Do I Need Surgery for My Old Ankle Injury? Your Options

Do I need surgery for an old ankle injury?

Hello doctor, I fractured my ankle when I was about 19 years old.
At that time, the doctor at Mennonite Hospital told me that my right ankle was slightly displaced and that there was a small crack in my tibia, recommending surgery.
However, after switching to Tzu Chi Hospital, they just put me in a cast.
After healing, I didn't feel any abnormalities in my leg for about 10 years; I could run, walk, and jump normally.
Now at 33 years old, I've gained about 20 kg compared to the past.
A few years ago, I wore wooden-soled leather shoes for about two to three years.
Last year, I noticed that my heel would hurt when I walked, and during a trip to Japan, I developed plantar fasciitis.
So this year, I switched to leather shoes with air cushioning.
Walking in them doesn't cause any particular pain.
However, recently, whenever I go to the gym and do exercises that impact my heel (like on the stair climber or treadmill—pure brisk walking is fine), the heel might hurt for about 3 to 4 weeks.
Walking causes a sharp pain whenever my heel touches the ground.
But if I use the elliptical machine for 30 minutes, my foot feels fine.
I also feel like my foot fits more snugly in shoes, but there's no visible swelling.
When comparing the flexibility of both ankles, I can't see any differences.
I've been wondering if this is psychological.
I'm not sure if this is due to the old injury from when I was 19, combined with aging, or if it's really from wearing those wooden-soled shoes for too long.
Should I see a rehabilitation specialist or go directly to an orthopedic doctor? As a working professional who commutes by bike, I hope to avoid surgery if possible.

Niu, 30~39 year old female. Ask Date: 2017/07/17

Dr. Shi Guozheng reply Orthopedics

Plantar fasciitis requires wearing shoes with softer soles to reduce pressure on the plantar fascia.
Additionally, being overweight can increase stress on the plantar surface.
It is advisable to consult an orthopedic specialist.

Reply Date: 2017/07/17

More Info

When considering whether you need surgery for an old ankle injury, it's essential to evaluate your current symptoms, the history of your injury, and the impact on your daily life. Based on your description, it seems that you had a minor ankle injury at 19, which was treated conservatively with a cast instead of surgery. For about a decade, you experienced no significant issues, but now at 33, you are encountering pain in your heel and discomfort during certain activities, particularly those involving impact.

Understanding Your Symptoms
1. Pain on Impact: The pain you experience after high-impact activities, such as using the stair stepper or treadmill, suggests that your ankle may be sensitive to stress. This could be due to several factors, including:
- Post-Traumatic Changes: Even if you felt fine for many years, the initial injury could have led to subtle changes in the joint or surrounding tissues that may now be manifesting as pain.

- Overuse Injuries: Given your recent increase in activity and weight, you may be experiencing overuse injuries, such as tendinitis or plantar fasciitis, especially since you mentioned having plantar fasciitis symptoms during your trip to Japan.

- Footwear Impact: Wearing shoes that do not provide adequate support or cushioning can exacerbate existing conditions or lead to new ones.

2. No Visible Swelling or Deformity: The absence of swelling or visible deformity is a positive sign, indicating that there may not be an acute injury or significant structural damage. However, pain can still occur due to underlying issues that are not immediately visible.

When to Consider Surgery
Surgery is typically considered when:
- There is significant structural damage that cannot be managed conservatively.

- Pain persists despite conservative treatment (rest, physical therapy, orthotics).

- Your quality of life is severely affected, limiting your ability to perform daily activities or enjoy recreational activities.

Next Steps
1. Consultation: Given your symptoms, it would be wise to consult with a healthcare professional. You can start with either a physical therapist or an orthopedic specialist. A physical therapist can assess your movement patterns, strength, and flexibility, and may provide exercises to alleviate your symptoms. If they suspect a more serious underlying issue, they can refer you to an orthopedic surgeon.

2. Imaging Studies: If your symptoms persist, your doctor may recommend imaging studies, such as X-rays or an MRI, to evaluate the condition of your ankle joint and surrounding structures. This can help identify any degenerative changes, ligament injuries, or other issues that may require surgical intervention.

3. Conservative Management: Before considering surgery, explore conservative management options:
- Physical Therapy: A tailored rehabilitation program can strengthen the muscles around your ankle, improve flexibility, and reduce pain.

- Orthotics: Custom or over-the-counter orthotic inserts can provide additional support and cushioning, potentially alleviating pain during activities.

- Activity Modification: Adjusting your exercise routine to include low-impact activities can help manage pain while maintaining fitness.

4. Monitoring Symptoms: Keep track of your symptoms, noting any changes in pain intensity, frequency, or triggers. This information will be valuable for your healthcare provider in determining the best course of action.

Conclusion
In summary, while surgery may be an option if conservative treatments fail, it is essential to first explore non-invasive approaches. Consulting with a healthcare professional will provide clarity on your condition and the best path forward. Remember, many individuals with a history of ankle injuries can manage their symptoms effectively without surgery, especially with the right support and rehabilitation strategies.

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