Eight Months Post-Ankle Fracture: Struggling to Walk Normally

Eight months after a right ankle fracture, I am still unable to walk normally?

Hello Doctor: I have a right ankle fracture due to a car accident.
It has been eight months since the injury.
Currently, the following is known:
(1) Musculoskeletal ultrasound report: right ankle shows irregular echogenicity on the lateral side of the anterior talofibular ligament (ATF), and hypoechogenicity on the lateral side of the ankle joint.

(2) Peroneal nerve damage.

(3) X-ray taken four months post-fracture.

I kindly ask the doctor to explain:
a.
What does my musculoskeletal ultrasound report mean?
b.
I have been undergoing very aggressive treatment, both Western and traditional medicine, but I am still limping and experiencing daily foot numbness and pain.
What should I do to be able to walk normally like everyone else? (I have already undergone nearly 70 rehabilitation sessions and have been taking the prescribed vitamin F50 for two months.) Thank you, Doctor.

jant, 40~49 year old female. Ask Date: 2018/12/27

Dr. Zhan Xian reply Orthopedics

Ankle fractures accompanied by nerve injury require both physical and neurological examinations, as they are not merely simple fractures.
The treatment duration is longer.
If there are any discomfort or questions, please visit the orthopedic outpatient clinic.

Reply Date: 2018/12/27

More Info

It sounds like you've been through a challenging journey with your ankle fracture, and I commend your commitment to recovery. Let's break down your concerns regarding your current situation eight months post-injury.

a. Understanding Your Musculoskeletal Ultrasound Report
The ultrasound report indicates "irregular echogenicity" in the lateral side of the anterior talofibular ligament (ATF) and "hypoechogenicity" in the lateral side of the ankle joint. In simpler terms, this means that there are abnormalities in the tissue structure of the ATF ligament and possibly surrounding soft tissues. Irregular echogenicity can suggest inflammation, scar tissue, or even partial tears, while hypoechogenicity often indicates fluid accumulation or edema, which could be a sign of ongoing inflammation or injury.

These findings are not uncommon after an ankle fracture, especially if there has been nerve involvement or prolonged immobilization. The presence of these abnormalities may contribute to your ongoing symptoms of pain and instability.

b. Addressing Your Ongoing Symptoms and Recovery Challenges
It's understandable to feel frustrated after eight months of rehabilitation and still experience pain and difficulty walking. Here are some considerations and recommendations to help you move forward:
1. Continued Rehabilitation: While you have already undergone extensive rehabilitation (70 sessions), it may be beneficial to reassess your rehabilitation program. Working with a physical therapist who specializes in post-fracture recovery can help tailor a program that addresses your specific needs. Focus on exercises that improve strength, flexibility, and proprioception (the sense of body position).

2. Pain Management: Since you are experiencing persistent pain and numbness, it’s crucial to discuss these symptoms with your healthcare provider. They may recommend pain management strategies, which could include medications, physical therapy modalities (like ultrasound or electrical stimulation), or even injections if appropriate.

3. Neurological Assessment: Given the reported damage to the peroneal nerve, it may be beneficial to consult a neurologist or a specialist in nerve injuries. They can assess the extent of nerve damage and suggest treatments that may help alleviate symptoms like numbness and tingling.

4. Gradual Return to Activity: If you are not already doing so, consider incorporating low-impact activities that do not exacerbate your symptoms, such as swimming or cycling. Gradually increasing your activity level can help improve muscle strength and joint function without putting excessive strain on your ankle.

5. Orthotic Support: Using ankle braces or orthotic devices can provide additional support during your recovery. These devices can help stabilize the ankle and reduce the risk of re-injury while you regain strength and mobility.

6. Nutrition and Supplements: Continue to focus on a balanced diet rich in vitamins and minerals that support bone health, such as calcium and vitamin D. If you are taking supplements like the one you mentioned (likely a multivitamin), ensure they are appropriate for your needs and discuss any additional supplements with your healthcare provider.

7. Patience and Mental Health: Recovery from an injury like yours can be a long and sometimes frustrating process. It’s essential to be patient with yourself and acknowledge the progress you have made, even if it feels slow. Consider speaking with a mental health professional if you find that the emotional toll of your recovery is becoming overwhelming.

Conclusion
In summary, your ultrasound findings indicate some ongoing issues that may be contributing to your symptoms. A comprehensive approach involving continued rehabilitation, pain management, and possibly further neurological evaluation will be essential in your recovery journey. Remember, healing takes time, and it’s important to stay proactive in seeking the support you need. Keep communicating with your healthcare team, and don’t hesitate to ask for adjustments to your treatment plan as necessary. Wishing you a smooth and successful recovery!

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