Foot Pain After Tibia and Fibula Fractures: Next Steps

Plantar pain due to tibial and fibular fractures?

Hello Dr.
Chen, I sustained fractures of the left tibia and fibula on February 10 (the X-ray only showed the fibula fracture, while the tibia fracture was identified through a CT scan, which was not visible on the X-ray).
I subsequently underwent open reduction and internal fixation surgery.
A bone plate and screws were placed in the fibula, and another bone plate and screws were placed near the ankle joint in the tibia.
I was in a cast for two and a half months.
In early May, the orthopedic surgeon said the bones were healing well, but I still experienced significant pain while walking and needed crutches to move.
The orthopedic surgeon recommended physical therapy, and I continued with hydrotherapy and walking exercises at the hospital.
By the end of June, the range of motion in my ankle had recovered to about 80%, but I experienced numbness and pain throughout the sole of my foot.
When I returned to the orthopedic clinic, the doctor suggested it might be plantar fasciitis.
The rehabilitation physician also added treatments for plantar fasciitis to my therapy plan.
However, by the end of July, I still felt numbness and pain in the ball of my foot and heel, with only slight relief from the pain.
I would like to know if I should consult another orthopedic or rehabilitation specialist to confirm whether my foot pain is indeed plantar fasciitis.
The physical therapist mentioned that it could also be due to the bone plate in the tibia compressing a nerve near the ankle joint and suggested I see a neurosurgeon.
What should I do? Thank you, Dr.
Chen, for patiently reading my question.
I appreciate it!

Mi Ya, 40~49 year old female. Ask Date: 2020/07/30

Dr. Chen Bochen reply Orthopedics

I would like to ask if I should consult another orthopedic or rehabilitation specialist to confirm whether my foot pain is indeed plantar fasciitis? It would be advisable to find a physician who performs musculoskeletal ultrasound, as rehabilitation specialists typically do this more often.
The physical therapist mentioned that it could also be due to the plate near the ankle compressing the nerve, and suggested I see a neurosurgeon.
What should I do?
1.
The plate near the ankle is more likely to affect the nerves that control the dorsiflexion of the foot, while the nerves that innervate the plantar aspect of the foot are generally less affected.

2.
There are a few rehabilitation, orthopedic, and neurosurgeons who perform injection treatments for adhesions; I recommend searching online for such specialists.

3.
Once your fracture heals and the plate is removed, your chances of recovery will be higher.
Wishing you a speedy recovery.

Reply Date: 2020/07/30

More Info

After experiencing a tibia and fibula fracture, it is not uncommon to encounter ongoing pain and discomfort, especially when walking. The surgical intervention you underwent, which involved open reduction and internal fixation with plates and screws, is a standard procedure aimed at stabilizing the fractured bones. However, the recovery process can be complex and may involve several factors contributing to your current symptoms.

Firstly, it is essential to understand that the pain you are experiencing while walking, even after a significant period of rehabilitation, can be attributed to several potential causes. One common issue following such fractures is the development of post-traumatic osteoarthritis, which can occur due to the trauma to the joint surfaces during the injury. This condition can lead to pain, stiffness, and swelling in the affected area.

Additionally, your symptoms of numbness and tingling in the plantar aspect of your foot may suggest the possibility of nerve compression. As mentioned by your physical therapist, the hardware (plates and screws) used in your surgery could potentially be pressing against nearby nerves, leading to these sensations. This is particularly relevant if the pain is localized around the ankle joint where the tibia is fixed.

Another potential diagnosis, as suggested by your orthopedic doctor, is plantar fasciitis, which is inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of your foot. This condition is often characterized by sharp heel pain and can be exacerbated by prolonged periods of standing or walking, particularly if your foot mechanics have been altered due to the injury.

Given the complexity of your symptoms, it may be prudent to seek a second opinion from another orthopedic specialist or a rehabilitation physician. A thorough evaluation, including imaging studies such as X-rays or MRIs, can help determine if there are any complications related to the hardware or if there is another underlying issue contributing to your pain.

In the meantime, continuing with physical therapy is crucial. Your therapist can provide targeted exercises to strengthen the muscles around your ankle and improve flexibility, which may alleviate some of the discomfort. Modalities such as ultrasound therapy, electrical stimulation, or even dry needling may also be beneficial in managing pain and promoting healing.

You might also consider using orthotic devices, such as custom foot orthotics, which can help support your foot's arch and redistribute pressure away from painful areas. These devices can be particularly helpful if you are dealing with plantar fasciitis or other biomechanical issues.

Lastly, it is essential to listen to your body during this recovery phase. If certain activities exacerbate your pain, it may be wise to modify your activities or take breaks as needed. Gradually increasing your activity level while ensuring proper rest and recovery can help you regain strength and function in your foot.

In summary, your ongoing foot pain after tibia and fibula fractures is a multifaceted issue that may involve complications from the surgery, nerve compression, or conditions like plantar fasciitis. Seeking further evaluation and continuing with a structured rehabilitation program will be key to addressing your symptoms and improving your overall function.

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