Chronic Ankle Shortening and Muscle Tension After Old Leg Fracture

The muscle and tendon tissue at the site of an old fracture in the calf is being pulled, resulting in a persistent shortening of the ankle extension?

Approximately 30 years ago, I sustained an open fracture of the left tibia in a car accident.
The steel rod that was placed to support the knee has been removed, but the fixation wires remain in place, and there appears to be a small fragment closely adhered to the bone.
The physician believes this is not problematic.
The old injury site has caused muscle and tendon tissue pulling, resulting in a persistent shortening of the ankle extension and a noticeable upward curling of the toes.
The muscles on the outer side of the left calf are significantly tight and knotted.
Over the past year, there has been an acceleration in the severity of pain at the fracture healing site.
The muscle has increasingly enlarged, with a sensation of edema that is not muscular.
Movement of the ankle joint provides slight relief from the tight discomfort, but is accompanied by noticeable sounds.
Recently, I underwent a bone scan, ultrasound, and neurological examination, but no underlying cause has been identified.
I am seeking a physician's diagnosis and assistance.

Yue, 50~59 year old female. Ask Date: 2021/02/01

Dr. Shi Guozheng reply Orthopedics

It may be related to tissue adhesions, so you can try rehabilitation to see if it alleviates the symptoms.
If there is no improvement, further evaluation will be needed to determine if surgery is necessary.

Reply Date: 2021/02/01

More Info

Chronic pain and discomfort following an old leg fracture can be a complex issue, especially in older adults. In your case, the history of an open fracture and subsequent surgical interventions, including the removal of hardware, can contribute to ongoing symptoms. The presence of muscle tension, ankle shortening, and pain indicates that there may be several factors at play.

Firstly, it is essential to understand that after a significant injury like an open fracture, the healing process can lead to changes in the surrounding soft tissues, including muscles, tendons, and ligaments. These changes can result in muscle tightness and tension, which may contribute to the sensation of shortening in the ankle and the upward curling of the toes. This phenomenon is often referred to as "muscle imbalances," where certain muscle groups become overactive or tight while others may weaken, leading to altered biomechanics.

The pain you are experiencing at the fracture site, along with the swelling and the feeling of tightness in the calf muscles, could be due to several reasons:
1. Scar Tissue Formation: After surgery, scar tissue can develop around the fracture site and in the surrounding muscles. This can lead to stiffness and discomfort, as scar tissue is less flexible than normal tissue.

2. Muscle Imbalance: As mentioned earlier, the muscles around the ankle and lower leg may have developed imbalances due to the injury and subsequent immobilization. This can lead to compensatory movements that may exacerbate pain and discomfort.

3. Chronic Inflammation: The ongoing pain and swelling may indicate chronic inflammation in the area, which can be a result of the body’s response to the previous injury and surgery.

4. Nerve Involvement: Although recent nerve tests did not reveal any issues, it is still possible that nerve irritation or entrapment could be contributing to your symptoms, especially if there is swelling or muscle tightness.

To address these issues, a multi-faceted approach is often recommended:
- Physical Therapy: Engaging in a structured physical therapy program can help address muscle imbalances, improve flexibility, and strengthen the surrounding muscles. A physical therapist can provide targeted exercises to help alleviate tension and improve the range of motion in the ankle.

- Manual Therapy: Techniques such as massage, myofascial release, or other forms of manual therapy can help reduce muscle tension and improve circulation in the affected area.

- Stretching and Strengthening Exercises: Incorporating regular stretching and strengthening exercises into your routine can help alleviate tightness and improve overall function. Focus on the calf muscles, ankle mobility, and the muscles of the foot.

- Pain Management: Depending on the severity of your pain, over-the-counter pain relievers or anti-inflammatory medications may provide temporary relief. However, it is essential to consult with a healthcare provider before starting any medication.

- Hydration and Nutrition: Ensuring proper hydration and nutrition can support overall healing and reduce inflammation. Consider discussing dietary changes with a healthcare professional.

- Regular Follow-Up: Continue to follow up with your healthcare provider to monitor your symptoms and adjust your treatment plan as necessary. If symptoms persist or worsen, further imaging or interventions may be warranted.

In conclusion, while chronic pain and muscle tension following an old leg fracture can be challenging, a comprehensive approach involving physical therapy, pain management, and regular follow-up can significantly improve your quality of life. It is crucial to work closely with healthcare professionals to tailor a treatment plan that addresses your specific needs and concerns.

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