started to bear weight on it. The pain you feel on the left side of your ankle could be due to several factors:
1. Healing Process: The bone and surrounding soft tissues are still healing. Pain can be a normal part of this process, especially when you start to use the ankle again.

2. Immobilization Effects: Prolonged immobilization can lead to stiffness and discomfort as your body adjusts to movement again. The muscles around the ankle may have weakened due to disuse, contributing to pain when you start to walk.

3. Weight Bearing: Transitioning from a non-weight-bearing state to using crutches or a cane can be challenging. If you’re feeling pain when attempting to walk, it’s essential to listen to your body and not push through severe discomfort.

Exercises to Prevent Muscle Atrophy
While you are in a cast, your ability to perform traditional exercises is limited. However, there are still several strategies you can employ to maintain muscle strength and prevent atrophy:
1. Isometric Exercises: These involve contracting your muscles without moving the joint. For your calf and thigh muscles, you can try:
- Calf Raises: Stand on your good leg and raise your heel off the ground, holding for a few seconds before lowering.

- Quadriceps Sets: While sitting or lying down, tighten your thigh muscle and hold for a few seconds, then relax.

2. Upper Body Exercises: Engage in upper body workouts to maintain overall fitness. This can include seated dumbbell exercises, resistance band workouts, or even chair yoga.

3. Range of Motion Exercises: If your doctor approves, you can gently move your toes and foot within the limits of your cast. This helps maintain some flexibility and circulation.

4. Aquatic Therapy: If you have access to a pool and your doctor permits it, water exercises can be beneficial. The buoyancy of water reduces stress on your ankle while allowing you to move.

5. Gradual Weight Bearing: As you start to walk with a crutch, gradually increase the time you spend on your feet. Use the crutch to support your weight and avoid putting too much pressure on the injured ankle.

Recovery and Follow-Up
It’s crucial to follow your doctor’s advice regarding weight-bearing activities. If the pain persists or worsens, or if you notice increased swelling, it’s essential to communicate this with your healthcare provider. They may need to reassess your injury and recovery plan.

Nutrition and Healing
In addition to physical activity, consider your nutrition as part of the recovery process. A balanced diet rich in protein, vitamins (especially Vitamin D and calcium), and minerals will support bone healing and muscle recovery. Staying hydrated is also essential.

Conclusion
In summary, while experiencing pain and swelling after three months in a cast is not uncommon, it’s vital to approach your recovery with care. Engage in isometric exercises, maintain upper body strength, and gradually increase your weight-bearing activities as tolerated. Always consult with your healthcare provider before starting any new exercise regimen or if you have concerns about your recovery. Remember, patience is key in the healing process, and taking the right steps now will help ensure a successful return to full activity in the future.

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