Pain While Walking After a Fracture: Causes and Solutions

Experiencing pain while practicing walking after a fracture is common?

Hello, I suffered a comminuted fracture of the tibia and fibula on November 10, 2017, due to an accidental fall.
I underwent surgery the same day to have plates and screws inserted.
During my follow-up appointment on December 8, I had an X-ray taken, and the doctor advised that I only needed to use a single crutch, so at home, I have been walking while holding onto the walls.
However, when I go outside, I must use a crutch.
The doctor also encouraged me to return to work at any time, which led me to believe that my recovery was progressing well.

On December 18, I went out for an errand and ended up walking more than I intended (from 11:30 AM to 3:30 PM, walking and stopping intermittently).
Halfway through, I suddenly felt a sharp pain at the upper edge of the plate on my tibia, as if I had been electrocuted.
I immediately took a taxi to see the doctor and requested an X-ray for confirmation.
However, the doctor declined, stating that I had just had an X-ray during my last visit and that frequent imaging could be harmful.
He suggested that my pain was due to walking too much and prescribed painkillers, muscle relaxants, and stomach medication, asking me to return for another X-ray on December 28.

I am a bit worried.
Could it be that my poor posture is causing a stress fracture along the area of the plate? Or am I just overthinking it and it's simply due to walking too long?

Fang Fang, 20~29 year old female. Ask Date: 2017/12/19

Dr. Chen Yongxue reply Orthopedics

Hello, if there has been no undue external force after the surgery, there should not be any "fracture along the plate." Please try not to worry too much and make sure to attend your follow-up appointments.
Thank you.

Reply Date: 2017/12/19

More Info

Understanding pain while walking after a fracture can be a complex issue, as it often involves multiple factors related to the healing process, biomechanics, and individual patient circumstances. In your case, having sustained a severe injury like a tibial and fibular fracture, followed by surgical intervention with plates and screws, it is not uncommon to experience pain during the rehabilitation phase.

Causes of Pain After a Fracture
1. Healing Process: After a fracture, the body goes through a healing process that can take weeks to months. During this time, the bone regenerates and remodels, which can lead to discomfort. The pain you experienced after walking for an extended period may be due to the stress placed on the healing bone and surrounding tissues.

2. Biomechanical Changes: Following a fracture, the way you walk (gait) may change to compensate for pain or weakness. This altered gait can place additional stress on other joints and muscles, leading to pain. For instance, if you are favoring one leg or adjusting your posture to avoid discomfort, this can result in overuse injuries in other areas, such as the knee, hip, or lower back.

3. Nerve Sensitivity: After a significant injury, the nerves in the affected area may become more sensitive. This condition, known as central sensitization, can cause pain to feel more intense than it would otherwise. The sensation of being "zapped" or experiencing sharp pain can be attributed to this heightened sensitivity.

4. Muscle Weakness and Atrophy: Prolonged immobilization due to a fracture can lead to muscle weakness and atrophy. When you start walking again, the muscles may not be strong enough to support the joint properly, leading to pain and instability.

5. Scar Tissue Formation: Surgical interventions can lead to the formation of scar tissue, which may restrict movement and cause discomfort. This scar tissue can affect the surrounding muscles and tendons, leading to pain during activities like walking.

Solutions and Management Strategies
1. Physical Therapy: Engaging in a structured physical therapy program can be immensely beneficial. A physical therapist can help you with exercises that strengthen the muscles around the injured area, improve your gait, and increase your range of motion. They can also provide modalities such as ultrasound or electrical stimulation to help manage pain.

2. Gradual Increase in Activity: It is essential to gradually increase your activity level. Start with short walks and slowly build up your endurance. Listen to your body; if you experience pain, it may be a sign that you are pushing too hard too soon.

3. Pain Management: Over-the-counter pain relievers, such as NSAIDs (e.g., ibuprofen), can help manage pain and inflammation. However, it is crucial to follow your doctor's recommendations regarding medication use.

4. Gait Training: Working with a physical therapist on gait training can help correct any compensatory movements that may be causing pain. They can provide feedback on your walking pattern and suggest adjustments to improve your biomechanics.

5. Regular Follow-ups: Continue to have regular follow-ups with your orthopedic surgeon or healthcare provider. They can monitor your healing progress through physical examinations and imaging studies as needed, ensuring that there are no complications such as non-union or malunion of the fracture.

6. Mindfulness and Relaxation Techniques: Since pain can also be exacerbated by stress and anxiety, incorporating mindfulness practices, such as deep breathing or meditation, may help you manage your pain perception.

Conclusion
Experiencing pain while walking after a fracture is a common concern and can stem from various factors related to the injury and recovery process. By understanding these causes and implementing appropriate management strategies, you can work towards a more comfortable and effective rehabilitation. Always consult with your healthcare provider before making significant changes to your treatment plan or activity level.

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